Tinnitus

[David Baxter PhD]

Tinnitus
By Mayo Clinic staff
Aug. 1, 2008

Tinnitus (TIN-i-tus) is noise or ringing in the ears. A common problem, tinnitus affects about one in five people. But, it isn't a condition itself ? it's is a symptom of an underlying condition, such as age-related hearing loss, ear injury or a circulatory system disorder.

Although bothersome, in most cases tinnitus isn't a sign of something serious. For most people, symptoms of tinnitus get better with treatment. Sometimes it gets better by treating an underlying cause when one is identified. Other treatments reduce or mask the noise, making tinnitus less noticeable.

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

• Ringing
• 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 of your ears. In some cases, the sound can be so loud it interferes with your ability to concentrate or hear. Tinnitus may be present all of 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 can also 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 a muscular issue.

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

• Make an appointment to see your doctor if you have 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, you have hearing loss, or you feel dizzy along with 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 begins to worsen with age, usually starting around age 60. Loss of hearing can cause tinnitus. The medical term for this type of hearing loss is presbycusis.
• Exposure to loud noise. Loud noises can damage your ability to hear. 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. While short-term exposure, such as attending a loud concert, usually causes tinnitus that 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. However, when too much earwax accumulates it becomes too hard to wash away naturally (cerumenal impaction), causing tinnitus or problems with hearing.
• Changes in ear bones. 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, an inner ear disorder. Doctors think it's caused by abnormal inner ear fluid pressure or composition.
• Stress and depression. This is an especially common diagnosis when hearing tests are normal and no other cause of tinnitus can be identified.
• Head injuries or neck injuries. These neurological disorders affect nerves or brain function linked to hearing. Head or neck injuries generally cause tinnitus in only one ear.
• Acoustic neuroma, a noncancerous (benign) tumor. Acoustic neuromas develop on the cranial nerve, which runs from your brain to your inner ear and controls balance and hearing. This condition is also called vestibular schwannoma. It 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 fatty 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. Repositioning your head usually causes the sound to disappear.
• 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 you take, 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, tetracycline, 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 per day) may cause tinnitus.

Risk factors
Anyone can get tinnitus, but you might be at increased risk if:

• You've been exposed to loud noise without ear protection, especially on an ongoing basis
• You're an older adult. Tinnitus is most common in people over 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
Tinnitus can significantly affect quality of life. It affects people differently, but may be linked to:

• Fatigue
• 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.

Treatments and drugs
To treat your tinnitus, your doctor will first try to identify any underlying, treatable conditions 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:

• Earwax removal. Removing impacted earwax can decrease tinnitus symptoms.
• 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. These devices include:

• White noise machines. These devices, which produce noise simulating environmental sounds such as falling rain or the ocean, 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. This can be especially helpful if you have hearing problems as well as tinnitus.
• Masking devices. Similar to hearing aids, these devices produce a continuous, low-level white noise that suppresses tinnitus symptoms.

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 only used for 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 has the potential to become habit-forming.
• Acamprosate (Campral), a drug used to treat alcoholism, is effective in relieving tinnitus for some people. However, more research is needed to determine how well it works for tinnitus.

Lifestyle and home remedies
Often, tinnitus is caused by a permanent condition and the underlying cause can't be treated. But, for many people, making adjustments makes the symptoms less bothersome. These tips may help:

• Avoid possible irritants. Reduce your exposure to things that may make your tinnitus worse. Common examples include loud noises and nicotine.
• Cover up the noise. In a quiet setting, a fan, soft music or low-volume radio static may help mask the noise from tinnitus.
• Manage stress. Stress can make tinnitus worse. Stress management, whether through relaxation therapy, biofeedback or exercise, may provide some relief.
• Reduce your alcohol intake. Alcohol increases the force of your blood by dilating your blood vessels, causing greater blood flow, especially in the inner ear area.

Alternative medicine
There's little evidence that indicates alternative medicine treatments work for tinnitus. However, some alternative therapies that have been tried for tinnitus include:

• Acupuncture
• Hypnosis
• The herb ginkgo
• Zinc supplements

Coping and support
Tinnitus doesn't always improve or completely go away with treatment. Here are a few things that can help you cope:

• Counseling. A licensed therapist or psychologist can help you learn coping techniques to make tinnitus symptoms less bothersome. Counseling can also help with other problems often linked to tinnitus, including anxiety and depression.
• 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 ensure the information you're getting is accurate, it's best to make sure the group is facilitated by a physician, audiologist or other qualified health professional.
• Education. Learning as much as you can about tinnitus and ways to alleviate symptoms can help. And just understanding tinnitus better makes it less bothersome for some people.

Prevention
In many cases, tinnitus is the result of something that can't be prevented. However, taking care of your health can help prevent certain kinds of tinnitus.

• Use hearing protection. Over time, exposure to loud noise can damage the nerves in the ears, causing hearing loss and tinnitus. If you use chainsaws, work in an industry that uses loud machinery or use firearms (especially pistols or shotguns), always wear over-the-ear hearing protection.
• Protect your ears from loud music. Long-term exposure to amplified music with no ear protection or listening to music at very high volume though headphones ? when using an MP3 player, for example ? 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.