TINNITUS

Definition
Tinnitus is the perception of noise or ringing in the ears. A common problem,
tinnitus affects about 1 in 5 people. Tinnitus isn't a condition itself, it's a symptom of an
underlying condition, such as age-related hearing loss, ear injury or a circulatory system
disorder.
The noise can be intermittent or continuous, and can vary in loudness. It is often
worse when background noise is low, so you may be most aware of it at night when
you're trying to fall asleep in a quiet room. In rare cases, the sound beats in sync with
your heart (pulsatile tinnitus).
Although bothersome, tinnitus usually isn't a sign of something serious. Although
it can worsen with age, for many people, tinnitus can improve with treatment. Treating
an identified underlying cause sometimes helps. Other treatments reduce or mask the
noise, making tinnitus less noticeable.

Symptoms
Tinnitus involves the annoying sensation of hearing sound when no external sound is
present. Tinnitus symptoms include these types of phantom noises in your ears:

Ringing

Buzzing

Roaring

Clicking

Hissing

The phantom noise may vary in pitch from a low roar to a high squeal, and you may
hear it in one or both ears. In some cases, the sound can be so loud it can interfere with
your ability to concentrate or hear actual sound. Tinnitus may be present all the time, or
it may come and go.
There are two kinds of tinnitus.

Subjective tinnitus is tinnitus only you can hear. This is the most common type
of tinnitus. It can be caused by ear problems in your outer, middle or inner ear. It
also can be caused by problems with the hearing (auditory) nerves or the part of
your brain that interprets nerve signals as sound (auditory pathways).

Objective tinnitus is tinnitus your doctor can hear when he or she does an
examination. This rare type of tinnitus may be caused by a blood vessel problem, a
middle ear bone condition or muscle contractions.

Common causes of tinnitus

In many people, tinnitus is caused by one of these conditions:

Age-related hearing loss. For many people, hearing worsens with age, usually
starting around age 60. Hearing loss can cause tinnitus. The medical term for this
type of hearing loss is presbycusis.

Exposure to loud noise. Loud noises, such as those from heavy equipment,
chain saws and firearms, are common sources of noise-related hearing loss.
Portable music devices, such as MP3 players or iPods, also can cause noiserelated hearing loss if played loudly for long periods. Tinnitus caused by short-term
exposure, such as attending a loud concert, usually goes away; long-term
exposure to loud sound can cause permanent damage.

Earwax blockage. Earwax protects your ear canal by trapping dirt and slowing
the growth of bacteria. When too much earwax accumulates, it becomes too hard
to wash away naturally, causing hearing loss or irritation of the eardrum, which can
lead to tinnitus.

Ear bone changes. Stiffening of the bones in your middle ear (otosclerosis) may
affect your hearing and cause tinnitus. This condition, caused by abnormal bone
growth, tends to run in families.

Other causes of tinnitus

Some causes of tinnitus are less common, including:

Meniere's disease. Tinnitus can be an early indicator of Meniere's disease, an

inner ear disorder that may be caused by abnormal inner ear fluid pressure.

TMJ disorders. Problems with the temporomandibular joint, the joint on each
side of your head in front of your ears, where your lower jawbone meets your skull,
can cause tinnitus.

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 develops on the cranial

nerve that runs from your brain to your inner ear and controls balance and hearing.
Also called vestibular schwannoma, this condition generally causes tinnitus in only
one ear.

Blood vessel disorders linked to tinnitus

In rare cases, tinnitus is caused by a blood vessel disorder. This type of tinnitus is called
pulsatile tinnitus. Causes include:

Atherosclerosis. With age and buildup of cholesterol and other deposits, major
blood vessels close to your middle and inner ear lose some of their elasticity the
ability to flex or expand slightly with each heartbeat. That causes blood flow to
become more forceful, making it easier for your ear to detect the beats. You can
generally hear this type of tinnitus in both ears.

Head and neck tumors. A tumor that presses on blood vessels in your head or
neck (vascular neoplasm) can cause tinnitus and other symptoms.

High blood pressure. Hypertension and factors that increase blood pressure,
such as stress, alcohol and caffeine, can make tinnitus more noticeable.

Turbulent blood flow. Narrowing or kinking in a neck artery (carotid artery) or

vein in your neck (jugular vein) can cause turbulent, irregular blood flow, leading to
tinnitus.

Malformation of capillaries. A condition called arteriovenous malformation

(AVM), abnormal connections between arteries and veins, can result in tinnitus.
This type of tinnitus generally occurs in only one ear.

Medications that can cause tinnitus

A number of medications may cause or worsen tinnitus. Generally, the higher the dose
of these medications, the worse tinnitus becomes. Often the unwanted noise disappears
when you stop using these drugs. Medications known to cause or worsen tinnitus
include:

Antibiotics, including polymyxin B, erythromycin, vancomycin and neomycin

Cancer medications, including mechlorethamine and vincristine

Water pills (diuretics), such as bumetanide, ethacrynic acid or furosemide

Quinine medications used for malaria or other health conditions

Certain antidepressants may worsen tinnitus

Aspirin taken in uncommonly high doses (usually 12 or more a day)

Risk factors
Anyone can experience tinnitus, but these factors may increase your risk:

Loud noise exposure. Prolonged exposure to loud noise can damage the tiny
sensory hair cells in your ear that transmit sound to your brain. People who work in
noisy environments such as factory and construction workers, musicians, and
soldiers are particularly at risk.

