Tinnitus is when you experience ringing or other noises in one or both of your ears. The noise you hear when you have tinnitus isn’t caused by an external sound, and other people usually can’t hear it. Tinnitus can accompany any form of hearing loss, and its presence provides no diagnostic value in determining the cause of a hearing loss. Approximately 15% of the general population experiences some type of tinnitus, with prevalence beyond 20% in aging populations.
Tinnitus is most often described as a ringing in the ears, even though no external sound is present. However, tinnitus can also cause other types of phantom noises in your ears, including:
Most people who have tinnitus have subjective tinnitus, or tinnitus that only you can hear. The noises of tinnitus may vary in pitch from a low roar to a high squeal, and you may hear it in one or both ears. In some cases, the sound can be so loud it interferes with your ability to concentrate or hear external sound. Tinnitus may be present all the time, or it may come and go.
In rare cases, tinnitus can occur as a rhythmic pulsing or whooshing sound, often in time with your heartbeat. This is called pulsatile tinnitus. If you have pulsatile tinnitus, your doctor may be able to hear your tinnitus when he or she does an examination (objective tinnitus).
Common causes of tinnitus
In many people, tinnitus is caused by one of the following:
- Hearing loss. There are tiny, delicate hair cells in your inner ear (cochlea) that move when your ear receives sound waves. This movement triggers electrical signals along the nerve from your ear to your brain (auditory nerve). Your brain interprets these signals as sound.
- If the hairs inside your inner ear are bent or broken — this happens as you age or when you are regularly exposed to loud sounds — they can “leak” random electrical impulses to your brain, causing tinnitus.
- Ear infection or ear canal blockage. Your ear canals can become blocked with a buildup of fluid (ear infection), earwax, dirt or other foreign materials. A blockage can change the pressure in your ear, causing tinnitus.
- Head or neck injuries. Head or neck trauma can affect the inner ear, hearing nerves or brain function linked to hearing. Such injuries usually cause tinnitus in only one ear.
- Medications. A number of medications may cause or worsen tinnitus. Generally, the higher the dose of these medications, the worse tinnitus becomes. Often the unwanted noise disappears when you stop using these drugs. Medications known to cause tinnitus include nonsteroidal anti-inflammatory drugs (NSAIDs) and certain antibiotics, cancer drugs, water pills (diuretics), antimalarial drugs and antidepressants.
Other causes of tinnitus
Less common causes of tinnitus include other ear problems, chronic health conditions, and injuries or conditions that affect the nerves in your ear or the hearing center in your brain.
- Meniere’s disease. Tinnitus can be an early indicator of Meniere’s disease, an inner ear disorder that may be caused by abnormal inner ear fluid pressure.
- Eustachian tube dysfunction. In this condition, the tube in your ear connecting the middle ear to your upper throat remains expanded all the time, which can make your ear feel full.
- Ear bone changes. Stiffening of the bones in your middle ear (otosclerosis) may affect your hearing and cause tinnitus. This condition, caused by abnormal bone growth, tends to run in families.
- Muscle spasms in the inner ear. Muscles in the inner ear can tense up (spasm), which can result in tinnitus, hearing loss and a feeling of fullness in the ear. This sometimes happens for no explainable reason, but can also be caused by neurologic diseases, including multiple sclerosis.
- Temporomandibular joint (TMJ) disorders. Problems with the TMJ, the joint on each side of your head in front of your ears, where your lower jawbone meets your skull, can cause tinnitus.
- Acoustic neuroma or other head and neck tumors. Acoustic neuroma is a noncancerous (benign) tumor that develops on the cranial nerve that runs from your brain to your inner ear and controls balance and hearing. Other head, neck or brain tumors can also cause tinnitus.
- Blood vessel disorders. Conditions that affect your blood vessels — such as atherosclerosis, high blood pressure, or kinked or malformed blood vessels — can cause blood to move through your veins and arteries with more force. These blood flow changes can cause tinnitus or make tinnitus more noticeable.
