Tinnitus – Overview
The perception of noise or ringing in the ears is known as tinnitus. About 15 to 20 percent of people are affected by tinnitus which is a common problem. A condition itself is not tinnitus it’s a symptom of an underlying condition, such as age-related hearing loss, ear injury or a circulatory system disorder.
Tinnitus usually isn’t a sign of something critical although it is bothersome. Although for many people it can worsen with age but tinnitus can improve with treatment. An identified underlying cause when treated can sometimes help. Tinnitus is made less noticeable by other treatments which reduce or mask the noise.
The sensation of hearing sound when no external sound is present is involved un tinnitus. These types of phantom noises in the ears may be included in tinnitus symptoms:
The phantom noise may vary in pitch from a low roar to a high squeal, and can be heard in one or both ears. In some cases, the sound can be so loud that the ability to concentrate or hear external sound can be interfered. Tinnitus may be all the time present, or it may come and go.
Two kinds of tinnitus are available:
- Subjective tinnitusis tinnitus which can only heard by you and is the most common type of tinnitus which can be caused by ear problems in the outer, middle or inner ear. Problems with the hearing (auditory) nerves or the part of the brain that interprets nerve signals as sound (auditory pathways) can cause this type of tinnitus.
- Objective tinnitusis tinnitus which the doctor can hear when examination is done. A blood vessel problem causes this rare type of tinnitus, a middle ear bone condition or muscle contractions.
When to see a doctor
Doctor should be consulted if having tinnitus that bothers.
An appointment to be made to see the doctor if:
- Tinnitus is developed after an upper respiratory infection, such as a cold, and the tinnitus doesn’t improve within a week
Doctor should be consulted as soon as possible if:
- Having tinnitus that occurs suddenly or without an apparent cause
- Having hearing loss or dizziness with the tinnitus
Tinnitus can be caused or worsened by a number of health conditions. An exact cause is never found in many cases
Inner ear hair cell damage is a common cause of tinnitus. Hairs which are tiny and delicate in the inner ear move in relation to the pressure of sound waves which triggers cells to release an electrical signal through a nerve from the ear (auditory nerve) to the brain. These signals are interpreted by brain as sound. If the hairs inside the inner ear are bent or broken, random electrical impulses to the brain can be leaked, causing tinnitus.
Other ear problems, chronic health conditions, and injuries or conditions are included in other causes of tinnitus that affect the nerves in the ear or the hearing center in the brain.
Common causes of tinnitus
Tinnitus is caused by one of below conditions in many people:
- Age-related hearing loss.Hearing worsens with growing age for many people, usually starting around age 60. Tinnitus can be caused by hearing loss. The medical term used for this kind of hearing loss is known as presbycusis.
- Exposure to loud noise. Common sources of noise-related hearing loss are noises, such as those from heavy equipment, chain saws and firearms. MP3 players or iPods are portable music devices which also can cause noise-related hearing loss if played loudly for long periods. Short-term exposure can cause tinnitus, such as attending a loud concert, usually goes away; permanent damage can be caused by both short- and long-term exposure to loud sound.
- Earwax blockage.Ear canal is protected by trapping dirt and slowing the growth of bacteria. When too much earwax accumulates, washing away naturally becomes too hard, causing hearing loss or irritation of the eardrum, which can lead to tinnitus.
- Ear bone changes.Hearing may be affected by stiffening of the bones in the middle ear (otosclerosis) and cause tinnitus. This condition tends to run in families which are caused by abnormal bone growth.
Other causes of tinnitus
Some causes of tinnitus are less common which may include:
- Meniere’s disease.An early indicator of Meniere’s disease can be tinnitus, an inner ear disorder that may be caused by abnormal inner ear fluid pressure.
- TMJ disorders.Tinnitus can be caused by the problems with the temporomandibular joint, the joint on each side of the head in front of the ears, where the lower jawbone meets the skull.
- Head injuries or neck injuries.Head or neck trauma can affect the inner ear, hearing nerves or brain function linked to hearing. Such injuries generally cause tinnitus in only one ear.
- Acoustic neuroma.This noncancerous (benign) tumor is developed on the cranial nerve that runs from the brain to the inner ear and balance and hearing are controlled. Also known as vestibular schwannoma, this condition in only one ear tinnitus is caused.
- Eustachian tube dysfunction.The tube in the ear connecting the middle ear to the upper throat remains expanded all the time in this condition, which can make the ear feel full. This kind of dysfunction can be caused due to loss of a significant amount of weight, pregnancy and radiation therapy.
- Muscle spasms in the inner ear.Muscles in the inner ear can tense up (spasm), resulting in tinnitus, hearing loss and a feeling of fullness in the ear. No explainable reason when this happens sometimes, but can also be caused by neurologic diseases, including multiple sclerosis.
Blood vessel disorders linked to tinnitus
In rare cases, a blood vessel disorder can be a cause of tinnitus. This type of tinnitus is known as pulsatile tinnitus. Causes may include:
- With age and buildup of cholesterol and other deposits, some of the elasticity of major blood vessels close to the middle and inner ear may become lose which is the ability to flex or expand slightly with each heartbeat. Blood flow to become more forceful is caused, making it easier for the ear to detect the beats. This type of tinnitus in both ears can generally be heard in both ears
- Head and neck tumors.Tinnitus and other symptoms can be caused by a tumor that presses on blood vessels in the head or neck (vascular neoplasm).
