Tinnitus

Overview

Tinnitus is when you experience ringing or other noises in one or both of your ears. The noise you hear when you have tinnitus isn't caused by an external sound, and other people usually can't hear it. Tinnitus is a common problem. It affects about 15% to 20% of people, and is especially common in older adults.

Tinnitus is usually caused by an underlying condition, such as age-related hearing loss, an ear injury or a problem with the circulatory system. For many people, tinnitus improves with treatment of the underlying cause or with other treatments that reduce or mask the noise, making tinnitus less noticeable.

Symptoms

Tinnitus is most often described as a ringing in the ears, even though no external sound is present. However, tinnitus can also cause other types of phantom noises in your ears, including:

• Buzzing
• Roaring
• Clicking
• Hissing
• Humming

Most people who have tinnitus have subjective tinnitus, or tinnitus that only you can hear. The noises of tinnitus may vary in pitch from a low roar to a high squeal, and you may hear it in one or both ears. In some cases, the sound can be so loud it interferes with your ability to concentrate or hear external sound. Tinnitus may be present all the time, or it may come and go.

In rare cases, tinnitus can occur as a rhythmic pulsing or whooshing sound, often in time with your heartbeat. This is called pulsatile tinnitus. If you have pulsatile tinnitus, your doctor may be able to hear your tinnitus when he or she does an examination (objective tinnitus).

When to see a doctor

Some people aren't very bothered by tinnitus. For other people, tinnitus disrupts their daily lives. If you have tinnitus that bothers you, see your doctor.

Make an appointment to see your doctor if:

• You develop tinnitus after an upper respiratory infection, such as a cold, and your tinnitus doesn't improve within a week.

See your doctor as soon as possible if:

• You have hearing loss or dizziness with the tinnitus.
• You are experiencing anxiety or depression as a result of your tinnitus.

Causes

A number of health conditions can cause or worsen tinnitus. In many cases, an exact cause is never found.

Common causes of tinnitus

In many people, tinnitus is caused by one of the following:

• Hearing loss. There are tiny, delicate hair cells in your inner ear (cochlea) that move when your ear receives sound waves. This movement triggers electrical signals along the nerve from your ear to your brain (auditory nerve). Your brain interprets these signals as sound.

  If the hairs inside your inner ear are bent or broken — this happens as you age or when you are regularly exposed to loud sounds — they can "leak" random electrical impulses to your brain, causing tinnitus.

• Ear infection or ear canal blockage. Your ear canals can become blocked with a buildup of fluid (ear infection), earwax, dirt or other foreign materials. A blockage can change the pressure in your ear, causing tinnitus.
• Head or neck injuries. Head or neck trauma can affect the inner ear, hearing nerves or brain function linked to hearing. Such injuries usually cause tinnitus in only one ear.

• Medications. A number of medications may cause or worsen tinnitus. Generally, the higher the dose of these medications, the worse tinnitus becomes. Often the unwanted noise disappears when you stop using these drugs.

  Medications known to cause tinnitus include nonsteroidal anti-inflammatory drugs (NSAIDs) and certain antibiotics, cancer drugs, water pills (diuretics), antimalarial drugs and antidepressants.

Other causes of tinnitus

Less common causes of tinnitus include other ear problems, chronic health conditions, and injuries or conditions that affect the nerves in your ear or the hearing center in your brain.

• Meniere's disease. Tinnitus can be an early indicator of Meniere's disease, an inner ear disorder that may be caused by abnormal inner ear fluid pressure.
• Eustachian tube dysfunction. In this condition, the tube in your ear connecting the middle ear to your upper throat remains expanded all the time, which can make your ear feel full.
• 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, tends to run in families.
• Muscle spasms in the inner ear. Muscles in the inner ear can tense up (spasm), which can result in tinnitus, hearing loss and a feeling of fullness in the ear. This sometimes happens for no explainable reason, but can also be caused by neurologic diseases, including multiple sclerosis.
• Temporomandibular joint (TMJ) disorders. Problems with the TMJ, the joint on each side of your head in front of your ears, where your lower jawbone meets your skull, can cause tinnitus.
• Acoustic neuroma or other head and neck tumors. Acoustic neuroma is a noncancerous (benign) tumor that develops on the cranial nerve that runs from your brain to your inner ear and controls balance and hearing. Other head, neck or brain tumors can also cause tinnitus.
• Blood vessel disorders. Conditions that affect your blood vessels — such as atherosclerosis, high blood pressure, or kinked or malformed blood vessels — can cause blood to move through your veins and arteries with more force. These blood flow changes can cause tinnitus or make tinnitus more noticeable.
• Other chronic conditions. Conditions including diabetes, thyroid problems, migraines, anemia, and autoimmune disorders such as rheumatoid arthritis and lupus have all been associated with tinnitus.

