TINNITUS

Tinnitus, often simply referred to as ringing in the ears or head noises, is a sound heard in one or both ears that is described by different people in various ways.  To some it is a high-pitched ringing, whining or hissing sound, like listening to a conch shell.  To others it may be a low roaring noise.  Tinnitus can be very mild, noticeable only in a quiet room, or it can become so loud and annoying the victim hears nothing else.  It can be persistent, intermittent, coincide with a heartbeat, or throbbing, depending on the cause.

Approximately 37 million adults suffer from tinnitus.  For 7.5 million, the problem is so severe they are incapacitated.  While tinnitus does not cause hearing disorders, it may accompany decreased hearing and other ears symptoms such as pressure, unsteadiness, or dizziness.  Often it occurs alone.  Narrowing of neck vessels, congenital vascular problems, or other “non-ear sources” can produce tinnitus.  Typically, the ear is the primary source of the noise.  This general overview provides a small list of possible sources of tinnitus.  The list is not meant to be comprehensive, rather to provide some common sources of tinnitus.

 Causes in the Outer ear:

One of the most frequent causes of tinnitus is wax buildup in the outer ear canal.  Wax lying against the eardrum may induce ringing.  Likewise, other obstructions of the external ear canal such as swelling, a small hair shaft or foreign body touching the eardrum, can give rise to head noises.  Removal of the irritant typically relieves the sound.

 Causes in the Middle Ear:

Perforation of the eardrum or fluid accumulation behind the eardrum may provoke tinnitus.  Otosclerosis, a progressive process of the stapes bone, produces tinnitus after many years.  Acute otitis media, a more rapidly acute process due to painful inflammation in the middle ear can be linked with a pulsating tinnitus that disappears as the infection is controlled.  Other causes of middle ear head noises may include, tumor, allergy, injury, or medications.

 Causes in the Inner Ear:

Tinnitus arising from the inner ear frequently indicates more permanent and serious disease.  Because this area is beyond the view with an otoscope (medical instrument to examine the ear), it is more difficult to diagnose and treat.  Indirect studies such as hearing tests, radiologic studies, balance testing, and blood tests may be necessary to find the reason for the presence of tinnitus.

Exposure to a sudden loud noise, a gunshot or explosion for example, may result in tinnitus that subsides to a point but persists at a low level for an extended period of time.  Repeated exposure to excessive sound levels without adequate ear protection may result in permanent, loud tinnitus.  Trauma to the heard or neck as in a concussion or whiplash injury also may cause long-lasting tinnitus.

Some medications induce head noises.  Drugs containing aspirin in low doses cause a reversible ringing in the ears.  Other drugs such as quinine, streptomycin, neomycin, kanamycin, ethacrynic acid, furosemide, and many others have been known to produce tinnitus when taken over an extended period. 

Disorders affecting the cochlea (the hearing center) or the inner ear can cause tinnitus.  A common form is presbycusis, the high-frequency hearing loss that often occurs with aging.  Often the ringing may become apparent before the person realizes he or she has a hearing impairment.

Intermittent tinnitus can be linked with pressure increases in the inner ear fluid (hydrops) caused by allergies, infections, metabolic, or circulatory problems.  When tinnitus is accompanied by episodic dizziness, nausea, ear pressure or fullness, and distortion or decreased hearing, Meniere’s disease should be expected.

A particularly difficult diagnosis is the tinnitus resulting from a small tumor pressing on the vestibular nerve leading from the cochlea to the brain.  At first head noises may be the only symptom.  Later, hearing loss and unsteadiness may occur.  Extensive radiologic testing and balance studies or prolonged observation for changing signs may be required before such a tumor is discovered.

Other causes of tinnitus include high or low blood pressure, anemia, a growth in the jugular vein as it leaves the skull, diabetes, thyroid dysfunction, syphilis, glucose metabolic problems, autoimmune diseases, carotid artery narrowing or atherosclerosis to name just a few.

 Treatment:

Correcting treatable causes of tinnitus (e.g. allergy, infection, syphilis) often will improve the condition.  However, when the cause is unknown, or when head noises arise from within the cochlea, auditory nerve, or brain, treatment becomes more difficult.  Typically medications have not been proven to be effective.  Even surgical sectioning of the auditory or vestibular (hearing and balance) nerves often does not relieve the problem.

Because of the direct association between the hearing mechanism and the nervous system, tinnitus sufferers have been advised to avoid nervous tension, fatigue, and stimulants (e.g. coffee).  Sedatives may offer some people temporary relief.  Professional counseling may be considered in some circumstances as well.

Masking the ringing with other sounds is particularly helpful for sleeping.  Mild tinnitus is unnoticeable in the presence of background noise at a higher volume.  Thus a loud clock, a noise machine, or a radio tuned to static can provide enough competing sound to allow people to sleep.

When head noises are loud enough to interfere with daily concentration people with normal hearing may be helped by a tinnitus-masking device worn like a hearing aid.  For those with hearing impairment, a hearing aid may drown out the ringing with other ambient noise.  In some cases, the tinnitus disappears temporarily after the hearing aid is removed.  When a hearing aid doesn’t completely mask tinnitus, a combination hearing aid/tinnitus maker built into one case, called a tinnitus instrument, can be used.

 Conclusion: