Tinnitus is commonly described as a ringing in the ears, but it also can sound like roaring, clicking, hissing, or buzzing. It may be soft or loud, high pitched or low pitched. You might hear it in either one or both ears. Roughly 10 percent of the adult population of the United States has experienced tinnitus lasting at least five minutes in the past year. This amounts to nearly 25 million Americans.
What causes tinnitus?
Tinnitus (pronounced tin-NY-tus or TIN-u-tus) is not a disease. It is a symptom that something is wrong in the auditory system, which includes the ear, the auditory nerve that connects the inner ear to the brain, and the parts of the brain that process sound. Something as simple as a piece of earwax blocking the ear canal can cause tinnitus. But it can also be the result of a number of health conditions, such as:
- Noise-induced hearing loss
- Ear and sinus infections
- Diseases of the heart or blood vessels
- Ménière’s disease
- Brain tumors
- Hormonal changes in women
- Thyroid abnormalities
Tinnitus is sometimes the first sign of hearing loss in older people. It also can be a side effect of medications. More than 200 drugs are known to cause tinnitus when you start or stop taking them.
People who work in noisy environments—such as factory or construction workers, road crews, or even musicians—can develop tinnitus over time when ongoing exposure to noise damages tiny sensory hair cells in the inner ear that help transmit sound to the brain. This is called noise-induced hearing loss.
Service members exposed to bomb blasts can develop tinnitus if the shock wave of the explosion squeezes the skull and damages brain tissue in areas that help process sound. In fact, tinnitus is one of the most common service-related disabilities among veterans returning from Iraq and Afghanistan.
Pulsatile tinnitus is a rare type of tinnitus that sounds like a rhythmic pulsing in the ear, usually in time with your heartbeat. A doctor may be able to hear it by pressing a stethoscope against your neck or by placing a tiny microphone inside the ear canal. This kind of tinnitus is most often caused by problems with blood flow in the head or neck. Pulsatile tinnitus also may be caused by brain tumors or abnormalities in brain structure.
Even with all of these associated conditions and causes, some people develop tinnitus for no obvious reason. Most of the time, tinnitus isn’t a sign of a serious health problem, although if it’s loud or doesn’t go away, it can cause fatigue, depression, anxiety, and problems with memory and concentration. For some, tinnitus can be a source of real mental and emotional anguish.
Tinnitus Signs and Symptoms
Tinnitus is one of the most elusive conditions that health care professionals face. It is an auditory perception not directly produced externally.
It is commonly described as a hissing, roaring, ringing or whooshing sound in one or both ears, called tinnitus aurium, or in the head, called tinnitus cranii.
The sound ranges from high to low pitch and can be a single tone, multi-tonal, or noise-like, having no tonal quality. Tinnitus may be constant, pulsing or intermittent. It may begin suddenly or progress gradually.
Tinnitus can be broadly classified into two categories: objective and subjective.
Objective Tinnitus
This form is audible to an observer either with a stethoscope or simply by listening in close proximity to the ear. Objective tinnitus accounts for less than 5 percent of overall tinnitus cases and is often associated with vascular or muscular disorders. The tinnitus is frequently described as pulsatile, or synchronous with the patient’s heartbeat. In many instances, the cause of objective tinnitus can be determined and treatment, either medical or surgical, may be prescribed.
Subjective Tinnitus
This form is audible only to the patient and is much more common, accounting for 95 percent of tinnitus cases. Subjective tinnitus is a symptom that is associated with practically every known ear disorder and is reported to be present in over 80 percent of individuals with sensorineural hearing loss, which is caused by nerve and/or hair cell damage.
Because tinnitus, like pain, is subjective, two individuals may demonstrate identical tinnitus loudness and pitch matches yet be affected in significantly different ways. The severity of the tinnitus is largely a function of the individual’s reaction to the condition. That said, many tinnitus sufferers:
- Have difficulty sleeping or concentrating
- Feel depressed or anxious
- Report additional problems at work or at home that may contribute to the distress caused by tinnitus
- Describe a correlation of tinnitus perception with stress
- It is often difficult to determine whether a patient’s emotional state pre-existed, or is a result of the tinnitus.
How is tinnitus treated?
There is no cure for tinnitus. While treatment depends, in part, on the underlying cause, a doctor or audiologist can help people with tinnitus learn to live with the problem and achieve a good quality of life. Some helpful approaches include the following:
Hearing aids, including cochlear implants: If you have a hearing problem, treating it can make tinnitus less noticeable. Specialists often recommend a cochlear implant hearing aid for people with tinnitus who have serious hearing loss. These small devices are surgically implanted inside the ear, where they can use electrical signals to send external sounds directly to the auditory nerve.
Sound generators: This solution can be as simple as keeping a machine on your night table that produces relaxing sounds such as waterfalls or “white noise.” There are also wearable sound generators, or “masking devices,” that fit in your ear that can play soft sounds or music just loud enough to mask the tinnitus noise.
Acoustic neural stimulation: A device the size of your palm works through a pair of headphones to deliver a broadband acoustic signal embedded in music. This relatively new treatment can stimulate change in the neural circuits and make you less sensitive to tinnitus.
Medications for anxiety and depression: These medications can help with such tinnitus-related problems as distress, irritability, mood and the loss of sleep that can make it difficult to function.
Counseling: A counselor who is knowledgeable about tinnitus can help you better understand the problem and guide you in developing new ways to react to the sounds. Since tinnitus comes from within the mind, tremendous gains can be had with a trained psychiatrist or psychologist through disrupting “the cycle of the fixation.”
“The way we think of tinnitus is that it’s really a form of anxiety—tinnitus causes anxiety, which causes tinnitus—and then you become stuck in this feedback loop,” Dr. Hildrew says.