- Other chronic conditions. Conditions including diabetes, thyroid problems, migraines, anemia, and autoimmune disorders such as rheumatoid arthritis and lupus have all been associated with tinnitus.
Anyone can experience tinnitus, but these factors may increase your risk:
- Loud noise exposure. Loud noises, such as those from heavy equipment, chain saws and firearms, are common sources of noise-related hearing loss. Portable music devices, such as MP3 players, also can cause noise-related hearing loss if played loudly for long periods. People who work in noisy environments — such as factory and construction workers, musicians, and soldiers — are particularly at risk.
- Age. As you age, the number of functioning nerve fibers in your ears declines, possibly causing hearing problems often associated with tinnitus.
- Sex. Men are more likely to experience tinnitus.
- Tobacco and alcohol use. Smokers have a higher risk of developing tinnitus. Drinking alcohol also increases the risk of tinnitus.
- Certain health problems. Obesity, cardiovascular problems, high blood pressure, and a history of arthritis or head injury all increase your risk of tinnitus.
Though tinnitus is commonly associated with hearing loss, tinnitus severity correlates poorly with the degree of hearing loss. About one in seven tinnitus sufferers experiences severe annoyance, and 4% are severely disabled. When severe and persistent, tinnitus may interfere with sleep and ability to concentrate, resulting in considerable psychological distress.
Pulsatile tinnitus—often described by the patient as listening to one’s own heartbeat—should be distinguished from tonal tinnitus. Although often ascribed to conductive hearing loss, pulsatile tinnitus may be far more serious and may indicate a vascular abnormality, such as glomus tumor, venous sinus stenosis, carotid vaso-occlusive disease, arteriovenous malformation, or aneurysm. In contrast, a staccato “clicking” tinnitus may result from middle ear muscle spasm, sometimes associated with palatal myoclonus. The patient typically perceives a rapid series of popping noises, lasting seconds to a few minutes, accompanied by a fluttering feeling in the ear.
For routine, nonpulsatile tinnitus, audiometry should be ordered to rule out an associated hearing loss. For unilateral tinnitus, particularly associated with hearing loss in the absence of an obvious causative factor (ie, noise trauma), an MRI should be obtained to rule out a retrocochlear lesion, such as vestibular schwannoma. MRA and MRV and temporal bone computed tomography (CT) should be considered for patients who have pulsatile tinnitus to exclude a causative vascular lesion or sigmoid sinus abnormality.
Tinnitus does not have a cure yet, but treatments that help many people cope better with the condition are available. Most doctors will offer a combination of the treatments below, depending on the severity of your tinnitus and the areas of your life it affects the most.
- Hearing aids often are 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.
- Counseling helps you learn how to live with your tinnitus. Most counseling programs have an educational component to help you understand what goes on in the brain to cause tinnitus. Some counseling programs also will help you change the way you think about and react to your tinnitus. You might learn some things to do on your own to make the noise less noticeable, to help you relax during the day, or to fall asleep at night.
- Wearable sound generators are small electronic devices that fit in the ear and use a soft, pleasant sound to help mask the tinnitus. Some people want the masking sound to totally cover up their tinnitus, but most prefer a masking level that is just a bit louder than their tinnitus. The masking sound can be a soft “shhhhhhhhhhh,” random tones, or music.
- Tabletop sound generators are used as an aid for relaxation or sleep. Placed near your bed, you can program a generator to play pleasant sounds such as waves, waterfalls, rain, or the sounds of a summer night. If your tinnitus is mild, this might be all you need to help you fall asleep.
- 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 in the brain, which eventually desensitizes you to the tinnitus. The device has been shown to be effective in reducing or eliminating tinnitus in a significant number of study volunteers.
- Cochlear implants are sometimes used in people who have tinnitus along with severe hearing loss. A cochlear implant bypasses the damaged portion of the inner ear and sends electrical signals that directly stimulate the auditory nerve. The device brings in outside sounds that help mask tinnitus and stimulate change in the neural circuits.
- 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 proved effective in clinical trials.