- High blood pressure.Tinnitus maybe more noticeable in hypertension and factors that increase blood pressure, such as stress, alcohol and caffeine.
- Turbulent blood flow.Turbulent, irregular blood flow can be caused by narrowing or kinking in a neck artery (carotid artery) or vein in neck (jugular vein), leading to tinnitus.
- Malformation of capillaries.A condition known as arteriovenous malformation (AVM), abnormal connections between arteries and veins, can result in tinnitus. In only one ear this type of tinnitus occurs.
Medications that can cause tinnitus
Tinnitus can be caused or become worse by a number of medications. Generally, the tinnitus becomes worse if the dose of these medications is higher. When these drugs are stopped then often the unwanted noise disappears. Medications which are known to cause or worsen tinnitus include:
- Antibiotics,including polymyxin B, erythromycin, vancomycin (Vancocin HCL, Firvanq) and neomycin
- Cancer medications,including methotrexate (Trexall) and cisplatin
- Water pills (diuretics),such as bumetanide (Bumex), ethacrynic acid (Edecrin) or furosemide (Lasix)
- Quinine medicationsused for malaria or other health conditions
- Certain antidepressants,which may worsen tinnitus
- Aspirintaken in uncommonly high doses (usually 12 or more a day)
In addition, tinnitus can be caused by some herbal supplements, as can nicotine and caffeine.
Tinnitus can be experienced by anyone can, but below factors may increase risk:
- Loud noise exposure.Tiny sensory hair cells in ear that transmit sound to brain can be damaged by prolonged exposure. People are at risk who are working in noisy environments such as factory and construction workers, musicians, and soldiers.
- The number of functioning nerve fibers in the ears declines with age, possibly causing hearing problems often associated with tinnitus.
- Tinnitus is more likely to be experienced by men.
- Risk of developing tinnitus is high in smokers.
- Cardiovascular problems.Risk of tinnitus is increased by conditions that affect the blood flow, such as high blood pressure or narrowed arteries (atherosclerosis).
Quality of life can be affected significantly by tinnitus. Although people are affected people differently, if having tinnitus, below may also experience:
- Sleep problems
- Trouble concentrating
- Memory problems
- Anxiety and irritability
Tinnitus may not be affected directly by treating these linked conditions, but it can help in feeling better.
In many cases, the result of something that can’t be prevented is tinnitus. However, some precautions can help in the prevention of certain types of tinnitus.
- Use hearing protection.Over time, nerves in the ears can be damaged with exposure to loud sounds, causing hearing loss and tinnitus. If chain saws are used, are a musician, work in an industry that uses loud machinery or use firearms (especially pistols or shotguns), over-the-ear hearing protection should be worn always.
- Turn down the volume.Hearing loss and tinnitus can be caused by long-term exposure to amplified music with no ear protection or listening to music at very high volume through headphones.
- Take care of cardiovascular health.Tinnitus linked to blood vessel disorders can be prevented through regular exercise, eating right and taking other steps to keep the blood vessels healthy.
Ears, head and neck will be examined by the doctor to look for possible causes of tinnitus. Tests may include:
- Hearing (audiological) exam.As part of the test, wearing earphones through which will be played specific sounds into one ear at a time while sitting in a soundproof room. Hearing the sound will be indicated by the candidate, and the results are compared with results considered normal for the age. This can help in ruling out or identifying likely causes of tinnitus.
- Moving eyes, clenching jaw, or moving neck, arms and legs might be asked by the doctor to perform. If tinnitus changes or worsens, identifying an underlying disorder that needs treatment can be done with the help of this
- Imaging tests.Depending on the suspected cause of the tinnitus, imaging tests might be needed such as CT or MRI scans.
The sounds heard can help the doctor identifying a possible underlying cause.
- Sharp clicking sounds may be caused by muscle contractions in and around the ear that is heard in bursts. Several seconds to a few minutes is the timespan in which they may last.
- Rushing or humming are sound fluctuations that are usually vascular in origin, and may be noticed when exercising or changing positions, such as when lying down or standing up.
- High blood pressure, an aneurysm or a tumor, and blockage of the ear canal or eustachian tube are blood pressure problems which can amplify the sound of the heartbeat in ears (pulsatile tinnitus).
- Low-pitched ringing.Conditions that can cause low-pitched ringing in one ear include Meniere’s disease. Tinnitus may become very loud before an attack of vertigo — a sense that you or your surroundings are spinning or moving.
- High-pitched ringing.A high-pitched ringing or buzzing can be caused by exposure to a very loud noise or blow to the ear that usually goes away after a few hours. However, tinnitus might be permanent if there’s hearing loss as well. Long-term noise exposure, age-related hearing loss or medications can cause a persistent, high-pitched ringing in both ears. Continuous, high-pitched ringing in one ear can be caused by acoustic neuroma
- Other sounds.Low-pitched tinnitus can be caused by stiff inner ear bones (otosclerosis) that may be continuous or may come and go. A variety of sounds are caused by earwax, foreign bodies or hairs in the ear canal can rub against the eardrum.
