Although it is often referred to as "ringing in the ears," tinnitus can be perceived as many different sounds including hissing, clicking or whistling.
Tinnitus affects up to 1 in 10 adults and is more likely in those over 60.
Common causes are excessive or cumulative noise exposure, head and neck injuries, and ear infections. In a small number of individuals, tinnitus is a sign of a serious underlying medical condition.
There is no cure for tinnitus, although there are many options for managing it. The majority of individuals with chronic tinnitus adjust to the ringing over time.
For others, tinnitus can be debilitating, and may lead to insomnia, difficulty with concentration, poor work or school performance, irritability, anxiety, and depression.
Contents of this article:
Here are some key points about tinnitus. More detail and supporting information is in the main article.
What is tinnitus?
Tinnitus is consciously hearing a sound that is not generated by any source outside the body. It is not a disease, but a symptom of an underlying problem.
In almost all cases, tinnitus is a subjective noise, meaning that only the person who has tinnitus can hear it. The most common form of tinnitus is a high-pitched steady ringing. Although tinnitus can be annoying, it is not usually a sign of anything more serious.
Causes of tinnitus
Tinnitus can be caused by damage to the inner ear due to the aging process and exposure to excessively loud noise.
The most common cause of tinnitus is damage and loss of the tiny sensory hair cells in the cochlea of the inner ear.
This damage typically occurs as a result of the normal aging process, and from prolonged exposure to excessively loud noise. Hearing loss coincides with tinnitus.
Research also suggests that the sensory loss of certain sound frequencies leads to changes in how the brain processes sound.
As the brain receives less external stimuli around a specific frequency, it begins to adapt and change. Tinnitus may be the brain's way of filling in the missing sound frequencies it no longer receives from its own auditory system.
Some medications such as aspirin, ibuprofen, certain antibiotics, and diuretics can be "ototoxic" - damage the inner ear, resulting in tinnitus.
Other possible causes of tinnitus are:
- Head and neck injuries
- Ear infections
- A foreign object, or earwax touching the eardrum
- Eustachian tube (middle ear) problems
- Temporomandibular joint (TMJ) disorders
- Stiffening of the middle ear bones
- Traumatic brain injury
- Cardiovascular diseases
A potentially more serious form of tinnitus can sound like a heartbeat (pulsatile); it could indicate an abnormal growth, perhaps a tumor or an abnormal connection between a vein and artery, in the region of the ear. This type of tinnitus requires a medical evaluation as soon as possible.
Risk factors for tinnitus
Tinnitus is a common problem in the general population with notable risk factors that increase one's risk of developing the condition. These include:
- Noise exposure from work, headphones, concerts, explosives
- Gender - men are affected more than women
- Hearing loss
- Age - older individuals have a higher likelihood of developing tinnitus
Symptoms of tinnitus
Tinnitus is a non-auditory, internal sound that can be intermittent or continuous, in one or both ears, and either a low- or high-pitch squeal. The varying sounds of tinnitus have been described as whistling, chirping, clicking, screeching, hissing, static, roaring, buzzing, pulsing, whooshing, or musical.
The volume of the sound can fluctuate and is often most noticeable at night or during periods of quiet. Tinnitus is often accompanied by a certain amount of hearing loss.
Tests and diagnosis of tinnitus
It is important for anyone experiencing tinnitus to be evaluated by a doctor for a thorough examination and evaluation to determine an underlying cause.
One of the primary goals of a medical evaluation is to exclude any life-threatening (yet rare) causes of tinnitus. A referral to an otolaryngologist (ear, nose, and throat specialist) may be necessary.
Questions that a doctor might ask at the evaluation include:
- How or when did it start?
- Are the noises constant, intermittent, or pulsating?
- Is it accompanied by hearing loss or dizziness?
- Pain or jaw clicking?
- Have you had a recent illness or injury?
- Was there an exposure to loud noise such as a rock concert or explosives?
Treatment for tinnitus
While some people are able to ignore tinnitus, others will require treatment.
Treating any underlying cause of the tinnitus is the first step in addressing the condition, such as prompt care for an ear infection, discontinuing ototoxic medications, and treating TMJ problems.
For the majority of those experiencing tinnitus, there is no cure. Most people "get used" to tinnitus and learn to tune it out.
Attempting to ignore tinnitus rather than focusing more attention on it can provide substantial relief.
When this does not work, the treatments that work best for tinnitus are those that address the aspects of tinnitus that make the condition most difficult; relieving insomnia, anxiety, hearing difficulties, social isolation, and treating depression can significantly improve the quality of one's life.
Additionally, there are many other things a person can do to successfully manage tinnitus, some of these are listed below.
Sound therapy is a broad term that incorporates using external noise to mask the individual's perception of tinnitus. Low-level background music, white noise, or specialized ear maskers can be very effective.
The sound choice for masking should be pleasant to the individual. Masking devices are a temporary relief; the awareness of tinnitus returns when the sound therapy is turned off.
Hearing aids are a common type of sound therapy; they amplify environmental sounds and redirect attention to those noises instead of the tinnitus.
Tinnitus Retraining Therapy or Tinnitus Feedback Retraining
Tinnitus retraining therapy (TRT) involves retraining the auditory system to accept the abnormal sounds of tinnitus as natural rather than disruptive.
This is done with the help of a trained professional and a wearable device that emits low-level white noise. TRT requires ongoing counseling sessions to assist the individual in coping with the tinnitus.
This therapy's success is proportionate to the severity of the tinnitus and the individual's overall mental health. Follow-up studies suggest around 80 percent of individuals obtained some relief of their tinnitus with TRT.
Although improving one's wellness will not stop tinnitus, it can limit the intensity and provide immense physical, emotional, and spiritual benefits. Exercise, healthy eating, good sleep habits, smoking cessation, recreational and social activities, and stress management and relaxation techniques are things a person can consider to achieve optimum wellness.
One of the preventable causes of tinnitus is noise exposure. Sometimes tinnitus can be noticed early before any hearing loss develops. Using hearing protection (ear mufflers and plugs) in noisy environments, and using common sense with personal listening devices might prevent worsening or future hearing damage.
Unfortunately, it cannot reverse the damage already done.