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Tinnitus

What is Tinnitus?

Tinnitus is a ringing, swishing, or other type of noise that seems to originate in the ear or head. In many cases, it is not a serious problem, but rather a nuisance that eventually resolves. Tinnitus is caused by problems in the 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). Nearly 36 million Americans suffer from this disorder. In almost all cases, only the patient can hear the noise.

What Causes Tinnitus?

Tinnitus can arise in any of the following areas: the outer ear, the middle ear, the inner ear, or by abnormalities in the brain. Some tinnitus or head noise is normal. If you go into a sound-proof booth and normal outside noise is diminished, you will become aware of these normal sounds. We are usually not aware of these normal body sounds because outside noise masks them. Anything that blocks these background sounds will cause us to be more aware of our own head sounds. Fluid, infection, or disease in the middle ear bones or ear drum (tympanic membrane) can also cause tinnitus.

One of the most common causes of tinnitus is damage to the microscopic endings of the hearing nerve in the inner ear. Advancing age is generally accompanied by a certain amount of hearing nerve impairment, and consequently, tinnitus. Today, loud noise exposure is a very common cause of tinnitus and it often damages hearing as well. Unfortunately, many people are unconcerned about the harmful effects of excessively loud noise, firearms, and high-intensity music. Some medications (for example, aspirin) and other diseases of the inner ear (Meniere’s syndrome) can cause tinnitus. Tinnitus can in very rare situations be a symptom of such serious problems as an aneurysm or a brain tumor (acoustic tumor).

How is Tinnitus Evaluated?

A medical history, physical examination, and a series of special tests can help determine precisely where the tinnitus is originating. It is helpful for the doctor to know if the tinnitus is constant, intermittent, or pulsating (synchronous with the heartbeat), or if it’s associated with hearing loss or loss of balance (vertigo). All patients with persisting unexplained tinnitus need a hearing test (audiogram). Patterns of hearing loss may lead the doctor to the diagnosis.

Other tests, such as the auditory brain stem response (ABR), a computerized test of the hearing nerves and brain pathways, computer tomography scan (CT scan) or, magnetic resonance imaging (MRI scan) may be needed to rule out a tumor occurring on the hearing or balance nerve. These tumors are rare, but they can cause tinnitus.

What is the Treatment of Tinnitus?

After a careful evaluation, your doctor may find an identifiable cause and be able to treat or make recommendations to treat the tinnitus. Once you have had a thorough medical and audiological evaluation, an essential part of treatment is your own understanding of the tinnitus (what has caused it, and your options for treatment).

In many cases, there is no specific treatment for tinnitus. It may simply go away on its own, or it may be a permanent disability that patients learn to “live with.”

Is There Anything to Do to Lessen Intensity of the Tinnitus?

It is important to realize that the hearing system is one of the most delicate and sensitive mechanisms in the body. Since it is a part of the general nervous system, it is sensitive, to some degree, by anything that affects the overall health of the individual (both physical and psychological). Therefore, in order to lessen the intensity of tinnitus, it is advisable to make every effort to:

  • Avoid exposure to loud sounds and noises
  • Control blood pressure
  • Decrease salt intake
  • Avoid nerve stimulants such as coffee, colas (caffeine), and tobacco (nicotine)
  • Reduce anxiety
  • Stop worrying about the tinnitus. Often, the more you worry and concentrate on the noise, the louder it will become
  • Get adequate rest and avoid fatigue
  • Exercise
  • Utilize masking noise. Tinnitus is usually more bothersome when the surroundings are quiet, especially when you are in bed. A competing sound such as a ticking clock, a radio, fan, or white noise machine may help mask tinnitus. Some hearing aid-like devices which generate a competitive sound may help reduce awareness of the tinnitus.
  • Biofeedback may help or diminish tinnitus in some patients
  • Avoid aspirin or aspirin products in large quantities

Tinnitus at a Glance

  • Tinnitus is abnormal ear noise
  • Tinnitus can arise in any of the four sections of the ear:
    • outer ear
    • middle ear
    • inner ear
    • brain
  • Persisting unexplained tinnitus is evaluated with a hearing test (audiogram)
  • Measures can be taken to lessen the intensity of tinnitus