Tinnitus

When internally produced sounds that may include ringing, whistling, buzzing, whooshing, or chirping are heard in the ears, it’s a condition called tinnitus. The distracting sounds can vary in intensity and duration. Some people may experience tinnitus intermittently while others may hear the sounds consistently.

• Tinnitus affects anywhere from 30 to 50 million people in the United States
• Treatment for tinnitus will depend on whether or not there’s an underlying condition contributing to it and the severity of symptoms

The condition is often chronic (lasting longer than 4-6 months) but can be temporary. Age-related hearing loss or noise-induced hearing loss are frequently contributing factors to tinnitus. Exposure to loud sounds causes certain cells in the hollow tube in the inner ear (cochlea) to become damaged. Ringing or hissing/buzzing tinnitus is a result of the loss of cells in the inner ear but the sound perception is created by brain cells. Pulsing or whooshing tinnitus is caused by hearing internal movement of blood in the head or neck.

While noise-induced hearing loss and tinnitus can affect anyone, musicians, people who work in construction, and individuals consistently exposed to loud sounds are more susceptible. Some people with tinnitus won’t have any hearing loss at all on an audiogram, but on more accurate testing such as otoacoustic emissions we will find evidence of hearing loss in all patients. Some people suffering from tinnitus may become sensitive to sound (hyperacusis). Hormonal changes related to lifestyle issues such as constant fatigue, poor sleeping habits, anxiety, and depression can sometimes contribute to tinnitus. Additional causes or contributing factors may include

• Age-related or any type of sensorineural/conductive hearing loss
• A virus, ear infection, or blockage in the ear (usually causes temporary tinnitus)
• Ménière’s disease affecting the part of the inner ear associated with balance
• Certain medications, especially some anti-inflammatory drugs
• Severe head injuries can cause hearing loss (i.e., fracture of the skull/temporal bone)
• Severe head injuries can cause AV fistulas and cause pulsatile tinnitus
• Neck injuries can cause pseudoaneurysm or dissections and cause pulsatile tinnitus

For some people, tinnitus is a minor annoyance while other sufferers might find it difficult to concentrate, sometimes to the point where the condition interferes with an individual’s personal and professional life. The following signs and symptoms may be related to different forms of tinnitus:

• Perception of music or singing (musical tinnitus) – often associated with brain disorders such as memory problems
• Near-continuous sound with fluctuating volume (tonal/hissing/buzzing tinnitus)
• Perception of pulsing sounds (pulsatile tinnitus)

In some instances, only the person experiencing tinnitus will hear sounds (subjective tinnitus), and sometimes a doctor can hear the sounds a patient is hearing with a stethoscope (objective tinnitus – most often pulsatile or whooshing). Diagnosis involves an examination of the patient’s ears, head, and neck to determine the likely cause of the type of tinnitus being experienced.

A hearing test can rule out or confirm suspected causes. Image testing is sometimes done to further narrow down or rule out a source of tinnitus depending on the type and sidedness of the tinnitus. A patient may be asked to make certain movements with their eyes, jaw, neck, arms, and legs to determine if there is an underlying condition that will need to be treated. The sounds that a patient reports hearing often help identify any possible underlying causes. In some cases, no cause can be found.

Treatment recommendations will vary based on symptoms experienced and whether or not an underlying cause is identified. For example, ears with excessive wax can be cleaned and medications likely causing symptoms can be stopped or changed. If tinnitus remains after suspected underlying sources are treated, masking devices may help minimize the sounds heard. If hearing loss is a contributing factor, hearing aids can be programmed to reduce noises. A cochlear implant may be recommended for patients with severe hearing loss to improve the hearing and possibly tinnitus.

Noise suppression that involves white noise machines and tinnitus retraining with various devices can sometimes make symptoms less bothersome. Tricyclic antidepressants may also help reduce the severity of symptoms for some patients. Sound therapy is more specific to the patient’s symptoms and needs, which sometimes makes it a more effective treatment option than white noise machines. Medication therapy is often used in conjunction with sound therapy in most patients. Alternative treatments such as acupuncture may help some patients, though there is no good scientific evidence for the effectiveness of acupuncture. Surgery for tinnitus is rarely recommended, but it may be necessary if there’s a tumor, cyst, hole in the ear drum, or ear bone abnormalities (such as conductive hearing loss, superior canal dehiscence, or otosclerosis) contributing to tinnitus symptoms.

Tinnitus is sometimes manageable for sufferers if certain irritants that make symptoms worse are avoided. This may include minimizing exposure to loud environments as much as possible and avoiding caffeine and nicotine.

Tinnitus isn’t usually preventable. However, precautions such as using proper hearing protection, reducing loud volumes, and maintaining a healthy diet may reduce the risk of developing certain types of tinnitus.