Tinnitus

Overview

Tinnitus (TIN-ih-tus or tih-NIE-tus) is when you experience ringing or other noises in one or both of your ears. The noise you hear when you have tinnitus isn't caused by a sound that comes from outside your ear. Usually, other people can't hear the sound. Tinnitus is common. It affects about 15% to 30% of people and is more common in older adults.

Tinnitus is usually caused by another condition, such as age-related hearing loss, an ear injury or an issue with the blood vessels. For many people, tinnitus gets better after treating the condition that is causing it. There are also treatments that lessen or mask the noise, making tinnitus less noticeable.

Causes

Tinnitus is a symptom of more than 200 different health conditions, not a disease itself. These other health conditions can cause or worsen tinnitus. In many cases, healthcare professionals can't find an exact cause.

Common causes of tinnitus

The most common causes of tinnitus can be broken down into four different types. These are:

• Conditions related to hearing loss. There are small, fragile hair cells in the inner ear, called the cochlea, that move when sound waves enter the ear. This movement triggers electrical signals along the nerve from the ear to the brain, called the auditory nerve. The brain interprets these signals as sound.

  Age or regular exposure to loud sounds can bend or break the hairs inside the inner ear. Once bent or broken, they can then "leak" random electrical impulses to the brain, causing tinnitus. About 9 of 10 people with tinnitus have some hearing loss caused by noise.

• Medicines harmful to the ear. Some medicines may cause or worsen tinnitus. Generally, the higher the dose of these medicines, the worse tinnitus becomes. Usually medicines will cause tinnitus in both ears. Often the unwanted noise goes away when you stop using these medicines.

  Medicines and substances known to cause or worsen tinnitus include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Some antibiotics.
  • Cancer medicines.
  • Water pills, called diuretics.
  • Medicines used to treat malaria.
  • Some antidepressants.
  • Marijuana.
  • Tobacco.
  • Some herbal supplements.

• Conditions related to ear structure and function. Some examples of these types of conditions include:

  • Ear infections. These are infections typically caused by bacteria or viruses that infect the middle ear, often following a cold, flu or allergies.
  • Ear canal blockage. A blockage of wax, dirt or other foreign materials can change the pressure in the ear, causing tinnitus.
  • Problems with the eustachian tube. The eustachian (u-STAY-shun) tube connects the middle of the ear to the back of the throat. Sometimes losing large amounts of body weight or having radiation treatment near the nose and throat can cause the eustachian tube to not work correctly.
  • Conditions that affect the temporomandibular joint (TMJ). There is a temporomandibular (tem-puh-roe-man-DIB-u-lur) joint on both sides of the head in front of the ears, where the lower jawbone meets the skull. Issues with the TMJ can cause tinnitus.
  • Changes to ear bones. Stiffening of the bones in the middle ear, called otosclerosis, may affect hearing and cause tinnitus, either in one or both ears. This condition, caused by unusual bone growth, tends to run in families.
  • Muscle spasms in the inner ear. Muscles in the inner ear can tense up or spasm, sometimes causing tinnitus, hearing loss and a feeling of fullness in the ear. This sometimes happens for no clear reason, but it can be caused by brain and nervous system diseases such as multiple sclerosis.

• Conditions related to blood vessels. Blood flow changes can cause tinnitus or make it louder. One type of tinnitus, called pulsatile tinnitus, is usually caused by conditions related to blood vessels, also called vascular conditions.

  Some of the vascular conditions that can lead to or affect tinnitus are the buildup of fats, cholesterol and other substances in artery walls, called atherosclerosis, high blood pressure, and kinked or malformed blood vessels.

Other causes of tinnitus

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

• Meniere's disease. Tinnitus can be an early sign of Meniere's disease, an inner ear condition that may be caused by inner ear fluid pressure.
• Head or neck injuries. Head or neck trauma can affect the inner ear, hearing nerves or brain function linked to hearing. Such injuries usually cause tinnitus in only one ear.
• Migraines. A type of migraine headache called vestibular migraine, can cause dizziness, a loss of balance called vertigo, and tinnitus.
• Acoustic neuroma or other head and neck tumors. Acoustic neuroma is a noncancerous, also called benign, tumor. It grows on the cranial nerve that runs from the brain to the inner ear and affects balance and hearing. Other head, neck or brain tumors also can cause tinnitus.
• Other chronic conditions. Conditions such as diabetes, thyroid conditions, migraines, anemia, and autoimmune conditions such as rheumatoid arthritis and lupus have all been connected with tinnitus.

