You may have heard the saying, “Were your ears ringing?” if someone overheard a compliment about you. And most of us have experienced the unusual feeling of ringing in our ears after a loud concert or being too close to the fireworks. Imagine if it didn’t go away…that’s tinnitus.
Tinnitus is the perception of noise or ringing in the ears. It’s unfortunately common, affecting about 1 in 5 people. Tinnitus can be a symptom of an underlying condition, such as age-related hearing loss, ear injury or a circulatory system disorder. Patients find it distracting and bothersome, so identifying whether there is an underlying cause is helpful.
Tinnitus can manifest as ringing, buzzing, roaring, clicking, fluttering, or hissing in the head or ears. The most common type is subjective, meaning that only the patient can hear it. It’s related to problems in your outer, middle, inner ear, the hearing nerves, or the part of your brain that interprets hearing. Objective tinnitus is rarer, and can sometimes be heard by your doctor on examination. It may originate from a blood vessel or small muscle contracting in the middle ear.
Tinnitus may be pulsatile, irregular or continuous. Pulsatile tinnitus goes along with the heartbeat, and can be related to temporary swelling of the Eustachian tube from a cold, atherosclerosis or a blood vessel near the ear. Irregular sounds can be related to spasms of the tiny stapedius muscle in the middle ear or loose wax or hair in the ear canal. Continuous tinnitus is the most common, and hardest to treat. It is usually related to age-related or noise-induced hearing loss. Other causes include Meniere’s disease, TMJ disorders, trauma, hypertension, and tumors of the hearing or balance nerves. Medications that can be culprits include high-dose aspirin, water pills, quinine, and certain antibiotics and cancer treatments.
In most cases, a visit to your doctor is necessary in order to examine your ears, head, neck and balance when looking for possible causes of tinnitus. It’s likely you’ll need a hearing test, even if you aren’t aware that your hearing is down. Depending on the suspected cause of your tinnitus, you may need radiology tests such as CT or MRI scans.
Treatment depends on what is found. Sometimes it’s as easy as cleaning the wax out of your ear. For others it could mean treating an underlying cardiovascular problem. If the issue seems to be hearing, noise suppression using white noise may help suppress the sound so that it’s less bothersome. Your doctor may suggest using an electronic device to suppress the noise such as white noise machines, which produce simulated environmental sounds such as falling rain or ocean waves. Fans, humidifiers, dehumidifiers and air conditioners in the bedroom may also help cover the internal noise at night. Hearing aids can be specially programmed to help filter out tinnitus. Tinnitus retraining is another program that uses sound modification coupled with counseling to help patients through.
Medications can have a limited role in treatment, but are not a cure. Low dose anti-depressants and anxiety medications have been used to soothe tinnitus symptoms. Melatonin has been helpful for some patients.
Lifestyle choices make a difference. Patients do better if they avoid loud noises, caffeine, alcohol and nicotine. Stress management though meditation, biofeedback and exercise seem to help. One published study showed that listening to Mozart daily was helpful!
Other therapies that have been tried for tinnitus include acupuncture, Botox, hypnosis, ginkgo biloba, zinc supplements and B vitamins. It is difficult to report effectiveness when compared to placebo, but some patients find relief.
Most patients learn how to cope with it and notice tinnitus less as time goes by. The American Tinnitus Association (www.ATA.org,) support groups and counseling can also be great resources.