Definition

Tinnitus is the perception of abnormal ear or head noises. Tinnitus is unpleasant enough itself, and is sometimes a symptom of other problems, including hearing loss , tumors, and narrowing of the blood vessels. Noises may be high pitched and “ringing,” or sound more like a clicking. Some tinnitus is pulsatile, which means it may be caused by the flow of blood that accompanies each heart beat, and this happens in cases of narrowing of the blood vessels.

	The Ear
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Causes

Many diseases and conditions are associated with tinnitus, including:

• Hearing loss, the most frequent cause of persistent tinnitus
• Exposure to loud noises
• Stroke
• Certain medications (see below)
• Wax or a foreign body in the ear canal
• Allergies
• Ear infection
• Fluid in the ear
• Ruptured membrane in the ear
• Meniere's disease
• High or low blood pressure
• Injury to the head or neck
• Tumors
• Blood vessel disorders, such as an aneurysm or hardening of the arteries
• Diabetes
• Thyroid problems

Rare episodes of tinnitus lasting at most a few minutes are quite common in normal people, especially after exposure to loud noises. Be sure to see a doctor for tinnitus that is persistent and/or associated with hearing loss, dizziness, change in personality, speech, or weakness in any body area. Tinnitus that is pulsatile or heard only on one side also generally requires a medical evaluation. Evaluation should be more urgent when tinnitus comes on rapidly, and especially when it is associated with personality change or any loss of bodily function.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Your risk of tinnitus increases with:

• Exposure to loud noises
• Depression
• Stress
• Fatigue
• Anxiety
• Certain medications:
  • Aspirin
  • Quinine and its derivatives
  • Some antibiotics (aminoglycosides)
  • Some diuretics (water pills)
• Toxins:
  • Heavy metals
  • Carbon monoxide
  • Alcohol

Symptoms

The sensations of tinnitus may have the following characteristics:

• Ringing, roaring, buzzing, whistling, or hissing sounds
• Intermittent, continuous, or pulsatile quality
• Same or varying intensity
• Single or multiple tones
• Ringing that comes and goes
• More annoying symptoms at night or when there are fewer distractions
• Sensation of normal internal events such as blood pulsing or muscles contracting
• Sometimes tinnitus is accompanied by hearing loss and vertigo

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. Special attention will be paid to your head, neck, and ears.

You will be asked questions about:

• Your sensations
• Medication use
• Whether breathing, dizziness, or anything else increases or decreases the sensation

The doctor will look at your ear canal and eardrum using an instrument with a light that is held at the external opening of the ear. A tuning fork can help evaluate hearing. You should receive a complete hearing test. Other tests, such as an MRI scan , may be ordered to rule out serious conditions.

Treatment

Tinnitus treatment depends on what is causing the symptoms. This may mean, for example:

• Wearing a specially made splint to help manage TMJ
• Taking antibiotics for a sinus or ear infection
• Removal of wax from the ear canal

Therapy aims to eliminate or reduce bothersome sensations. Treatment may include:

Medication

Antidepressants may be helpful in some patients. If Meniere's disease (a relatively common cause of tinnitus) is diagnosed, medications specific to that disorder may be prescribed.

Other mediations include valium .

Mechanical Devices

Devices include:

• Hearing aid—sometimes relieves tinnitus and improves hearing in some people with hearing loss
• Tinnitus masker—a device that emits a low level of white noise to help cover up the internal sensations and block out external noises

Lifestyle and Self-care Measures

Measures to discuss with your doctor if no cure or specific treatment is available include:

• Learn and practice stress management and relaxation techniques.
• Biofeedback may help. Biofeedback teaches people how to control body functions they normally do not think about.
• Consider seeing a counselor to develop new coping skills and relaxation techniques.
• Consider joining a support group .
• Avoid anything that makes tinnitus sensations worse, such as:
  • Loud noises
  • Alcohol
  • Smoking
  • Salt
  • Caffeine
• Exercise regularly to improve circulation.
• Make time to relax and get enough sleep .
• Playing a radio or a white-noise machine for about 30 minutes at bedtime may help relieve the ringing sensations at night.

Surgery

Surgery may help relieve certain causes of tinnitus if the cause of the tinnitus is treated.

• Tinnitus caused by a tumor frequently subsides after the growth is removed.
• If the tinnitus is due to wax build-up, it can be relieved by cleaning the ears.
• Abnormalities in blood vessels which lead to tinnitus can sometimes be corrected with surgery.
• Surgery may also be an option for patients with Meniere's disease, but is usually performed only for disabling dizziness.

Prevention

You may be able to prevent tinnitus from developing with a few simple measures:

• Avoid exposure to excessive noise.
• Wear earplugs in noisy situations.
• Wear earmuffs when mowing the grass.
• Learn and practice stress management and relaxation techniques.
• Limit use of drugs that damage hearing.

RESOURCES:

American Academy of Otolaryngology–Head and Neck Surgery
http://www.entnet.org

American Tinnitus Association
http://www.ata.org

CANADIAN RESOURCES:

Canadian Society of Otolaryngology
http://www.entcanada.org/default.asp

The Canadian Hearing Society
http://www.chs.ca/

References:

American Academy of Otolaryngology–Head and Neck Surgery website. Available at: http://www.entnet.org .

American Speech-Language-Hearing Association website. Available at: http://www.asha.org/default.htm .

American Tinnitus Association website. Available at: http://www.ata.org .

Conn's Current Therapy 2001 . WB Saunders Co.; 2001.

Primary Care Medicine. 4th ed. Lippincott Williams & Wilkins; 2000.

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