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Tinnitus

Causes and Symptoms Prevention and Treatment

Causes and Symptoms

Tinnitus Causes

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One in two people experience an odd ringing, hum, throb, or whistling noise in their ears at least once in their lifetime. This phenomenon is known as tinnitus. For most people, tinnitus is temporary and a secondary symptom of an underlying condition, such as age-related hearing loss, ear injury, or a circulatory system disorder. According to the American Tinnitus Association (ATA) approximately 25 million Americans, or about 10 percent of the adult population, experience tinnitus in any given year.

Overview:

What is tinnitus and how is it identified?
Is tinnitus harmful?
How long does tinnitus last?
How do I get tinnitus?
What are the main triggers of tinnitus?
What should I do if I’m affected by tinnitus?

What is tinnitus and how is it identified?

Tinnitus the perception of noise in your ears or head not caused by external noise. It presents itself as ringing, buzzing, roaring, clicking, hissing, or a humming sound. Tinnitus can be triggered by several different causes, and sounds vary dramatically from person to person. The sound can be perceived in one ear, in the center of the head, in wave-like intervals, or be continuous.

For some, the sound is loud enough to interfere with the ability to concentrate or hear external sounds. It may be present all the time, or it may come and go. Tinnitus remains a mystery to the scientific community due to its range of symptoms and causes. However, tinnitus is not an illness, but a symptom.

Although it is not a life-threatening condition, tinnitus can worsen with age and is bothersome to deal with on a daily basis. It’s often associated with hearing loss, even though many people living with tinnitus don’t have measurable hearing loss. Since there are many tinnitus causes, it’s important to understand what it is and how to identify the symptoms.

Is tinnitus harmful?

Tinnitus does not cause physical harm. However, occasional or permanent exposure to continuous noise can negatively affect a person’s overall health and social well-being. According to the ATA, people with tinnitus often experience:

Distress
Depression
Anxiety
Frequent mood swings
Sleep disturbances
Irritability or frustration
Poor concentration

Researchers are not sure why some people can easily ignore tinnitus and why others are negatively affected by the noise. Some researchers believe that the noise in the ear of the person affected is perceived as threatening or significant, then the body reacts with emotional reinforcement mechanisms activated by the limbic system (a set of structures in the brain that deal with emotions and memory). This results in anxiety, depression, and insomnia. There are two distinct types of tinnitus recognized:

Compensated tinnitus

Compensated tinnitus is described by those who register noise but it causes little or no psychological strain. They can block out the noise and quality of life is not largely affected.

Decompensated tinnitus

Decompensated tinnitus is a severe form of tinnitus. It causes a high level of psychological strain and has a direct negative impact on the quality of life.

How long does tinnitus last?

The duration of tinnitus can vary. For some, it occurs briefly then immediately disappears. For others, it can remain for weeks or even a lifetime. Medical professionals classify tinnitus lengths into three categories:

Acute tinnitus: Appears quickly and can last up to three months and then stops spontaneously. Acute tinnitus may be treatable with medication.

Subacute tinnitus: Reoccurs in three to 12 months. In some cases, it may last longer. Treatment with medication and/or relaxation exercises may improve the condition.
Chronic tinnitus: Symptoms persist for a year or more. The symptoms are treatable with therapeutic or pharmaceutical intervention.

How do I get tinnitus?

Tinnitus is an indication that something is wrong in the auditory system. Any damage in the ear (ear canal, eardrum, hairs, etc), the auditory nerve that connects the inner ear to the brain, and the parts of the brain that process sound can result in tinnitus. Even an earwax blockage in the ear canal can cause tinnitus. Most tinnitus cases are considered subjective tinnitus, which means the perception of sound in the absence of an acoustic stimulus and is heard only by the patient. However, tinnitus causes can be the result of several health conditions such as:

Noise-induced hearing loss
Ear and sinus infections
Diseases of the heart or blood vessels
Ménière’s disease
Brain tumors
Hormonal changes in women
Thyroid abnormalities

Common ringing in ear causes include:

Idiopathic

This means that a source for the phantom noise cannot be identified. Medical professionals refer to it as primary tinnitus. One popular theory indicates that sensory cells that lie within the cochlea (the spiral cavity located within the inner ear) are unable to direct signals to the brain because they are irritated or damaged. This causes the brain’s auditory response area to become highly activated and produce phantom noises, or tinnitus.

Wax Buildup

Wax in the ear protects the interior ear by catching and trapping debris that inadvertently finds its way into the ear. Under normal conditions, ear wax will naturally push its way out of the ear. Occasionally, there is a buildup of wax in the ears which causes mild hearing loss and tinnitus.

