Tinnitus is the medical name for the perception of noise in one ear, both ears or the head, despite the lack of external stimuli which might create these sounds. The word comes from the Latin tinnitus, or "ringing." One or both ears can be afflicted by tinnitus, depending on the cause. The noise comes from inside the body rather than an outside source.
In addition to being irritating, tinnitus may also be a symptom of more troubling underlying problems such as tumors, infections, or hearing loss. Patients who experience tinnitus should consult a doctor to determine what the cause is and receive treatment. A doctor may not be able to make the sound go away, but he or she can help patients manage it.
People with tinnitus can experience different types of sound. Most people describe it as a ringing sound but other sounds may include:
buzzing
clicking
humming
whistling
music
or whining noises
Sometimes, the noise associated with tinnitus beats in time with a person's pulse. This is known as pulsatile tinnitus.
Tinnitus is often worse at quiet times, such as when you are trying to get to sleep. This is because there is less background noise to distract you from the sounds of tinnitus. The sound may also be more noticeable when you are tired.
Tinnitus is a symptom rather than a condition itself. The sounds are usually only heard by the person who has tinnitus, although in a few rare cases, they can also be heard by other people.
Temporary tinnitus can be caused by a cold, a blow to the head, or prolonged exposure to a loud noise, such as an explosion or similar loud noise, in which case the tinnitus will subside after a period of time.
There are technically two types of tinnitus. The vast majority of cases are subjective, meaning that only the patient can hear the sounds. In other instances, known as objective tinnitus, a doctor can hear the noises as well when he or she examines the patient. The two types of tinnitus have different underlying causes, and objective tinnitus can sometimes be treatable, whereas subjective tinnitus is much more difficult.
Common causes of tinnitus include head trauma, damage to the nerve endings in the ear, blocked canals, ear infections, and the use of certain prescription drugs. When the cause is something like a tumor or earwax obstruction, the tinnitus can be treated by removing the offending item. If the cause is medication, a doctor may recommend a change of medication, or change the dosage. Things like nerve damage are not as easy to treat, unfortunately.
When a patient complains of tinnitus, a doctor will usually perform screening to eliminate causes such as systemic infections, just to be rule out any potential causes not seen on physical examination. In a case where a doctor cannot eliminate the tinnitus, the patient learns how to manage it. Many patients use masking devices such as fans or ear implants to create pleasant white noise. Patients are also encouraged to manage their stress well, since stress appears to be linked to recurrent tinnitus.
Tinnitus can affect different people in different ways. Some people are only mildly affected while others are severely affected.
Some people with tinnitus are more sensitive to everyday sounds than others. For example, a person with tinnitus may find a radio or television painfully loud when it is at a normal volume for most people. This is known as hyperacusis.
If you have tinnitus, it may be more noticeable at certain times or in certain situations. For example, if you have mild tinnitus, you are more likely to notice it when you are in quiet places because noisy environments can mask the sounds.
Some cases of tinnitus may also be related to your posture. For example, you may experience sounds when you are lying or sitting down or when you turn your head. After these types of movements, pressure changes in your nerves, muscles or blood vessels may affect the noises associated with tinnitus.
Most tinnitus is perceived as a high-pitched sound such as hissing, whistling or buzzing. There are, however, some other forms of tinnitus.
For some people, tinnitus can be a low-frequency noise, such as humming, murmuring, rumbling or deep droning. Other people with tinnitus experience musical hallucinations, where they repeatedly hear musical tunes or songs in their head.
These less common types of tinnitus are described in more detail below.
People who constantly hear low-frequency noise often think it is coming from an external source rather than from inside their head or ears.
Sources of external low-frequency noise include:
road and air traffic noise
underground gas pipes
home appliances, such as fans and fridges
air-conditioning units
The wind, sea and thunder are natural sources of low-frequency noise.
To determine where the noise that you can hear is coming from, ask other people whether they can hear it. If they can also hear the noise, it is unlikely that tinnitus is the cause.
If you can only hear the noise when you are in one place, it may be coming from an external source, whereas if you can hear it all the time, you may have tinnitus. Stress or a recent illness may be related to your symptoms.
Musical hallucinations are more common among people with long-term tinnitus and hearing loss. However, sometimes they are also experienced by people who have normal hearing and those with an increased sensitivity to sound (hyperacusis).
As with other forms of tinnitus, there is sometimes no apparent reason for musical hallucinations. However, stress can sometimes be a trigger.
Pulsatile tinnitus is a type of tinnitus where you hear rhythmical noises that beat in time with your pulse. It is usually caused by either:
blood flow changes in the blood vessels near your ear
increased awareness of the blood flow near your ears
The blood flow through an artery can sometimes become restricted. This can be due to a build-up of fatty deposits (plaques) on the inside wall of the artery that cause the artery to narrow (atherosclerosis). The narrowed artery prevents the blood from flowing smoothly and causes it to become noisy.
