Ringing in the Ears
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Definition
Tinnitus is the perception of abnormal ear or head noises without any external sound. Noises may be high pitched, ringing, clicking, or buzzing. Pulsatile tinnitus is caused by the flow of blood that accompanies each heartbeat.

The Ear

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Causes
Tinnitus is caused by:

  • Cochlear damage from noise exposure
  • Hearing loss
  • Damage to the auditory system
Occasional episodes of tinnitus lasting at most a few minutes are quite common in normal people, especially after exposure to loud noises.

Risk Factors
Factors that may increase your chance of developing tinnitus include:

  • Occupations or activities that expose you to loud noises
  • Wax or a foreign body in the ear canal
  • Stress
  • Fatigue
  • Certain medications, such as aspirin, antibiotics, or diuretics
  • Toxins, such as heavy metals, carbon monoxide, or alcohol
  • Certain health conditions, such as:
  • Blood vessel disorders, such as an aneurysm, fistula, or hardening of the arteries are associated with pulsatile tinnitus
  • Fluid in the ear
  • Ruptured membrane in the ear
  • Injury to the head or neck
The Center for Communication and Hearing maintains an updated list of medications that are associated with tinnitus.

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
  • 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 .

When Should I Call My Doctor?
Call your doctor if you have tinnitus, especially if it:

  • Is associated with hearing loss, vertigo, change in personality, speech, or weakness in any body area
  • Starts after head or neck injury
  • Is associated with new medication
  • Is pulsatile
  • Is associated with pain in the ear, fever, nausea, or vomiting
Diagnosis
The doctor will ask about your symptoms and medical history. A physical exam will be done. Special attention will be paid to your head, neck, and ears.

You will be asked questions about:

  • The sensations that you have
  • The factors that may increase or decrease the sensation
  • The medications that you take
  • History of trauma
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. Imaging tests, such as a CT scan or MRI , may be ordered to rule out serious conditions.

A hearing test includes:

  • Tympanogram
  • Auditory brain response
  • Electrocochleoraphy—to test for Meniere's disease
Treatment
Tinnitus treatment depends on what is causing the symptoms. This may mean:

  • Wearing a specially made splint to help manage temporomandibular joint disorder
  • Taking antibiotics for a sinus or ear infection
  • Having the wax removed from your ear canal
  • Stopping or changing medications to see if tinnitus goes away
Therapy aims to eliminate or reduce bothersome sensations. Treatment may include:

Medication
No medication has been shown to be very effective in treating tinnitus. Your doctor may still try to use some medications to ease your symptoms. These may include antidepressants and sedatives.

If you have Meniere's disease, your doctor may prescribe medication to treat that condition.

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:

Surgery
Surgery may help relieve certain causes of tinnitus. These include:

  • Tinnitus caused by a tumor frequently subsides after the growth is removed
  • Abnormalities in blood vessels that lead to tinnitus can sometimes be corrected with surgery
  • Surgery may also be an option for patients with Meniere's disease, but it is usually done only for disabling vertigo
Prevention
To help reduce your chance of developing tinnitus, take these steps:

  • 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 medications that damage hearing.



RESOURCES:
American Academy of Otolaryngology—Head and Neck Surgery

American Tinnitus Association

CANADIAN RESOURCES:
The Canadian Hearing Society

Canadian Society of Otolaryngology

References:
About tinnitus. American Tinnitus Association website. Available at: http://www.ata.org/for-patients/about-tinnitus . Accessed September 20, 2013.

Acute otitis media. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed.ebscohost.com/about/about-us . Updated June 3, 2013. Accessed September 20, 2013.

Conn HF, Rakel. Conn’s Current Therapy. 54th ed. Philadelphia, PA: WB Saunders Company; 2002.

Goroll A, Mulley A. Primary Care Medicine. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2000.

Tinnitus. American Speech-Language-Hearing Association website. Available at: http://www.asha.org/public/hearing/Tinnitus . Accessed September 20, 2013.

Tinnitus. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed.ebscohost.com/about/about-us . Updated July 1, 2013. Accessed September 20, 2013.

Tinnitus. American Academy of Otolaryngology—Head and Neck Surgery website. Available at: http://www.entnet.org/HealthInformation/tinnitus.cfm . Accessed July 7, 2009.

10/16/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Baldo P, Doree C, Lazzarini R, Molin P, McFerran D. Antidepressants for patients with tinnitus. Cochrane Database Syst Rev. 2009;(4):CD003853.

Last Reviewed September 2013



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