Ringing in the Ears

Definition

Tinnitus is the perception of abnormal ear or head noises. Tinnitus is unpleasant enough itself. It is also sometimes a symptom of other problems, including hearing loss, tumors, and narrowing of the blood vessels.

Noises may be high pitched and “ringing,” or sound more like a clicking. Some tinnitus is pulsatile. This means that it may be caused by the flow of blood that accompanies each heartbeat. This type of tinnitus is a result of the narrowing of the blood vessels.

The Ear

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Causes

Many diseases and conditions are associated with tinnitus, including:

• Hearing loss, the most frequent cause of persistent tinnitus
• Exposure to loud noises
• Wax or a foreign body in the ear canal
• Temporomandibular joint (TMJ) disorder
• Ear infection
• Fluid in the ear
• Stroke
• Certain medicines (see below)
• Allergies
• Ruptured membrane in the ear
• Meniere's disease
• High or low blood pressure
• Injury to the head or neck
• Tumors
• Blood vessel disorders, such as an aneurysm or hardening of the arteries
• Diabetes
• Thyroid problems

Occasional episodes of tinnitus lasting at most a few minutes are quite common in normal people, especially after exposure to loud noises.

Risk Factors

Your risk of tinnitus increases with:

• Exposure to loud noises
• Depression
• Stress
• Fatigue
• Anxiety
•   Certain medicines:
  • Aspirin
  • Quinine and its derivatives
  • Some antibiotics (aminoglycosides)
  • Some diuretics (water pills)
• Toxins:
  • Heavy metals
  • Carbon monoxide
  • Alcohol

Symptoms

The sensations of tinnitus may have the following characteristics:

• Ringing, roaring, buzzing, whistling, or hissing sounds
• Intermittent, continuous, or pulsatile quality
• Same or varying intensity
• Single or multiple tones
• Ringing that comes and goes
• More annoying symptoms at night or when there are fewer distractions
• Sensation of normal internal events, such as blood pulsing or muscles contracting

Sometimes tinnitus is accompanied by hearing loss and vertigo.

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. Special attention will be paid to your head, neck, and ears.

You will be asked questions about:

• The sensations that you have
• The factors that may increase or decrease the sensation (eg, breathing, dizziness)
• The medicines that you take

The doctor will look at your ear canal and eardrum using an instrument with a light that is held at the external opening of the ear. A tuning fork can help evaluate hearing. You should receive a complete hearing test. Other tests, such as a magnetic resonance imaging (MRI) scan, may be ordered to rule out serious conditions.

Treatment

Tinnitus treatment depends on what is causing the symptoms. This may mean, for example:

• Wearing a specially made splint to help manage temporomandibular joint disorder
• Taking antibiotics for a sinus or ear infection
• Having the wax removed from your ear canal

Therapy aims to eliminate or reduce bothersome sensations. Treatment may include:

Prevention

You may be able to prevent tinnitus from developing with a few simple measures:

• Avoid exposure to excessive noise.
• Wear earplugs in noisy situations.
• Wear earmuffs when mowing the grass.
• Learn and practice stress management and relaxation techniques.
• Limit use of drugs that damage hearing.