Age. As you age, the number of functioning nerve fibers in your ears declines,
possibly causing hearing problems often associated with tinnitus.

Gender. Men are more likely to experience tinnitus.

Smoking. Smokers have a higher risk of developing tinnitus.

Cardiovascular problems. Conditions that affect your blood flow, such as high
blood pressure or narrowed arteries (atherosclerosis), can increase your risk of
tinnitus.

Complications
Tinnitus can significantly affect quality of life. Although it affects people differently, if you
have tinnitus, you also may experience:

Fatigue

Stress

Sleep problems

Trouble concentrating

Memory problems

Depression

Anxiety and irritability

Diagnosis

Hearing (audiological) exam. As part of the test, you'll sit in a soundproof room
wearing earphones through which will be played specific sounds into one ear at a
time. You'll indicate when you can hear the sound, and your results are compared
with results considered normal for your age. This can help rule out or identify
possible causes of tinnitus.

Movement. Your doctor may ask you to move your eyes, clench your jaw, or
move your neck, arms and legs. If your tinnitus changes or worsens, it may help
identify an underlying disorder that needs treatment.

Imaging tests. Depending on the suspected cause of your tinnitus, you may
need imaging tests such as CT or MRI scans.

The sounds you hear can help your doctor identify a possible underlying cause.

Clicking. Muscle contractions in and around your ear can cause sharp clicking
sounds that you hear in bursts. They may last from several seconds to a few
minutes.

Rushing or humming. Usually vascular in origin, you may notice sound

fluctuations when you exercise or change positions, such as when you lie down or
stand up.

Heartbeat. Blood vessel problems, such as high blood pressure, an aneurysm or

a tumor, and blockage of the ear canal or eustachian tube can amplify the sound of
your heartbeat in your 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. Exposure to a very loud noise or a blow to the ear can
cause a high-pitched ringing or buzzing that usually goes away after a few hours.
However, if there's hearing loss as well, tinnitus may be permanent. Long-term
noise exposure, age-related hearing loss or medications can cause a continuous,
high-pitched ringing in both ears. Acoustic neuroma can cause continuous, highpitched ringing in one ear.

Other sounds. Stiff inner ear bones (otosclerosis) can cause low-pitched tinnitus
that may be continuous or may come and go. Earwax, foreign bodies or hairs in
the ear canal can rub against the eardrum, causing a variety of sounds.

In many cases, the cause of tinnitus is never found. Your doctor can discuss with you
steps you can take to reduce the severity of your tinnitus or to help you cope better with
the noise.
Treating an underlying health condition
To treat your tinnitus, your doctor will first try to identify any underlying, treatable
condition that may be associated with your symptoms. If tinnitus is due to a health

condition, your doctor may be able to take steps that could reduce the noise. Examples
include:

Earwax removal. Removing impacted earwax can decrease tinnitus symptoms.

Treating a blood vessel condition. Underlying vascular conditions may require

medication, surgery or another treatment to address the problem.

Changing your medication. If a medication you're taking appears to be the

cause of tinnitus, your doctor may recommend stopping or reducing the drug, or
switching to a different medication.

Noise suppression
In some cases white noise may help suppress the sound so that it's less bothersome.
Your doctor may suggest using an electronic device to suppress the noise. Devices
include:

White noise machines. These devices, which produce simulated environmental

sounds such as falling rain or ocean waves, are often an effective treatment for
tinnitus. You may want to try a white noise machine with pillow speakers to help
you sleep. Fans, humidifiers, dehumidifiers and air conditioners in the bedroom
also may help cover the internal noise at night.

Hearing aids. These can be especially helpful if you have hearing problems as
well as tinnitus.

Masking devices. Worn in the ear and similar to hearing aids, these devices
produce a continuous, low-level white noise that suppresses tinnitus symptoms.

Tinnitus retraining. A wearable device delivers individually programmed tonal

music to mask the specific frequencies of the tinnitus you experience. 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.

Medications
Drugs can't cure tinnitus, but in some cases they may help reduce the severity of
symptoms or complications. Possible medications include:

Tricyclic antidepressants, such as amitriptyline and nortriptyline, have been

used with some success. However, these medications are generally used for only
severe tinnitus, as they can cause troublesome side effects, including dry mouth,
blurred vision, constipation and heart problems.

Alprazolam (Niravam, Xanax) may help reduce tinnitus symptoms, but side
effects can include drowsiness and nausea. It can also become habit-forming.

Alternative medicine
There's little evidence that alternative medicine treatments work for tinnitus. However,
some alternative therapies that have been tried for tinnitus include:

Acupuncture

Hypnosis

Ginkgo biloba

Zinc supplements

B vitamins

Neuromodulation using transcranial magnetic stimulation (TMS) is a painless,

noninvasive therapy that has been successful in reducing tinnitus symptoms for some
people. Currently, TMS is utilized more commonly in Europe and in some trials in the
U.S. It is still to be determined which patients might benefit from such treatments.