If you have impaired hearing or a hearing condition, such as a perforated eardrum, your awareness of sounds that come from inside your body, such as your blood flow, may be increased. This is because your hearing becomes more sensitive and internal noises are not drowned out by external sounds.
A number of health conditions can cause or worsen tinnitus. In many cases, an exact cause is never found. Most causes of tinnitus are not harmful. The main causes are described below.
A common cause of tinnitus is inner ear cell damage. Tiny, delicate hairs in your inner ear move in relation to the pressure of sound waves. This triggers ear cells to release an electrical signal through a nerve from your ear (auditory nerve) to your brain. Your brain interprets these signals as sound. If the hairs inside your inner ear are bent or broken, they can "leak" random electrical impulses to your brain, causing tinnitus.
Other causes of tinnitus include other ear problems, chronic health conditions, and injuries or conditions that affect your auditory nerves or the hearing center in your brain.
In older people, tinnitus is often caused by natural hearing loss, which makes the hearing nerves less sensitive. In younger people, tinnitus can sometimes occur as a result of hearing damage caused by excessive noise.
In many people, tinnitus is caused by one of these conditions:
Age-related hearing loss. For many people, hearing worsens with age, usually starting around age 60. Hearing loss can cause tinnitus. The medical term for this type of hearing loss is presbycusis.
Exposure to loud noise. Loud noises, such as those from heavy equipment, chain saws and firearms, are common sources of noise-related hearing loss. Portable music devices, such as MP3 players or iPods, also can cause noise-related hearing loss if played loudly for long periods. Tinnitus caused by short-term exposure, such as attending a loud concert, usually goes away; long-term exposure to loud sound can cause permanent damage.
Earwax blockage. Earwax protects your ear canal by trapping dirt and slowing the growth of bacteria. When too much earwax accumulates, it becomes too hard to wash away naturally (cerumenal impaction), causing hearing loss or irritation of the eardrum, which can lead to tinnitus.
Ear bone changes. Stiffening of the bones in your middle ear (otosclerosis) may affect your hearing and cause tinnitus. This condition, caused by abnormal bone growth, runs in families.
Some causes of tinnitus are less common. These include:
Meniere's disease. Doctors think this inner ear disorder is caused by abnormal inner ear fluid pressure or composition.
Stress and depression. These conditions are commonly associated with tinnitus and seem to aggravate it.
TMJ disorders. Problems with the temperomandibular joint, the joint on each side of your head in front of your ears, where your lower jawbone meets your skull, can cause tinnitus.
Head injuries or neck injuries. These neurological disorders can affect the inner ear, hearing nerves or brain function linked to hearing. Head or neck injuries generally cause tinnitus in only one ear.
Acoustic neuroma. This noncancerous (benign) tumor develops on the cranial nerve that runs from your brain to your inner ear and controls balance and hearing. Also called vestibular schwannoma, this condition generally causes tinnitus in only one ear.
In rare cases, tinnitus is caused by a blood vessel disorder. This type of tinnitus is called pulsatile tinnitus. Causes include:
Head and neck tumors. A tumor that presses on blood vessels in your head or neck (vascular neoplasm) can cause tinnitus and other symptoms.
Atherosclerosis. With age and buildup of cholesterol and other deposits, major blood vessels close to your middle and inner ear lose some of their elasticity — the ability to flex or expand slightly with each heartbeat. That causes blood flow to become more forceful and sometimes more turbulent, making it easier for your ear to detect the beats. You can generally hear this type of tinnitus in both ears.
High blood pressure. Hypertension and factors that increase blood pressure, such as stress, alcohol and caffeine, can make tinnitus more noticeable.
Turbulent blood flow. Narrowing or kinking in a neck artery (carotid artery) or vein in your neck (jugular vein) can cause turbulent blood flow, leading to tinnitus.
Malformation of capillaries. A condition called arteriovenous malformation (AVM), which occurs in the connections between arteries and veins, can result in tinnitus. This type of tinnitus generally occurs in only one ear.
A number of medications may cause or worsen tinnitus. Generally, the higher the dose of medication, the worse tinnitus becomes. Often the unwanted noise disappears when you stop using these drugs. Medications known to cause or worsen tinnitus include:
Antibiotics, including chloramphenicol, erythromycin, gentamicin, vancomycin and bleomycin
Cancer medications, including mechlorethamine and vincristine
Diuretics — water pills — such as bumetanide, ethacrynic acid, furosemide
Quinine medications used for malaria or other health conditions
Chloroquine, a malaria medication
Aspirin taken in uncommonly high doses (12 or more a day)
To treat your tinnitus, your doctor will first try to identify any underlying, treatable condition that may be associated with your symptoms. If tinnitus is due to a health condition, your doctor may be able to take steps that could reduce the noise. Examples include:
Earwax removal. If your tinnitus is caused by a build-up of earwax, eardrops or ear irrigation may be recommended. Removing impacted earwax can decrease tinnitus symptoms. Ear irrigation involves using a pressurised flow of water to remove the earwax.
