Tinnitus is thought to affect 50 million Americans. It usually occurs after the age of 50 years, but children and adolescents can experience it, too.
Common causes are excessive or cumulative noise exposure, head and neck injuries, and ear infections. It can occasionally indicate a serious underlying medical condition.
There is no cure for tinnitus, but there are ways of managing it. Most people with chronic tinnitus adjust to the ringing over time, but 1 in 5 will find it disturbing or debilitating.
Here are some key points about tinnitus. More detail is in the main article.
- Around 50 million Americans experience some form of tinnitus.
- Most tinnitus is due to damage to the cochlea, or inner ear.
- Certain medications can cause or worsen tinnitus, for example, aspirin, particularly in large doses.
- People with tinnitus may be over-sensitive to loud noise.
- Most people learn to live with tinnitus, but help is available for those who find this difficult.
What is tinnitus?
Tinnitus refers to a ringing, whistling or other sound in the ears.
Tinnitus happens when we consciously hear a sound that does not come from any source outside the body. It is not a disease, but a symptom of an underlying problem.
The noise is usually subjective, meaning that only the person who has tinnitus can hear it.
The most common form is a steady, high-pitched ringing. This can be annoying, but it does not usually indicate a serious condition.
In fewer than 1 percent of cases, it may be objective. This means that other people can hear the noise. This type of noise may be caused by cardiovascular or musculoskeletal movements in the person's body. This can be a sign of a medical emergency.
Tinnitus is a non-auditory, internal sound that can be intermittent or continuous, in one or both ears, and either low- or high-pitched.
The varying sounds have been described as whistling, chirping, clicking, screeching, hissing, static, roaring, buzzing, pulsing, whooshing, or musical.
The volume of the sound can fluctuate. It is often most noticeable at night or during periods of quiet. There may be some hearing loss.
The first step is to treat any underlying cause of tinnitus.
This may involve:
- prompt care for an ear infection
- discontinuing any ototoxic medications
- treating any temporomandibular joint (TMJ) problems, which affect the joint betwen the jaw bone and the cheek bone
There is no cure for most cases of tinnitus. Most people become accustomed to it and learn to tune it out. Ignoring it rather than focusing on it can provide relief.
When this does not work, the individual may benefit from treatment for the effects of tinnitus, insomnia, anxiety, hearing difficulties, social isolation, and depression. Dealing with these issues can significantly improve a person's quality of life.
Here are some other things a person can do to manage tinnitus and its effects.
Sound therapy uses external noise to mask the individual's perception of tinnitus. Low-level background music, white noise, or specialized ear maskers can help.
The choice of sound should be pleasant to the individual. Masking devices offer temporary relief, and 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 (TRT) involves retraining the auditory system to accept the abnormal sounds of tinnitus as natural rather than disruptive.
It involves help from a trained professional and wearing a device that emits low-level white noise. Ongoing counseling sessions can help people cope 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 that TRT provides relief for around 80 percent of people with tinnitus.
Cognitive behavioral therapy (CBT) can help relieve depression in people with tinnitus, although it does not appear to reduce the sound.
One way to prevent tinnitus, and possibly hearing loss, is by avoiding exposure to loud noises.
To prevent hearing damage from developing or worsening:
- use hearing protection, such as ear mufflers and earplugs, in noisy environments
- play personal listening devices at a moderate volume
Improving wellness will not stop tinnitus, but overall wellbeing can help limit its intensity and provide physical and emotional benefits.
Exercise, healthy eating, good sleeping habits, avoiding smoking and excessive alcohol, recreational and social activities, and stress management and relaxation techniques can all help achieve optimum wellness.
Unfortunately, once the damage is done, there is no way to reverse it.
Anyone who is experiencing tinnitus should visit a doctor for an examination and evaluation to determine the underlying cause.
A medical evaluation can exclude any rare but life-threatening causes of tinnitus. A referral to an otolaryngologist, or ear, nose, and throat specialist, may be necessary.
Questions that a doctor might ask include:
How or when did it start?
- Are the noises constant, intermittent, or pulsating?
- Is there any hearing loss or dizziness?
- Is there any pain or jaw clicking?
- Have you had a recent illness or injury?
- Has there been any exposure to loud noise, such as a rock concert or explosives?
Tests may include:
- a complete examination of the ear, head, neck, and torso
- hearing tests
- laboratory blood tests
- imaging studies
The most common cause of tinnitus is damage and loss of the tiny sensory hair cells in the cochlea of the inner ear.
This tends to happen as people age, and it can also result from prolonged exposure to excessively loud noise. Hearing loss may coincide with tinnitus.
Research 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." They cause damage to the inner ear, resulting in tinnitus.
Other possible causes 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
If a foreign body or earwax causes tinnitus, removing the object or wax often makes the tinnitus go away.
Tinnitus that sounds like a heartbeat may be more serious. It could be due to an abnormal growth in the region of the ear, such as a tumor or an abnormal connection between a vein and artery.
It needs a medical evaluation as soon as possible.
Teens, loud music, and possible future hearing problems
One study found that out of 170 teenagers, over half had experienced tinnitus in the previous year. Research has proposed that "potentially risky leisure habits," such as listening to loud music on personal devices, could trigger tinnitus.
However, the investigators found that those who were prone to tinnitus tended to keep their music volume down, suggsting they may already have a hidden susceptibility to hearing loss in the future.
They propose monitoring for tinnitus and a low tolerance for loud noise from an early age, as these could be early signs of future hearing loss.
Tinnitus is a common problem in the general population, especially among those with certain risk factors.
- noise exposure from work, headphones, concerts, explosives, and so on
- gender, as men are affected more than women
- hearing loss
- age, as older individuals are more susceptible