What’s the Buzz

What is Tinnitus?

Tinnitus is the medical term for ringing in the ears. It is a phantom sound, meaning it isn’t caused by an external sound, and other people can’t hear it. 

Tinnitus is not a disease but rather a symptom. It is rarely caused by a serious medical condition and is quite common. According to the National Institute on Deafness and Other Communication Disorders (NIDCD), about 10% of the U.S. adult population (more than 25 million people) have tinnitus. In some people, tinnitus is barely noticeable and does not affect their daily life. In others, it can be loud enough to cause problems with concentration, sleep, and mood changes.

It is sometimes possible to treat tinnitus by addressing the underlying condition causing it. Avoiding known triggers may also prevent tinnitus from getting worse. There are also ways to treat tinnitus, such as using sound therapy to mask the ringing noise and provide tinnitus relief.

Tinnitus Symptoms

Tinnitus can be present in one or both ears. Tinnitus is often described as “hearing a ringing in the ears.” Some other sounds can include buzzing, clicking, roaring, whistling, squealing, humming, or hissing. The loudness of sound can vary from person to person, along with the pitch. 

Types of Tinnitus

Pulsatile Tinnitus

Some people hear a whooshing or rhythmic sound that occurs in step with their heartbeat. This is called pulsatile tinnitus. 

Subjective Tinnitus vs Objective Tinnitus

In most cases, tinnitus is subjective, meaning only the affected person can hear the ringing in the ears. However, sometimes, tinnitus is objective, meaning a healthcare provider can hear the sound with a stethoscope, for example, in people with pulsatile tinnitus. Objective tinnitus is usually due to an identifiable cause that can be treated.

Somatosensory Tinnitus

Some people report that head and neck movements, eye movements, or touching certain parts of their body can change their tinnitus symptoms. This is called somatosensory tinnitus.

What Causes Tinnitus?

According to the National Institute on Deafness and Other Communication Disorders (NIDCD), common causes of tinnitus include:

Exposure to Loud Sounds

Long-term exposure to loud noises in the workplace, such as machinery or gunfire, can cause tinnitus. Exposure to loud sounds at sporting events or loud music at concerts can also trigger tinnitus.

Hearing Loss 

There is a strong link between hearing loss and tinnitus, including age-related hearing loss and hearing loss due to loud noises. This happens because the inner ear gets damaged. It results in the ear sending random acoustic stimulation signals to the brain, which are perceived as tinnitus. However, not everyone with hearing loss will develop tinnitus. And not everyone with tinnitus has hearing loss. Find out: What Are the Different Types of Hearing Loss?

Earwax and Ear Infection

Earwax blockage, middle ear infection, or buildup of debris in the ear canal can lead to increased pressure in the ear, which can cause tinnitus.

Head and Neck Trauma

Injuries to the head and neck can affect the ear, nerves carrying sound signals, or the part of the brain responsible for hearing function. Trauma usually causes tinnitus only in one ear.

Medications

Certain medications are toxic to the ear and can cause or worsen hearing loss and/or tinnitus. More commonly known medications that can cause or exacerbate tinnitus include nonsteroidal anti-inflammatory drugs (NSAIDs), cancer medications, antidepressants, antibiotics, antimalarials, and diuretics (water pills). If you are experiencing tinnitus, ask your doctor or pharmacist to see if any of your medications might contribute to your tinnitus symptoms.

Health Conditions

Tinnitus can be a symptom of an underlying medical condition such as:

• Meniere’s disease (an ear disorder)

• Infections: measles, Lyme disease, meningitis

• Eustachian tube dysfunction

• Muscle spasms in the inner ear

• Changes in the ear bones

• Temporomandibular joint disorders (TMJ)

• Head and neck tumors such as acoustic neuromas

• Circulation or blood vessel problems, such as high blood pressure, plaque formation in arteries, and kinked or twisted blood vessels in the ear

• Chronic conditions such as diabetes, thyroid disorders, anemia, migraine, and autoimmune conditions such as lupus and rheumatoid arthritis

Common Tinnitus Risk Factors

• Age: Older adults are at a higher risk of experiencing tinnitus due to age-related hearing loss and inner ear damage.

• Gender: Men are more likely to have tinnitus than women.

• Occupation: Factory workers, construction workers, musicians, and soldiers are at a higher risk of experiencing tinnitus due to exposure to loud noises on the job.

