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by Wood D

Ringing in the Ears

(Tinnitus)

Definition

Tinnitus is the perception of sound when there is no actual noise. It may be a buzzing, hissing, whistling, swooshing, and clicking noise. Pulsatile tinnitus is caused by the flow of blood. It happens with each heartbeat. Tinnitus can be a temporary or long-term problem.
Anatomy of the Ear
IMAGE
Copyright © Nucleus Medical Media, Inc.

Causes

Sound waves cause vibration or pressure on small structures in the ear. This creates signals that are sent to the brain. Damage to this system may cause signals when sound is not present. It may be caused by one or more of the following:
  • Damage to inner ear hair cells
  • Damage to inner ear after you are around loud sounds—may last only few minutes
  • Ear bone changes such as stiffening of bones in the middle ear
  • Ear wax build-up
  • Age-related hearing loss
  • Damage to ear drum or nerves
Different health problems can cause or worsen tinnitus. An exact cause may not be found.

Risk Factors

Factors that may increase your chances of tinnitus:
  • Work or activity that has loud noises
  • Wax or object in the ear canal
  • Stress
  • Fatigue
  • Smoking
  • Certain medicine, such as aspirin, antibiotics, or diuretics
  • Toxins, such as heavy metals, carbon monoxide, or alcohol
  • Certain health conditions, such as:
  • Blood vessel problems, such as an aneurysm, fistula, or hardening of the arteries
  • Fluid in the ear
  • Ruptured membrane in the ear
  • Injury to the head or neck

Symptoms

Tinnitus may have:
  • Ringing, roaring, buzzing, clicking, whistling, or hissing sounds
  • May happen in short bursts, pulses, or ongoing noise
  • Intensity may stay the same or vary
  • Single or multiple tones
  • Worsening at night or when there are fewer distractions
  • Sensation of inside movement, such as blood pulsing or muscles movement
Hearing loss or vertigo may also be present.

When Should I Call My Doctor?

Call your doctor if you have tinnitus, especially if it:
  • Comes with hearing loss, dizziness, vertigo, change in personality, speech, or weakness in any body area
  • Starts after head or neck injury
  • Started with new medicine
  • Is pulsatile—tied to blood flow
  • Comes with pain in the ear, fever, nausea, or vomiting
  • Is making it hard to go through daily activity

Diagnosis

The doctor will ask about your symptoms and past health. A physical exam will be done. The doctor will ask about:
  • Sensations that you have
  • Factors that may increase or decrease the sensation
  • Medicine that you take
  • History of trauma
The doctor will look at your ear canal with a scope. You may have a complete hearing test. A CT or MRI scan may be done. It will help to rule out more serious causes.
In addition to hearing the test may include:
  • Tympanogram
  • Auditory brain response

Treatment

When possible, the cause will be treated. This may stop tinnitus.
Other treatment will help to get rid of or reduce bothersome sensations. Steps may include:

Medication

Tricyclic antidepressants may help to treat severe tinnitus. It may ease your symptoms.

Mechanical Devices

Devices include:
  • Hearing aid—may ease tinnitus and improves hearing in some.
  • Tinnitus masker—a device that makes a low level of white noise such as falling rain or ocean waves. It can help cover up sensations.

Lifestyle and Self-care Measures

Steps that may help to ease noise include:
Avoid anything that makes tinnitus sensations worse such as:

Prevention

To help reduce your chances of tinnitus:
  • Avoid exposure to very loud noise.
  • Wear earplugs in noisy places.
  • Wear earmuffs when mowing the grass or using any other loud machinery.
  • Learn and practice stress management.
  • Limit use of medicine that damages hearing.

RESOURCES

American Academy of Otolaryngology—Head and Neck Surgery
http://www.entnet.org
American Tinnitus Association
https://www.ata.org

CANADIAN RESOURCES

Canadian Hearing Society
http://www.chs.ca
Canadian Society of Otolaryngology—Head and Neck Surgery
http://www.entcanada.org

References

Tinnitus. American Academy of Otolaryngology—Head and Neck Surgery website. Available at: http://www.entnet.org/?q=node/1324. Accessed December 17, 2019.
Tinnitus. American Speech-Language-Hearing Association website. Available at: http://www.asha.org/public/hearing/Tinnitus. Accessed December 17, 2019.
Tinnitus. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116486/Tinnitus. Updated July 18, 2019. Accessed December 17, 2019.
Understanding the facts. American Tinnitus Association website. Available at: https://www.ata.org/understanding-facts. Accessed December 17, 2019.

Revision Information

  • Reviewer: EBSCO Medical Review Board Nicole Meregian, PA
  • Review Date: 12/2019
  • Update Date: 06/12/2020
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