Complications

Tinnitus affects people differently. For some people, tinnitus has a big impact on their quality of life. If you have tinnitus, you also may have:

• Fatigue.
• Stress.
• Sleep difficulties.
• Trouble focusing.
• Memory issues.
• Depression.
• Anxiety and irritability.
• Headaches.
• Problems with work and family life.

Treating these linked conditions may not affect tinnitus directly, but it can help you feel better.

Diagnosis

Your healthcare professional will typically diagnose you with tinnitus based on your symptoms alone. But to treat your symptoms, your health professional will try to find whether your tinnitus is caused by another condition. Sometimes a cause can't be found.

To help find the cause of your tinnitus, your healthcare professional will likely ask you about your medical history and check your ears, head and neck. Common tests include:

• Hearing or audiological exam. During the test, you'll sit in a soundproof room wearing earphones that send specific sounds into one ear at a time. You'll show when you can hear the sound, and your results will be compared with results considered typical for your age. This can help rule out or find possible causes of tinnitus.
• Movement. Your healthcare professional 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 find another condition that needs treatment.
• Imaging tests. Depending on the suspected cause of your tinnitus, you may need imaging tests such as CT or MRI scans. A computerized tomography (CT) scan is a type of imaging that uses X-ray techniques to make more detailed images of the body. Magnetic resonance imaging (MRI) is a medical imaging technique that uses a magnetic field and computer-generated radio waves to make detailed 3D images of the organs and tissues in the body.
• Lab tests. Your health professional may draw blood to check for anemia, thyroid conditions, heart disease or vitamins that the body does not have enough of.

Do your best to describe for your healthcare professional what kind of tinnitus noises you hear. The sounds you hear can help your healthcare professional find a possible cause.

• Clicking. This type of sound suggests that muscle contractions in and around your ear might be the cause of your tinnitus.
• Pulsing, rushing or humming. These sounds usually stem from blood vessel causes, also known as vascular conditions, such as high blood pressure. You may notice the sounds when you exercise or change positions, such as when you lie down or stand up.
• Low-pitched ringing. This type of sound may point to ear canal blockages, Meniere's disease or stiff inner ear bones, called otosclerosis.
• High-pitched ringing. This is the most common tinnitus sound. Likely causes include loud noise exposure, hearing loss or medicines. Acoustic neuroma can cause continuous, high-pitched ringing in one ear.

Lifestyle and home remedies

Sometimes treatments for tinnitus don't work well or several treatments are needed. Sometimes people get used to tinnitus. For many people, making some lifestyle changes helps to make tinnitus symptoms less bothersome. These tips may help:

• Use hearing protection. Over time, exposure to loud sounds damages the nerves in the ears, causing hearing loss and tinnitus. To keep your tinnitus from getting worse, take steps to protect your hearing. If you use chain saws, are a musician, work in an industry that uses loud machinery, or use firearms such as pistols or shotguns, always wear over-the-ear hearing protection.
• Turn down the volume. Listening to music at very high volume through headphones can cause hearing loss and tinnitus.
• Use white noise. If tinnitus is worse in quiet settings, try using a white noise machine to mask the noise from tinnitus. If you don't have a white noise machine, a fan, soft music or low-volume radio static may help.
• Limit alcohol, caffeine and nicotine. These substances, especially when used in excess, can affect blood flow and worsen tinnitus.

Coping and support

Besides any treatment options your healthcare professional offers, here are some suggestions to help you cope with tinnitus:

• 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 make sure that the information you get in the group is correct, it's best to choose a group led by a doctor, audiologist or other qualified health professional.
• Education. Learning as much as you can about tinnitus and ways to ease symptoms can help. And understanding tinnitus better makes it less bothersome for some people.
• Stress management. Stress can make tinnitus worse. Stress management, whether through relaxation therapy, biofeedback or exercise, may give you some relief.