Overview

Tinnitus is the perception of noise or ringing in the ears. A common problem, tinnitus
affects about 15 to 20 percent of 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.

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

 Ringing
 Buzzing
 Roaring
 Clicking
 Hissing
 Humming

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 external 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 can also 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.

Causes

A number of health conditions can cause or worsen tinnitus. In many cases, an exact
cause is never found.

A common cause of tinnitus is inner ear hair cell damage. Tiny, delicate hairs in your
inner ear move in relation to the pressure of sound waves. This triggers cells to release
an electrical signal through a nerve from your ear (auditory nerve) to your brain. Your
brain interprets these signals as sound. If the hairs inside your inner ear are bent or
broken, they can "leak" random electrical impulses to your brain, causing tinnitus.

Other causes of tinnitus include other ear problems, chronic health conditions, and
injuries or conditions that affect the nerves in your ear or the hearing center in your
brain.

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 noise-
related hearing loss if played loudly for long periods. Tinnitus caused by
short-term exposure, such as attending a loud concert, usually goes away; both
short- and 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.
 Eustachian tube dysfunction. In this condition, the tube in your ear
connecting the middle ear to your upper throat remains expanded all the time,
which can make your ear feel full. Loss of a significant amount of weight,
pregnancy and radiation therapy can sometimes cause this type of dysfunction.
 Muscle spasms in the inner ear. Muscles in the inner ear can tense up
(spasm), which can result in tinnitus, hearing loss and a feeling of fullness in
 the ear. This sometimes happens for no explainable reason, but can also be
caused by neurologic diseases, including multiple sclerosis.

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 (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 medications used for malaria or other health conditions
 Certain antidepressants, which may worsen tinnitus
 Aspirin taken in uncommonly high doses (usually 12 or more a day)

In addition, some herbal supplements can cause tinnitus, as can nicotine and caffeine.

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.
 Sex. 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 may also experience:

 Fatigue
 Stress
 Sleep problems
 Trouble concentrating
 Memory problems
 Depression
 Anxiety and irritability

Prevention

In many cases, tinnitus is the result of something that can't be prevented. However,
some precautions can help prevent certain kinds of tinnitus.

 Use hearing protection. Over time, exposure to loud sounds can damage the
nerves in the ears, causing hearing loss and tinnitus. If you use chain saws, are
a musician, work in an industry that uses loud machinery or use firearms
(especially pistols or shotguns), always wear over-the-ear hearing protection.
 Turn down the volume. Long-term exposure to amplified music with no ear
protection or listening to music at very high volume through headphones can
cause hearing loss and tinnitus.
 Take care of your cardiovascular health. Regular exercise, eating right and
taking other steps to keep your blood vessels healthy can help prevent tinnitus
linked to blood vessel disorders.

Diagnosis
Your doctor will examine your ears, head and neck to look for possible causes of
tinnitus. Tests include:

 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. These sound fluctuations are usually vascular in
origin, and you may notice them 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, high-pitched 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.

Treatment

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 the following:

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

Lifestyle and home remedies

Often, tinnitus can't be treated. Some people, however, get used to it and notice it less
than they did at first. For many people, certain adjustments make the symptoms less
bothersome. These tips may help:

 Avoid possible irritants. Reduce your exposure to things that may make your
tinnitus worse. Common examples include loud noises, caffeine and nicotine.
  Cover up the noise. In a quiet setting, a fan, soft music or low-volume radio
static may help mask the noise from tinnitus.
 Manage stress. Stress can make tinnitus worse. Stress management, whether
through relaxation therapy, biofeedback or exercise, may provide some relief.
 Reduce your alcohol consumption. Alcohol increases the force of your blood
by dilating your blood vessels, causing greater blood flow, especially in the
inner ear area.

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
 Melatonin
 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 used 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.

Coping and support

Tinnitus doesn't always improve or completely go away with treatment. Here are
some suggestions to help you cope:

 Counseling. A licensed therapist or psychologist can help you learn coping

techniques to make tinnitus symptoms less bothersome. Counseling can also
help with other problems often linked to tinnitus, including anxiety and
depression.
 Support groups. Sharing your experience with others who have tinnitus may
be helpful. There are tinnitus groups that meet in person, as well as internet
forums. To ensure that the information you get in the group is accurate, it's
best to choose a group facilitated by a physician, audiologist or other qualified
health professional.
 Education. Learning as much as you can about tinnitus and ways to alleviate
symptoms can help. And just understanding tinnitus better makes it less
bothersome for some people.

Reference:
Mayo clinic on hearing and balance by Dr.David A. Zapala