Tinnitus is the medical term for ringing in the ears, a symptom caused by a variety of different conditions. It is usually subjective in nature, which means that only you can perceive it. While the sensation is commonly referred to as "ringing," the perceived noise can take a number of different forms; you may perceive a buzzing, clicking, roaring, or hissing sound.

The noise may be a pulsatile sound, that is, one with a distinct rhythm similar to the beating of your heart. Tinnitus may be present in either ear or both ears. It may be constant, meaning that it is present all the time, or it may be intermittent, meaning that it comes and goes. Tinnitus is often, though not always, associated with hearing loss.

As a symptom, tinnitus is usually not indicative of a serious medical condition. However, the ringing or perceived noise can range from mild to severe. At best, tinnitus can be a mild annoyance that people can learn to live with; at worst, it can negatively affect a person's quality of life.

Some cases of tinnitus are temporary while other cases are chronic, which means that they occur over a long period of time. While there is no cure for tinnitus, there are a number of treatments that can be effective. The first step in treating tinnitus is to determine what is causing it.

You must first undergo a workup by your doctor, who will attempt to diagnose the cause of your tinnitus by asking you questions about your symptoms and performing a physical examination, with particular focus on the ears. Diagnostic hearing tests and imaging procedures, such as an MRI or CT, may also be necessary. 

If your doctor is unable to make a diagnosis, he or she may refer you to an otologist, who specializes in treating the ears, or an audiologist, who specializes in hearing.


Causes of Tinnitus

Tinnitus is a secondary complaint, which means that it is caused by another primary condition. These conditions are varied and can include nerve damage, earwax buildup, blood vessel dysfunction, abnormal growths, or ear-related disorders such as otosclerosis, Meniere's disease, or TMJ disorder. Tinnitus also can occur as a side effect of certain medications.

Sensorineural Dysfunction

The most common cause of tinnitus is sensorineural dysfunction; that is, damage to the nerves inside your ears that transmit hearing signals to your brain. In order to understand sensorineural dysfunction, you must first understand how your ears work.

The cochlea is the shell-like organ inside your inner ear that is responsible for hearing. Your cochlea is lined with thousands of tiny hairs called cilia. The cilia are attached to nerve cells that connect the ear to the brain. When sound waves enter the ear, the cilia move. The movement of the cilia stimulates the nerves that they are attached to, and the nerves then send a signal to the brain, which interprets the signal as sound.

The cilia of the cochlea are extremely delicate. Exposure to loud noise can damage the cilia and the nerves that are attached to them. When the cilia are damaged, they do not function correctly; abnormal movement of the cilia in the absence of external sound waves may result in tinnitus.

If the exposure to loud noise is short-term, the damage to the cilia that causes tinnitus is usually (though not always) temporary.

For example, if you attend a loud concert one night, you may experience ringing in your ears the next morning, but it will usually resolve itself within a few days' time. However, long-term exposure to loud noises can damage the cilia permanently. 

Cilia do not regenerate, so there is no way to reverse this kind of damage. For this reason, people who perform jobs in which they are frequently exposed to loud noises, such as construction workers, musicians, and military service members, are recommended to protect their ears with devices such as earplugs or noise-cancelling helmets in order to prevent hearing damage from occuring in the first place.

Another common cause of sensorineural damage that can result in tinnitus is age-related hearing loss, also known as "presbycusis," from the Greek words "presbys" meaning "old," and "akousis," meaning "hearing." Even if you are careful to limit your exposure to loud noises, the cilia in your inner ear can break down over time, causing hearing loss that also may be associated with tinnitus.


Severe Earwax Buildup

ear problem

The purpose of earwax is to trap dirt and bacteria within the ear canal and prevent these foreign particles from entering the middle and inner ear, where they can cause infection. However, sometimes an excess of earwax builds up inside the ear canal. When this happens, it can result in hearing loss by preventing sound waves from entering the inner ear. The eardrum, also known as the tympanic membrane, can be irritated by the accumulation of earwax, and tinnitus can result from the irritation.

Blood Vessel Disorders

If your tinnitus is pulsatile, meaning that it follows a distinct pattern or rhythm, it may be the result of a blood vessel disorder. The rhythm of the tinnitus can be correlated with the beating of your heart because that's actually what it is; your heartbeat is being amplified into the inner chambers of your ears.

Pulsatile tinnitus can be caused by conditions such as high blood pressure, atherosclerosis (also known as hardening of the arteries), kinking of an artery or vein in the neck that results in turbulent blood flow, or malformation of capillaries. While pulsatile tinnitus is rare, it may be objective, which means that your doctor will be able to hear it too while conducting an ear exam.


Side Effects of Medication

Tinnitus

Some medications can cause tinnitus as a side effect. Medications that can cause tinnitus include high-dose aspirin, antibiotics, cancer medications, and diuretics (medications that reduce the buildup of fluid in bodily tissues).

This type of tinnitus typically resolves itself if you stop taking the medication, but you should never discontinue a prescription medication without consulting with your doctor first. If your tinnitus is occuring as a side effect of medication, your doctor will either discontinue the medication and prescribe something else or adjust the dosage of your medication to reduce the unwanted side effect.

Other Ear-Related Conditions

There are other conditions specifically related to the ear that may result in tinnitus: acoustic neuroma, a benign tumor that grows on the cranial nerve that connects your inner ear to your brain; otosclerosis, a hardening or stiffening of your middle ear bones; and Meniere's disease, a condition caused by abnormal fluid pressure of the inner ear.

Another possible cause of tinnitus is TMJ syndrome, an irritation of the joint where your lower jaw connects to your skull. Because this joint (the temporomandibular joint, or TMJ) is located right in front of your ear on either side of your head, your ears can be affected by the inflammation of the joint.

Ear check up


Common Tinnitus Treatments

Once the cause of your tinnitus is determined, the treating physician will formulate a treatment plan. When tinnitus is caused by another disorder, such as Meniere's or TMJ syndrome, the primary condition is treated first. If the tinnitus does not resolve, other avenues of treatment are then explored to target the tinnitus specifically.

In rare cases, as when the tinnitus is caused by an abnormal growth, such as a tumor or a calcium deposit on the ear bone as occurs in otosclerosis, a surgical procedure may be deemed necessary. However, most treatment options for tinnitus are nonsurgical in nature.

In cases where the tinnitus is caused by an irritant, such as excess earwax, removal of the irritant typically resolves the symptoms. In the case of earwax buildup, this typically means flushing the ear with warm water or suctioning the earwax away with an instrument called a curette.

If the tinnitus occurs in association with hearing loss, the use of hearing aids may lessen the severity of tinnitus, as tinnitus typically worsens in the absence of exterior noises. 

Tinnitus that occurs in the absence of hearing loss will not improve with the use of hearing aids. However, there is a similar treatment modality that can be used by tinnitus sufferers called a noise-suppressing or masking device. 

Like a hearing aid, it is worn inside the ear canal, but instead of amplifying external sounds, it creates an alternate sound to counteract the effect of the ringing noise. If you do not want to wear a device in your ear, or if the cost is prohibitive, you can use a white noise machine to create a low-level of background noise throughout the entire room, which may be particularly helpful in your bedroom at night if your tinnitus prevents you from falling asleep easily.

Other treatment modalities include cognitive and behavioral therapy, stress relief techniques such as meditation, and alternative treatments like acupuncture. While there is no medication to treat tinnitus, antidepressants or anti anxiety medications can lessen the psychological effects of having constant ringing in the ears.

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