Medical Edge Newspaper Column

Living with Ear Noise

April 2, 2007
Dear Mayo Clinic:
I am retired, and I have a problem with tinnitus that seems to be getting worse. It sounds like high-pressure air being forced through a small hole. Sometimes it's coordinated with my heartbeat. What causes tinnitus? What kinds of treatment are available? -- Tucson, Ariz.

Answer:
Tinnitus, more informally called "ringing in the ears," is sound -- such as ringing, roaring, or humming -- that only you can hear because it's generated by some abnormality within your own body. Though the symptom can range from mildly annoying to emotionally distressing, the cause is not usually a serious health risk.

The leading cause is thought to be hearing loss, which we all develop as we age. As the inner ear's hair cells (which help transmit sound information to the brain) die off over time and fail to regenerate, the brain begins to compensate, some researchers think, by "turning up the volume." Others believe that the brain actually starts generating its own extraneous signal, though no one can yet explain why. Whatever the mechanism, this age-related hearing loss does not usually lead to total deafness, nor does the tinnitus itself provoke any additional hearing loss.

Some potential causes of tinnitus are simple to identify, such as a buildup of earwax or an ear infection. Sometimes it's related to medications (such as certain antihypertensives) taken for other conditions. Rarely, when the tinnitus is in one ear only, it may be the result of a benign tumor growing on the nerve that carries auditory signals. Directly dealing with such underlying causes can ease or eliminate the tinnitus. Similarly, tinnitus from head injuries, depending on their seriousness and extent, can be transient or permanent.

In less than one percent of cases, tinnitus is caused by a vascular problem, such as narrowing of the carotid artery or jugular vein, resulting in turbulent blood flow. We actively investigate such causes when a patient reports predominantly "pulsatile" tinnitus, or head noise in synch with the heartbeat, particularly when it involves only one ear. For it to occur only sometimes, as you have experienced, is common and usually innocuous.

While the stress of daily life can exacerbate tinnitus, and the condition itself can increase one's stress level, stress doesn't cause it.

There is no cure for tinnitus that results from hearing loss, but it is a symptom that is usually quite manageable, and with straightforward methods. Thus, my customary first "treatment" for patients is education. I explain how hearing occurs (how the brain and ear "talk" to each other), how that process can be disturbed, the high probability that the cause of the tinnitus is not life-threatening, the significant likelihood that the patient will feel better over time, and that large numbers of people manage to live with tinnitus quite well (some 40-50 million Americans are estimated to have it to some degree).

But if a patient does need help in reducing the perceived noise level, the next step is some form of "masking" to cover up the noise. Such simple interventions as a fan, soft music, or low-volume radio static may suffice. If not, "tinnitus maskers" -- devices (similar in appearance to hearing aids) that produce offsetting sounds -- may help.

Sometimes, particularly when hearing loss has been significant, a hearing aid helps. As a result of better hearing sounds in your environment, the tinnitus may be masked. For more severe tinnitus a trial of a medication, biofeedback, or stress reduction may provide relief.

The best way to deal with tinnitus is to prevent the hearing loss in the first place. For example, it's important to wear earplugs when mowing the lawn, operating a snow blower, or using noisy household appliances or tools. While the associated sound levels may not be as intense as, say, that of a jet engine, noise-induced hearing loss is a function not only of volume but also of duration. For the same reason, sound volumes of now-ubiquitous mobile music devices should be set conservatively.

-- Colin L.W. Driscoll, M.D., Otorhinolaryngology, Mayo Clinic, Rochester, Minn.