• Tobacco and alcohol use: Smoking and drinking alcohol increases the risk of tinnitus.

• Health conditions: High blood pressure, arthritis, and head injuries are risk factors.

Tests for Diagnosing Tinnitus

Your healthcare provider can make a diagnosis of tinnitus based on your medical history and other symptoms that accompany tinnitus. They may order additional tests to find out a potential underlying cause of your tinnitus. This can include laboratory tests, imaging tests, audiological (hearing) tests, and movement tests. 

If you have had tinnitus diagnosed but the cause cannot be identified, your primary care doctor may refer you to an audiologist or otolaryngologist (ENT or ear, nose and throat doctor) for further evaluation of the cause.

The type of sound you are hearing may provide a clue:

• Clicking sounds can be due to muscle contractions in the inner ear.

• Humming or pulsing sounds may be due to blood vessel problems.

• Low-pitched tinnitus can be due to a blockage, problems with ear bones, or Meniere’s disease.

• High-pitched ringing may be due to exposure to loud noises or medications.

• One-sided continuous high-pitched tinnitus may be due to an acoustic neuroma.

Tinnitus Treatment

Treatment of Underlying Conditions

Treatment for tinnitus depends on the underlying cause and may include:

• Ear wax removal

• Hearing aids

• Changes in medications

• Treatment for underlying health conditions

• Antidepressant or anti-anxiety medications

Other Tinnitus Treatment Options 

Other ways to treat chronic tinnitus include:

• Acoustic Therapy (sound therapies): Electronic devices such as white noise machines and sound masking devices may provide relief for those with tinnitus by masking the tinnitus sounds or simply providing distractions. These devices block tinnitus using external noises, such as natural sounds (rain, waterfall, waves, and rain). If you don’t have a special white noise machine, you can try listening to soft music, switching on a fan, or using a mobile phone app that can play white noise and other relaxing sounds. Sound therapy works on the principle that the brain can only process sound one at a time. Pleasant sounds block out tinnitus and provide immediate relief, allowing you to focus on the tasks at hand. 

• Behavioral Therapies: Therapies such as cognitive behavioral therapy (CBT) or tinnitus retraining therapy (TRT) can help to make tinnitus symptoms less bothersome. These treatment options help people with tinnitus learn to manage their condition.

• Education and Support Groups: They can help patients suffering from tinnitus understand their condition better and learn ways to manage it.

Surgical Options and Advanced Therapies for Severe Cases

Surgical treatment of tinnitus is rarely necessary. However, it may be offered in some cases, for example, surgical removal of an acoustic neuroma or surgery on inner ear bones or nerves.

Natural and Home Remedies for Tinnitus

• Chronic tinnitus can cause mood changes, anxiety, and depression. The American Tinnitus Association, therefore, recommends stress management and relaxation therapy as an important component of managing the condition. For example, listening to soft music or other relaxing sounds can distract from tinnitus and lower stress levels.

• Dietary supplements such as ginkgo biloba, vitamins A, B, C, and E, magnesium, phosphorus, iron, zinc, and melatonin are commonly used natural home remedies for tinnitus. However, there is little scientific evidence to suggest that they can actually treat tinnitus. Supplements can interact with your other medications and increase the risk of side effects, including tinnitus. Always check with your healthcare provider before taking any dietary supplements.

Can Tinnitus Be Cured?

There is no known cure for tinnitus. However, treatment of an underlying condition, wearing a hearing aid for hearing loss, or sound masking can make tinnitus less noticeable and bothersome.

Emerging Research and Future Treatments for Tinnitus

Researchers are working to better understand tinnitus and develop new treatments for this distressing symptom. Some of the treatment options being studied include:

• Magnetic or electrical stimulation on parts of the inner ear.

• Transcranial magnetic stimulation.

• Deep brain stimulation. 

• Medications to reduce hyperactive sound signals in the brain.

Prevention of Tinnitus: Lifestyle Changes and Ear Protection

These tips can lower your risk of developing tinnitus:

• If you have occupational exposure to loud sounds, use over-ear hearing protection to prevent damage to your ears. 

• Listen to music at a low volume. Very high volumes can lead to tinnitus and hearing loss.

• Limit caffeine, alcohol, and nicotine - these are risk factors for tinnitus.