Tinnitus

Definition

Tinnitus (TIN-i-tus) is 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.

Symptoms

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

• Buzzing
• Roaring
• Clicking
• Whistling
• 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.
• 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, an inner ear bone condition or muscle contractions.

When to see a doctor
If you have tinnitus that bothers you, see your doctor.

• Make an appointment to see your doctor if you develop tinnitus after an upper respiratory infection, such as a cold, and your tinnitus doesn't improve within a week.
• See your doctor as soon as possible if you have tinnitus that occurs suddenly or without an apparent cause, or if you have hearing loss or dizziness with the tinnitus.                        

• 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 cell damage. Tiny, delicate hairs in your inner ear move in relation to the pressure of sound waves. This triggers ear 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 your auditory nerves 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; 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 (cerumenal impaction), 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, runs in families.
  Other causes of tinnitus
  Some causes of tinnitus are less common. These include:
  • Meniere's disease. Doctors think this inner ear disorder is caused by abnormal inner ear fluid pressure or composition.
  • Stress and depression. These conditions are commonly associated with tinnitus and seem to aggravate it.
  • TMJ disorders. Problems with the temperomandibular 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. These neurological disorders can affect the inner ear, hearing nerves or brain function linked to hearing. Head or neck 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:
  • Head and neck tumors. A tumor that presses on blood vessels in your head or neck (vascular neoplasm) can cause tinnitus and other symptoms.
  • 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 and sometimes more turbulent, making it easier for your ear to detect the beats. You can generally hear this type of tinnitus in both ears.
  • 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 blood flow, leading to tinnitus.
  • Malformation of capillaries. A condition called arteriovenous malformation (AVM), which occurs in the 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 medication, 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 chloramphenicol, erythromycin, gentamicin, vancomycin and bleomycin
  • Cancer medications, including mechlorethamine and vincristine
  • Diuretics — water pills — such as bumetanide, ethacrynic acid, furosemide
  • Quinine medications used for malaria or other health conditions
  • Chloroquine, a malaria medication
  • Aspirin taken in uncommonly high doses (12 or more a day)

  • Risk factors

    
    You've been exposed to loud noise without ear protection, especially on an ongoing basis.Anyone can get tinnitus, but you might be at increased risk if:
    • You're over age 65.
    • You have age-related hearing loss.
    • You're a man.
    • You're Caucasian.
    • You have post-traumatic stress disorder (PTSD). Tinnitus is especially aggravated by loud noises in people with PTSD.

    • Complications

      
      FatigueTinnitus can significantly affect quality of life. Although it affects people differently, if you have tinnitus, you also may experience:
      • Stress
      • Sleep problems
      • Trouble concentrating
      • Memory problems
      • Depression
      • Anxiety and irritability
      Treating these linked conditions may not affect tinnitus directly, but it can help you feel better.

      Tests and diagnosis

      By Mayo Clinic staff
      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 around your ear can cause sharp clicking sounds you hear in bursts. They may last from several seconds to a few minutes.
      • Heartbeat. Blood vessel problems, such as high blood pressure, an aneurysm or a tumor 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 a vertigo attack — 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

      Treatments and drugs

      
      Earwax removal. Removing impacted earwax can decrease tinnitus symptoms.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:
      • 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.
      • Hearing aids. These can be especially helpful if you have hearing problems as well as tinnitus.
      • Masking devices. Worn in the ear, 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 also can become habit-forming.

      • Prevention

        
        Use hearing protection. Over time, exposure to loud noise 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.In many cases, tinnitus is the result of something that can't be prevented. However, some precautions can help prevent certain kinds of tinnitus.
        • Turn down the volume. Long-term exposure to amplified music with no ear protection or listening to music at very high volume though 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.