Tinnitus is hearing ringing, buzzing, or other sounds without an external cause. Patients may experience tinnitus in one or both ears or in the head.
Tinnitus affects as many as 40 million adults in the United States. It is defined as either objective or subjective. In objective tinnitus, the doctor can hear the sounds, as well as the patient. Objective tinnitus is typically caused by tumors, turbulent blood flow through malformed vessels, or by rhythmic muscular spasms. Most cases of tinnitus are subjective, which means that only the patient can hear the sounds.
Causes and symptoms
Subjective tinnitus is frequently associated with hearing loss. About 90% of patients have sensorineural hearing loss
; 5% suffer from conductive hearing loss; 5% have normal hearing. The causes of subjective tinnitus include:
- impacted ear wax
- ear infections
- hardening of the structures of the inner ear
- hearing loss related to age or excessive noise
- ototoxic medications, including aspirin, quinine, some diuretics, heavy metals, alcohol, and certain antibiotics
- meniere's syndrome
- head trauma
- systemic diseases, including syphilis, hypertension, anemia, or hypothyroidism
- tumors of the ear
Diagnosis of tinnitus includes a physical examination
of the patient's head and neck. The doctor will use an otoscope to examine the ears for wax, infection, or structural changes. He or she will also use a stethoscope to listen to the blood vessels in the neck. Additional tests may include the following:
Tuning fork tests
The Rinne and Weber tests are commonly used to evaluate the type and severity of hearing loss. In the Weber test, the doctor holds a tuning fork against the patient's forehead or front teeth. If the hearing loss is sensorineural, the sound radiates to the ear with better hearing; if the hearing loss is conductive, the sound will be louder in the damaged ear. In the Rinne test, the tuning fork is placed alternately on the mastoid bone (behind the ear) and in front of the ear. In conductive hearing loss, bone conduction (BC) is greater than air conduction (AC). In sensorineural hearing loss, AC is greater than BC.
Magnetic resonance angiography
(MRA and MRV) can be used to evaluate malformations of the blood vessels. Computed tomography scans
(CT scans) or magnetic resonance imaging scans (MRIs) can be used to locate tumors or abnormalities of the brain stem.
The doctor may order a complete blood count
(CBC) with specific antibody tests to rule out syphilis or immune system disorders.
Some cases of tinnitus can be treated by removal of the underlying cause. These include surgical treatment of impacted ear wax, tumors, head injuries, or malformed blood vessels; discontinuance of ototoxic medications; and antibiotic treatment of infections.
Subjective tinnitus, especially that associated with age-related hearing loss, can be treated with hearing aids
, noise generators or other masking devices, biofeedback, antidepressant medications, or lifestyle modifications (elimination of smoking
, coffee, and aspirin).
A variety of alternative therapies may be helpful in the treatment of tinnitus. Dietary adjustments, including the elimination of coffee and other stimulants, may be useful, since stimulants can make tinnitus worse. In addition, reducing the amount of fat and cholesterol in the diet can help improve blood circulation to the ears. Nutritional supplementation with vitamin C, vitamin E, B vitamins
, calcium, magnesium, potassium, and essential fatty acids is also recommended. Gingko (Gingko biloba
) is often suggested, since it is believed to enhance circulation to the brain. Acupuncture
treatments may help decrease the level of tinnitus sounds the patient hears, and constitutional homeopathic treatment may also be effective.
The prognosis depends on the cause of the tinnitus and the patient's emotional response. Most patients with subjective tinnitus do not find it seriously disturbing, but about 5% have strong negative feelings. These patients are frequently helped by instruction in relaxation techniques.
Jackler, Robert K., and Michael J. Kaplan. "Ear, Nose, & Throat." In Current Medical Diagnosis and Treatment, 1998, edited by StephenMcPhee, et al., 37th ed. Stamford: Appleton & Lange, 1997.
— A disease of the inner ear, marked by recurrent episodes of loss of balance (vertigo) and roaring in the ears lasting several hours. Its cause is unknown.
— Damaging to the nerves controlling the senses of hearing and balance.
Sensorineural hearing loss
— Hearing loss caused by damage to the nerves or parts of the inner ear governing the sense of hearing.
tinnitus [tin´ĭ-tus, tĭ-ni´tus]
a noise in the ears, such as ringing, buzzing, or roaring, which may at times be heard by others than the patient. Common causes include presbycusis
, prolonged exposure to loud environmental noise, and such pathological conditions as inflammation and infection of the ear, otosclerosis
, meniere's disease
, and labyrinthitis
. Systemic disorders associated with tinnitus include hypertension and other cardiovascular diseases, neurologic disorders including head injury, hyperthyroidism, and hypothyroidism. Tinnitus often is one of the first symptoms produced by an ototoxic
Medical treatment begins with efforts to determine the underlying cause and treat it. When the cause cannot be found or is not amenable to control, symptomatic relief is attempted. However, some cases resist all conventional modes of therapy. Less traditional measures that have had varying degrees of success include biofeedback training and “masking.” Biofeedback training is especially helpful in those cases in which emotional stress and anxiety or hysteria are thought to be contributing factors. Through visual or auditory signals the person learns to relax and exert some degree of control over the autonomic nervous system. This can lower blood pressure and pulse rate and relax tense muscles. Masking simply provides a low-level noise to block out or mask the head noise heard by the person. Some examples include playing soft music or a tape of sounds of nature, such as a waterfall, while the person is resting or sleeping, providing “white sound” in the work setting, using a hearing aid to amplify sound from the outside and overcome head noise, and wearing a special tinnitus instrument that is a combination hearing aid and tinnitus masker for persons who have both hearing loss and tinnitus.
Persistent and severe tinnitus can interfere with patients' ability to perform their usual daily activities and prevent them from getting sufficient sleep and rest. Because the problem is so widespread, and for many persons incapacitating, there is a national association devoted to the study and management of tinnitus. Its address is American Tinnitus Association, P.O. Box 5, Portland, OR 97207.
Patient discussion about tinnitus
Q. What is Tinnitus? My doctor asked me if I have tinnitus and I didn't exactly understand what he meant. What is tinnitus?
A. Tinnitus is noises or ringing in the ears. It can be constant or come and go. It can be in one ear or both ears.Get another DOC if he cant tell you what it is.
Q. Tinnitus (Ringing and Other Ear Noise) Anybody have this problem?
Urrrrrrrrrrr, I think I want to shoot myself,you know what I mean.
It is worst than the chinese torture.
Someone, please send me a good tip how to stop it.
I have this for 4 yrs and it is driving me crazy.
You cannot enjoy total complete silence.
They say silence is golden but not when you have this ringgi in your ears.
It gets worst when there is no noise.
The only remedy I have is eating hot spicy curry, it helps for 2-3 wks and then it comes back again and then eating spicy food again.
Listening to classical music helps to.
Oh well.....just have to suck it up.
A. I've read that lipoflavinoids can help.
Q. I need help with tinnitus. Does anyone know of anything that helps ringing ears.
A. tinnitus is a symptom of a problem, the first thing you should do is to try to find out the underlying cause. what is the reason? been to a good party? high blood pressure? kidney function? taken any drugs or medication lately? new diet? allergy? you need to check that up. maybe an ear infection or just wax. but those are things that only a doc can check out. More discussions about tinnitus
get rid of the cause- get rid of the problem.