In many cases, the cause is never found for tinnitus. Steps to be taken can be discussed by the doctor to reduce the severity of the tinnitus or to help to cope better with the noise.
Treating an underlying health condition
To treat tinnitus, identifying any underlying, treatable condition might be first tried by the doctor that may be associated with the symptoms. If tinnitus is due to a health condition, steps might be taken by the doctor that could reduce the noise. Examples include:
- Earwax removal.Tinnitus symptoms may be reduced by removing impacted earwax.
- Treating a blood vessel condition.Medication, surgery or another treatment might be required for underlying vascular conditions and addressing the problem.
- Changing medication.If a medication being taken appears to be the cause of tinnitus, stopping or reducing the drug, or switching to a different medication might be suggested by the doctor.
In some cases the sound might be suppressed with the help of white noise so that it’s less bothersome. An electronic device to suppress the noise might be recommended by the doctor. Devices may include:
- White noise machines.Simulated environmental sounds are produced by these devices such as falling rain or ocean waves, are often an effective treatment for tinnitus. A white noise machine might need to be tried with pillow speakers to help to sleep. To help cover the internal noise at night, fans, humidifiers, dehumidifiers and air conditioners in the bedroom can be used.
- Hearing aids.If having hearing problems as well as tinnitus, hearing aids can be especially useful.
- Masking devices.Similar to hearing aids, masking devices are worn in the ear, these devices produce a continuous, low-level white noise that suppresses tinnitus symptoms.
- Tinnitus retraining. Individually programmed tonal music to mask the specific frequencies of the tinnitus being experienced, a wearable device is used. 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.
Tinnitus cannot be cured by drugs, but in some cases they may help reduce the severity of symptoms or complications. Possible medications included may be the following:
- Tricyclic antidepressants, such as amitriptyline and nortriptyline, have been used with some favorable outcomes. For only tinnitus which is severe, these medications are generally used, as they can cause troublesome side effects, including dry mouth, blurred vision, constipation and heart problems.
- Alprazolam (Xanax)may help reduce tinnitus symptoms, but drowsiness and nausea are included in side effects which can also become habit-forming.
Lifestyle and home remedies
Tinnitus cannot be treated often. However some people get used to it and noticing it is less than they did at first. Certain adjustments make the symptoms less bothersome for many people. Below tips may help:
- Avoid possible irritants.Things that make tinnitus worse should be reduced. Loud noises, caffeine and nicotine are included in common examples
- Cover up the noise. The noise can be masked from tinnitus with help of
- a quiet setting, a fan, soft music or low-volume radio static.
- Manage stress.Tinnitus can become worse with stress. Some relief may be provided by stress management, whether through relaxation therapy, biofeedback or exercise.
- Reduce alcohol consumption.Alcohol increases the force of the blood by dilating the blood vessels is increased by alcohol, causing greater blood flow, especially in the inner ear area.
Little evidence is present that alternative medicine treatments work for tinnitus. However, some alternative therapies that have been tried for tinnitus which may include:
- Ginkgo biloba
- Zinc supplements
- B vitamins
A painless, noninvasive therapy that has been successful in reducing tinnitus symptoms for some people is called as neuromodulation using transcranial magnetic stimulation (TMS). Currently in Europe, TMS is used more commonly and in some trials in the U.S. Which patients might benefit from such treatments is still to be determined.
Coping and support
With treatment, tinnitus doesn’t always improve or fully go away. Below are some suggestions to help in coping:
- Learning coping techniques to make tinnitus symptoms less bothersome can be done with the help of licensed therapist or psychologist. Other problems often linked to tinnitus can also be helped with counselling, including anxiety and depression.
- Support groups.It can be helpful by sharing the experience with others who have tinnitus. Meeting in person, as well as internet forums are kinds of tinnitus groups. The information to be made sure which is got in the group is accurate, it’s best to choose a group facilitated by a physician, audiologist or other qualified health professional.
- Learn as much as possible about tinnitus and ways to reduce symptoms can help. For some people just understanding tinnitus better makes it less bothersome.
Preparing for appointment
Preparation should be made to tell the doctor about:
- Signs and symptoms
- Medical history, including any other health conditions, such as hearing loss, high blood pressure or clogged arteries (atherosclerosis)
- All medications being consumed, including herbal remedies
What to expect from doctor
A number of questions is likely to be asked by the doctor, including:
- Beginning of experiencing symptoms?
- The noise heard sound like?
- Heard in one or both ears?
- Sound heard has been continuous, or does it come and go?
- Loudness of the noise?
- How much the noise bothers?
- If anything, improving the symptoms?
- If anything, worsening the symptoms?
- Exposure to loud noises?
- History of an ear disease or head injury?
After being diagnosed with tinnitus, an ear, nose and throat doctor (otolaryngologist) might need to be consulted. A hearing expert (audiologist) might also be required to work with