Definition
Tinnitus is the perception of abnormal ear or head noises. Tinnitus is unpleasant enough itself. It is also sometimes a symptom of other problems, including hearing loss, tumors, and narrowing of the blood vessels.
Noises may be high pitched and “ringing,” or sound more like a clicking. Some tinnitus is pulsatile. This means that it may be caused by the flow of blood that accompanies each heartbeat. This type of tinnitus is a result of the narrowing of the blood vessels.
Causes
Many diseases and conditions are associated with tinnitus, including:
- Hearing loss, the most frequent cause of persistent tinnitus
- Exposure to loud noises
- Wax or a foreign body in the ear canal
- Temporomandibular joint (TMJ) disorder
- Ear infection
- Fluid in the ear
- Stroke
- Certain medicines (see below)
- Allergies
- Ruptured membrane in the ear
- Meniere's disease
- High or low blood pressure
- Injury to the head or neck
- Tumors
- Blood vessel disorders, such as an aneurysm or hardening of the arteries
- Diabetes
- Thyroid problems
Occasional episodes of tinnitus lasting at most a few minutes are quite common in normal people, especially after exposure to loud noises.
Risk Factors
Your risk of tinnitus increases with:
- Exposure to loud noises
- Depression
- Stress
- Fatigue
- Anxiety
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Certain medicines:
- Aspirin
- Quinine and its derivatives
- Some antibiotics (aminoglycosides)
- Some diuretics (water pills)
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Toxins:
- Heavy metals
- Carbon monoxide
- Alcohol
Symptoms
The sensations of tinnitus may have the following characteristics:
- Ringing, roaring, buzzing, whistling, or hissing sounds
- Intermittent, continuous, or pulsatile quality
- Same or varying intensity
- Single or multiple tones
- Ringing that comes and goes
- More annoying symptoms at night or when there are fewer distractions
- Sensation of normal internal events, such as blood pulsing or muscles contracting
Sometimes tinnitus is accompanied by hearing loss and vertigo.
When Should I Call My Doctor?
Call your doctor if you have tinnitus, especially if it:
- Is associated with hearing loss, dizziness, change in personality, speech, or weakness in any body area
- Starts after head or neck injury
- Is associated with new medicine
- Is pulsatile
- Is associated with pain in the ear, fever, nausea, or vomiting
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. Special attention will be paid to your head, neck, and ears.
You will be asked questions about:
- The sensations that you have
- The factors that may increase or decrease the sensation (eg, breathing, dizziness)
- The medicines that you take
The doctor will look at your ear canal and eardrum using an instrument with a light that is held at the external opening of the ear. A tuning fork can help evaluate hearing. You should receive a complete hearing test. Other tests, such as a magnetic resonance imaging (MRI) scan, may be ordered to rule out serious conditions.
Treatment
Tinnitus treatment depends on what is causing the symptoms. This may mean, for example:
- Wearing a specially made splint to help manage temporomandibular joint disorder
- Taking antibiotics for a sinus or ear infection
- Having the wax removed from your ear canal
Therapy aims to eliminate or reduce bothersome sensations. Treatment may include:
Medication
No medicine has been shown to be very effective in treating tinnitus. Your doctor may still try to use some medicines to help your symptoms, though. Examples of medicines often tried include antidepressants and sedatives.
If you have Meniere's disease, your doctor may prescribe medicine to treat that condition.
Mechanical Devices
Devices include:
- Hearing aid—sometimes relieves tinnitus and improves hearing in some people with hearing loss
- Tinnitus masker—a device that emits a low level of white noise to help cover up the internal sensations and block out external noises
Lifestyle and Self-care Measures
Measures to discuss with your doctor if no cure or specific treatment is available include:
- Learn and practice stress management and relaxation techniques.
- Biofeedback may help. Biofeedback teaches people how to control body functions they normally do not think about.
- Consider seeing a counselor to develop new coping skills and relaxation techniques.
- Consider joining a support group .
- Avoid anything that makes tinnitus sensations worse, such as:
- Exercise regularly to improve circulation.
- Make time to relax and get enough sleep.
- Playing a radio or a white-noise machine for about 30 minutes at bedtime may help relieve the ringing sensations at night.
Surgery
Surgery may help relieve certain causes of tinnitus if the cause of the tinnitus is treated.
- Tinnitus caused by a tumor frequently subsides after the growth is removed.
- If the tinnitus is due to wax build-up, it can be relieved by cleaning the ears.
- Abnormalities in blood vessels that lead to tinnitus can sometimes be corrected with surgery.
- Surgery may also be an option for patients with Meniere's disease, but it is usually done only for disabling dizziness.
Prevention
You may be able to prevent tinnitus from developing with a few simple measures:
- Avoid exposure to excessive noise.
- Wear earplugs in noisy situations.
- Wear earmuffs when mowing the grass.
- Learn and practice stress management and relaxation techniques.
- Limit use of drugs that damage hearing.