Risk factors

Anyone can experience tinnitus, but these factors may increase your risk:

• Loud noise exposure. 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, also can cause noise-related hearing loss if played loudly for long periods. People who work in noisy environments — such as factory and construction workers, musicians, and soldiers — are particularly at risk.
• Age. As you age, the number of functioning nerve fibers in your ears declines, possibly causing hearing problems often associated with tinnitus.
• Sex. Men are more likely to experience tinnitus.
• Tobacco and alcohol use. Smokers have a higher risk of developing tinnitus. Drinking alcohol also increases the risk of tinnitus.
• Certain health problems. Obesity, cardiovascular problems, high blood pressure, and a history of arthritis or head injury all increase your risk of tinnitus.

Complications

Tinnitus affects people differently. For some people, tinnitus can significantly affect quality of life. If you have tinnitus, you may also experience:

• Fatigue
• Stress
• Sleep problems
• Trouble concentrating
• Memory problems
• Depression
• Anxiety and irritability
• Headaches
• Problems with work and family life

Treating these linked conditions may not affect tinnitus directly, but it can help you feel better.

Prevention

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 sounds can damage the nerves in the ears, causing hearing loss and tinnitus. Try to limit your exposure to loud sounds. And if you cannot avoid loud sounds, use ear protection to help protect your hearing. 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 through 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 obesity and blood vessel disorders.
• Limit alcohol, caffeine and nicotine. These substances, especially when used in excess, can affect blood flow and contribute to tinnitus.

Diagnosis

Your doctor will typically diagnose you with tinnitus based on your symptoms alone. But in order to treat your symptoms, your doctor will also try to identify whether your tinnitus is caused by another, underlying condition. Sometimes a cause can't be found.

To help identify the cause of your tinnitus, your doctor will likely ask you about your medical history and examine your ears, head and neck. Common tests include:

• Hearing (audiological) exam. During the test, you'll sit in a soundproof room wearing earphones that transmit specific sounds into one ear at a time. You'll indicate when you can hear the sound, and your results will be compared with results considered normal for your age. This can help rule out or identify possible causes of tinnitus.
• Movement. Your doctor may ask you to move your eyes, clench your jaw, or move your neck, arms and legs. If your tinnitus changes or worsens, it may help identify an underlying disorder that needs treatment.
• Imaging tests. Depending on the suspected cause of your tinnitus, you may need imaging tests such as CT or MRI scans.
• Lab tests. Your doctor may draw blood to check for anemia, thyroid problems, heart disease or vitamin deficiencies.

Do your best to describe for your doctor what kind of tinnitus noises you hear. The sounds you hear can help your doctor identify a possible underlying cause.

• Clicking. This type of sound suggests that muscle contractions in and around your ear might be the cause of your tinnitus.
• Pulsing, rushing or humming. These sounds usually stem from blood vessel (vascular) causes, such as high blood pressure, and you may notice them when you exercise or change positions, such as when you lie down or stand up.
• Low-pitched ringing. This type of sound may point to ear canal blockages, Meniere's disease or stiff inner ear bones (otosclerosis).
• High-pitched ringing. This is the most commonly heard tinnitus sound. Likely causes include loud noise exposure, hearing loss or medications. Acoustic neuroma can cause continuous, high-pitched ringing in one ear.

Treatment

Treatment for tinnitus depends on whether your tinnitus is caused by an underlying health condition. If so, your doctor may be able to reduce your symptoms by treating the underlying cause. Examples include:

• Earwax removal. Removing an earwax blockage can decrease tinnitus symptoms.
• Treating a blood vessel condition. Underlying blood vessel conditions may require medication, surgery or another treatment to address the problem.
• Hearing aids. If your tinnitus is caused by noise-induced or age-related hearing loss, using hearing aids may help improve your symptoms.
• 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.