Ear Infections

Ear infections of the middle ear, known as “otitis media.” This occurs when bacteria become lodged within the auditory tube due to a clog or obstruction (mucous). Some ear infection symptoms include ringing or buzzing sounds (tinnitus) but will include fever, pain in the affected ear, some degree of hearing loss, and even vertigo (dizziness). Once the infection is treated, the symptoms, including tinnitus, are resolved.

Blood Flow

Two blood-related conditions that are known to cause tinnitus are anemia and high blood pressure. Blow flow tinnitus is commonly referred to as pulsatile tinnitus or vascular/rhythmic tinnitus. It sounds similar to a whooshing sound or a rhythmic beat. This is also an example of objective tinnitus, a perceived sensation of sound that occurs in the absence of external acoustic stimulation but can be heard by the doctor or examiner.

Meniere’s Disease

Temporomandibular Joint Disorder (TMD or TMJ)

The temporomandibular joints allow you to open and close your lower jaw. When the joint is operating properly, the jaw moves smoothly without pain. However, erosion or misalignment of the shock-absorbing disk, arthritis, or excessive tooth grinding can cause TMJ. There are several reasons why TMJ can also cause tinnitus, but one of the main causes is damage to the shared nerves that serve both the jaw and the eardrum.

Loss of Hearing

According to the Hearing Health Foundation, roughly 90 percent of tinnitus cases occur with an underlying hearing loss.[2] Loss of hearing can occur from aging, injury to the ear, exposure to loud noises, and certain medical conditions, such as viral infections, meningitis, shingles, and diabetes. When any part of the ear that transmits sounds to the brain is damaged, the brain will compensate for any sound that is missing, resulting in tinnitus.

Otosclerosis

Otosclerosis is caused by abnormal bone remodeling in the middle ear. When this bone hardens, it can no longer freely move. This results in poor sound transmission, causing inner ear structures from functioning correctly resulting in hearing loss. The hearing loss can lead to a buzzing or roaring sound that’s associated with tinnitus.

Head and Neck Injuries

Whiplash or a blunt blow to the head can result in tinnitus because it can cause damage to the structures of the inner ear as well as the neck and head. Typically, head and neck injury-induced tinnitus only affects one ear; however, the effects are usually severe.

Damage to Inner and Middle Ear

Any damage to the ear can cause tinnitus. Specifically, eustachian tube dysfunction or ruptured eardrums can occur due to loud noises, changes in pressure, or from infections. These conditions will lead to acute pain, as well as temporary hearing loss and tinnitus.

Loud Noises

Exposure to loud noises is a common cause of tinnitus. Those who have regularly worked or are in a noisy environment for years without suitable hearing protection are at a much higher risk of tinnitus. Loud noises can damage structures within the inner ear that are responsible for hearing, which can result in noise-induced hearing loss. One or both ears can be affected, and the hearing loss can be short-term or permanent.

What are the main triggers of tinnitus?

Stress

Stress can lead to the development of tinnitus. It is not always clear whether it causes the onset of tinnitus, or is a contributing factor. However, it is common for tinnitus to start at times of high stress or after a period of stress. Studies have shown that those affected by acute hearing loss and tinnitus have more frequently been under severe stress than other ENT patients.

Ototoxic Medications

Ototoxic medications have been found to cause a phantom ringing sensation in the ear. The American Tinnitus Association (ATA) recognizes that the following ototoxic drugs may cause more permanent tinnitus symptoms:

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen
Certain antibiotics such as aminoglycosides
Certain cancer medications
Water pills and diuretics
Quinine-based medications
Certain anticonvulsants
Tricyclic antidepressants
Anti-anxiety medications
Antimalarial medications
Blood pressure controlling medications
Allergy medications
Chemotherapy drugs, including cisplatin

These medications can damage the ears and cause tinnitus when taken in high doses over a prolonged period of time.

Stimulants

The connection between stimulants such as alcohol and nicotine and tinnitus isn’t clear. Researchers suspect that it’s connected to cardiovascular disease, which can affect hearing structures within the ear. Other studies suggest that chemicals found in cigarettes, in particular, can impact vibrations in the middle ear and interfere with the neurotransmitters that are located in the auditory nerve as well as damage the Eustachian tube.

What should I do if I’m affected by tinnitus?

Acute tinnitus often goes away on its own. If the noise continues for more than a week or is a result of an injury and you experience hearing loss, you should see your primary care doctor. Your primary doctor will determine if the tinnitus is caused by an obstruction, such as earwax blocking the ear canal or something more serious.

You can find important information about treatments and therapy for tinnitus here: Tinnitus - Prevention and Treatment

Who should I go to for help?

If your doctor cannot find any medical condition responsible for your tinnitus, you may be referred to an otolaryngologist, more commonly known as an ENT doctor. The ENT will perform a physical exam to your head, neck, and ears as well as test your hearing to determine if you have hearing loss and/or tinnitus. You might also need to see an audiologist who can also measure your hearing and evaluate your tinnitus.