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Ringing in the Ears

(Tinnitus)

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.
Anatomy of 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 tinnitus may 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, a sensation of spinning while standing still.

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 people with Meniere's disease, but it is usually done only for disabling vertigo

Prevention

To help reduce your chance of 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 http://www.entnet.org

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

CANADIAN RESOURCES

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

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

References

About tinnitus. American Tinnitus Association website. Available at: http://www.ata.org/for-patients/about-tinnitus. Accessed September 26, 2014.

Acute otitis media. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 2, 2014. Accessed September 26, 2014.

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 Academy of Otolaryngology—Head and Neck Surgery website. Available at: http://www.entnet.org/content/tinnitus. Updated December 2010. Accessed September 26, 2014.

Tinnitus. American Speech-Language-Hearing Association website. Available at: http://www.asha.org/public/hearing/Tinnitus. Accessed September 26, 2014.

Tinnitus. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 26, 2014. Accessed September 26, 2014.

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

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