Noise suppression

Many times, tinnitus can't be cured. But there are treatments that can help make your symptoms less noticeable. Your doctor may suggest using an electronic device to suppress the noise. Devices include:

• White noise machines. These devices, which produce a sound similar to static, or environmental sounds such as falling rain or ocean waves, are often an effective treatment for tinnitus. You may want to try a white noise machine with pillow speakers to help you sleep. Fans, humidifiers, dehumidifiers and air conditioners in the bedroom also produce white noise and may help make tinnitus less noticeable at night.
• Masking devices. Worn in the ear and similar to hearing aids, these devices produce a continuous, low-level white noise that suppresses tinnitus symptoms.

Counseling

Behavioral treatment options aim to help you live with tinnitus by helping you change the way you think and feel about your symptoms. Over time, your tinnitus may bother you less. Counseling options include:

• Tinnitus retraining therapy (TRT). TRT is an individualized program that is usually administered by an audiologist or at a tinnitus treatment center. TRT combines sound masking and counseling from a trained professional. Typically, you wear a device in your ear that helps mask your tinnitus symptoms while you also receive directive counseling. Over time, TRT may help you notice tinnitus less and feel less distressed by your symptoms.
• Cognitive behavioral therapy (CBT) or other forms of counseling. A licensed mental health professional or psychologist can help you learn coping techniques to make tinnitus symptoms less bothersome. Counseling can also help with other problems often linked to tinnitus, including anxiety and depression. Many mental health professionals offer CBT for tinnitus in individual or group sessions, and CBT programs are also available online.

Medications

Drugs can't cure tinnitus, but in some cases they may help reduce the severity of symptoms or complications. To help relieve your symptoms, your doctor may prescribe medication to treat an underlying condition or to help treat the anxiety and depression that often accompany tinnitus.

Potential future treatments

Researchers are investigating whether magnetic or electrical stimulation of the brain can help relieve symptoms of tinnitus. Examples include transcranial magnetic stimulation (TMS) and deep brain stimulation.

Lifestyle and home remedies

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:

• Use hearing protection. Over time, exposure to loud sounds can damage the nerves in the ears, causing hearing loss and tinnitus. To keep your tinnitus from getting worse, take steps to protect your hearing. 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. Listening to music at very high volume through headphones can contribute to hearing loss and tinnitus.
• Use white noise. If tinnitus is especially noticeable in quiet settings, try using a white noise machine to mask the noise from tinnitus. If you don't have a white noise machine, a fan, soft music or low-volume radio static also may help.
• Limit alcohol, caffeine and nicotine. These substances, especially when used in excess, can affect blood flow and contribute to tinnitus.

Alternative medicine

There's little evidence that alternative medicine treatments work for tinnitus. However, some alternative therapies that have been tried for tinnitus include:

• Acupuncture
• Ginkgo biloba
• Melatonin
• Zinc supplements

Coping and support

In addition to any treatment options offered by your doctor, here are some suggestions to help you cope with tinnitus:

• Support groups. Sharing your experience with others who have tinnitus may be helpful. There are tinnitus groups that meet in person, as well as internet forums. To ensure that the information you get in the group is accurate, it's best to choose a group facilitated by a physician, audiologist or other qualified health professional.
• Education. Learning as much as you can about tinnitus and ways to alleviate symptoms can help. And just understanding tinnitus better makes it less bothersome for some people.
• Stress management. Stress can make tinnitus worse. Stress management, whether through relaxation therapy, biofeedback or exercise, may provide some relief.

Preparing for an appointment

Be prepared to tell your doctor about:

• Your signs and symptoms
• Your medical history, including any other health conditions you have, such as hearing loss, high blood pressure or clogged arteries (atherosclerosis)
• All medications you take, including herbal remedies

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

• When did you begin experiencing symptoms?
• What does the noise you hear sound like?
• Do you hear it in one or both ears?
• Has the sound you hear been continuous, or does it come and go?
• How loud is the noise?
• How much does the noise bother you?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Have you been exposed to loud noises?
• Have you had an ear disease or head injury?

After you've been diagnosed with tinnitus, you may need to see an ear, nose and throat doctor (otolaryngologist). You may also need to work with a hearing expert (audiologist).