Tinnitus

Tinnitus, when you hear sounds that aren’t coming from an outside source, is a common complaint. About 20% of people experience it in their lifetime. Many people find it easy to ignore and mostly notice it as background noise or at night when it’s quiet. But for some people, it can be quite bothersome - it can interrupt sleep or interfere with concentration or hearing. 

What is tinnitus?

Tinnitus is the perception of noise in your ear that occurs when nothing is causing the sound you’re hearing. Tinnitus includes sounds such as ringing, hissing, roaring, pulsing, whooshing, chirping, whistling, static, buzzing or clicking. Some people describe it as sounding like crickets while, for others, it’s a high-pitched ringing in the ears.

Tinnitus can:

• Be constant or intermittent
• Be in one or both ears
• Vary in loudness

There are three types of tinnitus:

• Subjective tinnitus, which is a ringing that is perceived only by the person hearing it. It can vary from mild to severe and quiet to loud. It’s the most common type of tinnitus.
• Objective tinnitus, which is a rare condition where the noise is generated within the body. You perceive it, and your doctor can also detect it by listening with a stethoscope on the side of your head or your neck, near your ear.
• Pulsatile tinnitus, which resembles a heartbeat and may be caused by movement of the membrane that covers the tympanic cavity. This type of tinnitus is associated with several medical conditions, so it should be evaluated by a doctor even if symptoms aren’t that bothersome.

What causes tinnitus?

Tinnitus is not a disease, but it may be a symptom of another condition. In most cases, it is the brain’s reaction to damage in your ear, auditory nerve or other parts of your auditory system. Some of the most common causes of tinnitus are:

• Age-related hearing loss, which typically starts around age 60, tends to be in both ears and involves the loss of high-frequency sounds. It is often described as a high-pitched ringing, and it’s the most common cause of tinnitus.
• Exposure to loud noises. A single loud noise, such as a gunshot, or extended exposure to loud noises, such as in certain work environments, can trigger tinnitus in one ear or both.
• Earwax impaction.
• Side effects from certain medications.
• Blood vessel disorders.
• Stiffening of the middle ear bones.
• Eustachian tube dysfunction.
• Migraines.
• Traumatic brain injuries.
• Head or neck injuries.
• Tumors.
• Ear infections.
• Ear diseases such as Ménière’s disease or otosclerosis.

While many factors can cause tinnitus, it’s often impossible to identify the cause.

How can tinnitus be prevented?

You can’t always prevent tinnitus since you can’t avoid causes like aging or certain illnesses and injuries. But these steps can help with some of its causes:

• Protect your hearing. Avoid exposing your ears to loud sounds. If you can’t avoid excessive noise levels, for example at work or at an exercise class at the gym, use earplugs or over-the-ear hearing protection to help limit the damage. Don't set the volume too high when you’re listening to music on headphones.
• Take care of your blood vessels. Some blood vessel disorders and blood flow issues (including high blood pressure) are linked with tinnitus. The steps you take to keep your heart healthy, like exercising and choosing healthy foods, can help with tinnitus, too.
• Limit or eliminate alcohol, caffeine and nicotine. Tinnitus may be linked with the excessive use of these substances.

How is tinnitus diagnosed?

To evaluate your tinnitus, you’ll want to start with a comprehensive hearing evaluation by an audiologist, a medical professional specializing in hearing and related issues. At your appointment, be prepared to describe your tinnitus. For example, is it constant or intermittent, high-pitched or low-pitched, quiet or loud?

Your audiologist will take your medical history and ask about noise exposure, ear trauma, balance issues, hearing loss and your medications. An otologic exam and audiologic hearing test can help identify or rule out injury or another disease that could be causing the tinnitus and may identify any hearing loss.

How is tinnitus treated?

For people with tinnitus, the most effective treatment is to eliminate the underlying cause if your doctor can identify it. In those cases, treatment will vary based on what’s triggering the problem. For example, removing impacted earwax or changing medications may help reduce or eliminate tinnitus.

If the cause isn’t clear, or if it’s something that can’t be treated, there are several options to try. Here are some types of therapy to consider:

• Hearing aids or cochlear implants if hearing loss is causing the tinnitus
• Sound therapy, which uses external sound waves to mask your symptoms, making tinnitus less noticeable
• Cognitive behavioral therapy (CBT), which can help you reframe your thought patterns
• Tinnitus retraining therapy (TRT)
• Hypnotherapy
• Myofascial trigger point therapy
• Tinnitus masking devices such as wearable sound generators or portable sound generating masking devices.

Although there is research being done regarding therapies such as neuromodulation, transcranial magnetic stimulation and vagus nerve stimulation, these treatment options are not readily available at this time.

It can also help to:

• Cut down or stop smoking and consuming alcohol
• Exercise regularly
• Practice relaxation and stress reduction techniques

It is important to treat tinnitus, especially if it interferes with your sleep or concentration. Untreated tinnitus is linked to mental health conditions such as depression and anxiety. Often, the tinnitus never goes away completely, so finding strategies for coping with symptoms is critical.