Nearly 36 million Americans suffer from tinnitus or head noises. It may be an intermittent sound or an annoying continuous sound in one or both ears. Its pitch can go from a low roar to a high squeal or whine. Prior to any treatment, it is important to undergo a thorough examination and evaluation by your otologist and audiologist. An essential part of the treatment will be understanding tinnitus and its causes.

Tinnitus

Tinnitus is the medical name indicating ringing in the ears, which includes noises ranging from loud roaring to clicking, humming, or buzzing. Most tinnitus comes from damage to the microscopic endings of the hearing nerve in the inner ear. The health of these nerve endings is important for hearing, and injury to them brings on hearing loss and often tinnitus. Hearing nerve impairment and tinnitus can also be a natural accompaniment of advancing age. Exposure to loud noise is probably the leading cause of tinnitus damage to hearing in younger people. Medical treatments and assistive hearing devices are often helpful to those with this condition.

Symptoms

Tinnitus is commonly defined as the subjective perception of sound by an individual, in the absence of external sounds. Tinnitus is not a disease in itself but a common symptom, and because it involves the perception of sound or sounds, it is commonly associated with the hearing system. In fact, various parts of the hearing system, including the inner ear, are often responsible for this symptom. At times, it is relatively easy to associate the symptom of tinnitus with specific problems affecting the hearing system; at other times, the connection is less clear.

Most of the time, the tinnitus is “subjective” – that is, the internal sounds can be heard only by the individual. Most subjective tinnitus associated with the hearing system originates in the inner ear. Damage and loss of the tiny sensory hair cells in the inner ear (that can be caused by different factors) may be commonly associated with the presence of tinnitus. It is interesting to note that the pitch of the tinnitus often coincides with the area of the maximal hearing loss.

A special category is tinnitus that sounds like one’s heartbeat or pulse, also known as “pulsatile tinnitus.” At times, the presence of pulsatile tinnitus may signal the presence of a vascular tumor in the general vicinity of the middle and inner ear. When noting this type of tinnitus, it is advisable to consult a physician to rule out the presence of a vascular tumor.

“Objective tinnitus” means that the examiner can actually listen in with a stethoscope or an ear tube and hear the sounds the patient hears.

Causes

One of the preventable causes of inner ear tinnitus is excessive noise exposure. In some instances of noise exposure, tinnitus is the first symptom before hearing loss develops, so it should be considered a warning sign and an indication of the need for hearing protection in noisy environments. Certain common medications can also damage inner ear hair cells and cause tinnitus. These include non-prescription medications such as aspirin, one of the most common and best-known medications that can cause tinnitus and eventual hearing loss. As we age, the incidence of tinnitus increases. Hearing loss associated with aging (also known as presbycusis) typically involves loss of and damage to the hair cells.

Tinnitus may be caused by different parts of the hearing system. At times, for instance, it may be caused by excessive ear wax, especially if the wax touches the ear drum, causing pressure and changing how the ear drum vibrates. Other times, loose hair from the ear canal may come in contact with the ear drum and cause tinnitus.

There are a number of non-auditory conditions that can cause tinnitus, as well as lifestyle factors. Hypertension or high blood pressure, thyroid problems, and chronic brain syndromes can all cause tinnitus without any specific auditory problems. Stress and fatigue may cause tinnitus, or can contribute to an exacerbation of an existing case. Poor diet and lack of exercise that may cause blood vessel and heart problems may also either cause it or exacerbate an existing condition. It is also possible that tinnitus could be caused by food or beverage allergies, but these causes are not well documented and are difficult to sort out.

Conditions that affect the hearing nerve can also cause tinnitus, the most common being benign tumors- typically originating from one of the balance nerves in close proximity to the hearing nerve. These are commonly referred to as acoustic neuroma or vestibular schwannoma. Tinnitus caused by an acoustic neuroma is usually unilateral and may or may not be accompanied initially by a hearing loss. Tinnitus may also originate from lesions on or in the vicinity of the hearing portion of the brain, called the auditory cortex. These can be traumatic injuries with or without skull fracture, as well as whiplash-type injuries common in automobile accidents. Benign tumors known as meningiomas that originate from the tissue that protects the brain may also be a cause for tinnitus that originates from the brain.

Evaluation

When you are evaluated for tinnitus, the first thing the doctor will do is obtain a complete history, investigating potential causative factors, and perform a thorough, targeted physical examination. Your doctor will try to determine how bothersome your tinnitus is, by asking certain questions or having you complete a self-assessment questionnaire. An audiogram (hearing test) will be obtained early in the evaluation to evaluate for hearing loss. You probably do not need radiologic testing (X-rays, CT scans or MRI scans) unless your tinnitus is unilateral, pulsatile, or associated with asymmetric hearing loss or neurological abnormalities.

Treatment

In most cases, there is no specific, tried-and-true treatment for ear and head noise. If we find a specific cause for your tinnitus, we may be able to offer specific treatment to eliminate the noise. However, most of the time, other than linking the presence of tinnitus to sensory hearing loss, specific causes are very difficult to identify.

Some treatments that may help:

  • Avoid exposure to loud sounds and noises.
  • Make sure your blood pressure is controlled. Your primary care physician can help with this.
  • Decrease your intake of salt. Salt impairs blood circulation.
  • Avoid stimulants such as coffee, tea, cola, and tobacco.
  • Exercise daily to improve your circulation.
  • Get adequate rest and avoid fatigue.
  • Recognize your head noise as an annoyance and try to ignore the sound as much as possible.

Masking a head noise with a competing sound at a constant low level, such as a ticking clock or radio static (white noise), may make it less noticeable. Tinnitus is usually more bothersome in quiet surroundings. Products that generate white noise are available through catalogs and specialty stores.

Hearing aids may reduce head noise while you are wearing them and sometimes cause the noise to go away temporarily. If you have a hearing loss, it is important not to set the hearing aid at excessively loud levels, as this can worsen the tinnitus in some cases. However, a thorough trial before purchase of a hearing aid is advisable if your primary purpose is the relief of tinnitus.

Tinnitus maskers can be combined within hearing aids. They emit a competitive but pleasant sound that can distract you from head noise. Some people find that a tinnitus masker may even suppress the head noise for several hours after it is used, but this is not true for all users.

The expert physicians and audiologists at the Midwest Ear Institute can help to provide comprehensive care and a thorough work-up of your tinnitus. They can make recommendations that often significantly help.