Tinnitus

Overview

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Tinnitus

Tinnitus

Many things can cause tinnitus, including broken or damaged hair cells in the part of the inner ear called the cochlea, changes in how blood moves through nearby blood vessels, issues with the jawbone joint, and conditions that affect how the brain processes sound.

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.

Symptoms

Symptoms of tinnitus vary. Most people with tinnitus describe hearing a ringing in the ears, even though no one else can hear the ringing sound. The noises of tinnitus may vary in pitch from a low roar to a high squeal. People can have tinnitus in one or both ears. In some cases, the sounds can be so loud that they make it hard to focus or hear other sounds. Tinnitus may be present all the time, or it may come and go.

Some of the types of sounds people with tinnitus report hearing are:

• Ringing.
• Buzzing.
• Roaring.
• Clicking.
• Hissing.
• Humming.
• Whooshing.
• Pulsing like the sound of a heartbeat.

There are two main types of tinnitus. These are:

• Subjective tinnitus. In this more common type of tinnitus, only you can hear the noises.
• Objective tinnitus. In this less common type of tinnitus, a healthcare professional also can hear sounds from the head, neck or ear during an exam. Objective tinnitus often has a specific cause that can be treated.

When to see a doctor

Some people aren't very bothered by tinnitus. For other people, tinnitus disrupts their daily lives. If you have tinnitus that bothers you, see your healthcare professional.

Make an appointment to see your healthcare professional if:

• Your tinnitus starts after an upper respiratory infection, such as a cold, and doesn't go away within a week.

See your healthcare professional as soon as possible if:

• You have sudden hearing loss, dizziness, numbness, or weakness in the face, arm or leg with the tinnitus.
• Your tinnitus is making you feel anxious or depressed or disrupts your sleep.
• You develop tinnitus after being in a car accident, getting hurt playing sports or in a similar event. In these cases, seek emergency medical care.

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.

Risk factors

Anyone can have tinnitus, but these factors may raise your risk:

• Loud noise exposure. Loud noises, such as those from heavy equipment, chain saws and firearms, and loud music all cause noise-related hearing loss. People who work in noisy places, such as factory and construction workers, musicians, and soldiers, are especially at risk.
• Age. As you age, the nerve fibers in your ears don't work as well, possibly causing the hearing issues related to tinnitus.
• Sex. Men are more likely to have tinnitus.
• Tobacco and alcohol use. People who smoke tobacco or use marijuana and other substances are more likely to have tinnitus. Drinking alcohol also raises the risk of tinnitus.
• Certain health conditions. Obesity, heart disease, high blood pressure, and a history of depression, anxiety, arthritis or head injury all raise your risk of 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.

Prevention

In many cases, tinnitus is caused by something that can't be prevented. But some precautions can help prevent certain kinds of tinnitus.

• Use hearing protection. Over time, exposure to loud sounds can damage the nerves in the ears, causing hearing loss and tinnitus. Many strategies can protect your hearing. For example, try to limit your exposure to loud sounds. If you can't avoid loud sounds, always wear over-the-ear hearing protection, especially if you use chain saws, are a musician, work in an industry that uses loud machinery, or use firearms such as pistols or shotguns.
• Turn down the volume. Long-term exposure to amplified music with no ear protection or listening to music at very high volume through headphones can cause hearing loss and tinnitus.
• Take care of your heart health. Regular exercise, eating right and taking other steps to keep your blood vessels healthy can help prevent tinnitus linked to obesity and blood vessel conditions.
• Limit alcohol, caffeine and nicotine. These substances, especially when used in excess, can affect blood flow and worsen tinnitus.