Tinnitus (pronounced tin-NY-tus) is commonly described as a ringing in the ears, but it also can sound like roaring, clicking, hissing, or buzzing. It may be soft or loud, high pitched or low pitched. It may be present in either one or both ears. It is estimated that nearly 50 million Americans, nearly 20% of the population in the United States, has experienced tinnitus at some point in their lives.
Tinnitus is a symptom that something is wrong in the auditory system, which includes the ear, the auditory nerve, and the parts of the brain that process sound. Something as simple as a piece of earwax blocking the ear canal can cause tinnitus. But it can also be the result of a number of health conditions, including: noise-induced hearing loss, age-related hearing loss, hypertension or heart disease, ear or sinus infection, or a brain tumor.
The most common patients who develop tinnitus are ones with noise-induced and age-related hearing loss. We believe that the inner ear cells of these patients have been damaged from years of noise trauma or secondary to nerve degeneration. It is then felt that these damaged cells secrete an energy that the auditory center of the brain perceives as the tinnitus “noise”. Therefore, although the cause of tinnitus begins in the ear, it then continues in the brain.
Despite many of these associated conditions and causes, some people develop tinnitus for no known reason. Most of the time, tinnitus isn’t a sign of a serious health problem. However, if it’s loud or doesn’t go away, it can cause other problems such as depression, insomnia, or problems with memory and concentration. In these few patients, tinnitus can be a source of real mental and emotional anguish.
Pulsatile tinnitus is a rare type of tinnitus that sounds like a rhythmic pulsing in the ear, usually in time with your heartbeat. A doctor may be able to hear it by pressing a stethoscope against your neck, just below the ear. This kind of tinnitus is most often caused by problems with blood flow in the head or neck. Pulsatile tinnitus also may be caused by brain tumors or other structural abnormalities.
The evaluation of tinnitus starts with taking a thorough patient history, identifying any risk factors such as noise exposure, a history of infections, or a family history of hearing loss. A complete examination of the head and neck is then performed to check for abnormalities. A formal hearing test is critical to check for any hearing loss. Based on the findings, further testing with a CT scan or MRI scan may be warranted to make a final diagnosis.
Frustrating to both patients and physicians is that most causes of tinnitus presently do not have a specific cure. Although there is no common cure yet, there are treatments that help many people cope better with the condition.
Hearing aids often are very helpful for people who have hearing loss along with tinnitus. Using a hearing aid adjusted to carefully control outside sound levels may make it easier for you to hear. The better you hear, the less you may notice your tinnitus.
For patients with associated noise-induced hearing loss, prevention of further noise damage is critical. Anything a patient can do to limit their exposure to loud noise – often by wearing earplugs or earmuffs – will help prevent tinnitus from getting worse.
Tabletop sound generators, also known as noise-masking devices, are used as an aid for relaxation or sleep. Placed near the bed, the patient can program a generator to play pleasant sounds such as waves, waterfalls, rain, or the sounds of a summer night. This is all that many patients need to cope with their symptoms.
Acoustic neural stimulation is a relatively new technique for people whose tinnitus is very loud or won’t go away. It uses a palm-sized device and headphones to deliver a broadband acoustic signal embedded in music. The treatment helps stimulate change in the neural circuits of the brain, which eventually desensitizes you to the tinnitus. The device has been shown to be effective in reducing or eliminating tinnitus in a number of study volunteers. However, the device is quite expensive.
Antidepressants and antianxiety drugs might be prescribed by your doctor to improve your mood and help you sleep. Other medications may be available at drugstores and on the Internet as an alternative remedy for tinnitus, but none of these preparations has been proven effective in clinical trials.
Counseling helps many patients learn how to live with their tinnitus. Most counseling programs have an educational component to help patients understand what causes tinnitus. Some counseling programs help patients change the way they think about and react to their tinnitus. Patients may learn some things to do on their own to make the noise less noticeable and to fall asleep at night.
Robert Wilson, MD.