Treating a blood vessel condition. Underlying vascular conditions may require medication, surgery or another treatment to address the problem.
Changing your medication. If a medication you're taking appears to be the cause of tinnitus, your doctor may recommend stopping or reducing the drug, or switching to a different medication.
However, in most cases of tinnitus, there is no cure and treatment aims to manage the symptom on a daily basis. Staff at specialist tinnitus clinics will be able to give you information about tinnitus and help you develop a strategy to manage it more effectively.
In some cases "white noise" may help suppress the sound so that it's less bothersome. Your doctor may suggest using an electronic device to suppress the noise. Devices include:
White noise machines. These devices, which produce simulated environmental sounds such as falling rain or ocean waves, are often an effective treatment for tinnitus. Some people find that having the radio or television on provides enough background noise to mask the sound of tinnitus. Others prefer to listen to more natural, relaxing sounds, such as the sound of the sea. You may want to try a white noise machine with pillow speakers to help you sleep.
Hearing aids. These can be especially helpful if you have hearing problems as well as tinnitus.
Masking devices. Worn in the ear, similar to hearing aids, these devices produce a continuous, low-level white noise that suppresses tinnitus symptoms.
Tinnitus retraining. A wearable device delivers individually programmed tonal music to mask the specific frequencies of the tinnitus you experience. Over time, this technique may accustom you to the tinnitus, thereby helping you not to focus on it. Counseling is often a component of tinnitus retraining.
Drugs can't cure tinnitus, but in some cases they may help reduce the severity of symptoms or complications. Possible medications include:
Tricyclic antidepressants, such as amitriptyline and nortriptyline, have been used with some success. However, these medications are generally used for only severe tinnitus, as they can cause troublesome side effects, including dry mouth, blurred vision, constipation and heart problems.
Alprazolam (Niravam, Xanax) may help reduce tinnitus symptoms, but side effects can include drowsiness and nausea. It also can become habit-forming.
Understanding tinnitus is an important part in learning how to manage it more effectively. Tinnitus counselling is usually carried out by hearing therapists, audiologists (hearing disorder specialists) or doctors.
Tinnitus counselling is a talking therapy that helps you learn more about your tinnitus and find ways of coping with it. Talking about your tinnitus and how it affects your everyday life may help you understand the condition better and possibly lessen its effects.
Cognitive behavioural therapy (CBT) is the term for a number of therapies that help treat problems such as anxiety, depression and post-traumatic stress disorder (PTSD).
CBT is based on the idea that a person's thoughts affect the way that they behave. Treatment aims to retrain the way a person thinks to change their behaviour.
If you have tinnitus and your knowledge about it is limited, you may have certain ideas about it that make you anxious and distressed. However, these beliefs may be untrue and changing them may reduce your stress and anxiety.
Tinnitus retraining therapy (TRT) uses a combination of sound therapy and counselling to help people cope better with their tinnitus.
TRT involves retraining the way your brain responds to tinnitus sound so that you start to tune out of it and become less aware of it. This is known as habituation.
TRT should only be
carried out by someone who has been trained in using the technique.
Often, tinnitus can't be treated. Some people, however, get used to it and notice it less than they did at first. For many people, certain adjustments make the symptoms less bothersome. These tips may help:
Avoid possible irritants. Reduce your exposure to things that may make your tinnitus worse. Common examples include loud noises and nicotine.
Cover up the noise. In a quiet setting, a fan, soft music or low-volume radio static may help mask the noise from tinnitus.
Manage stress. Stress can make tinnitus worse. Stress management, whether through relaxation therapy, biofeedback or exercise, may provide some relief.
Reduce your alcohol intake. Alcohol increases the force of your blood by dilating your blood vessels, causing greater blood flow, especially in the inner ear area.
There's little evidence that alternative medicine treatments work for tinnitus. However, some alternative therapies that have been tried for tinnitus include:
Acupuncture
Hypnosis
The herb ginkgo
Zinc supplements
Lipoflavonoid, a vitamin complex supplement
In many cases, tinnitus is the result of something that can't be prevented. However, some precautions can help prevent certain kinds of tinnitus.
Use hearing protection. Over time, exposure to loud noise can damage the nerves in the ears, causing hearing loss and tinnitus. If you use chain saws, are a musician, work in an industry that uses loud machinery or use firearms (especially pistols or shotguns), always wear over-the-ear hearing protection.
Turn down the volume. Long-term exposure to amplified music with no ear protection or listening to music at very high volume though headphones can cause hearing loss and tinnitus.
Take care of your cardiovascular health. Regular exercise, eating right and taking other steps to keep your blood vessels healthy can help prevent tinnitus linked to blood vessel disorders.