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Ringing in the Ears

(Tinnitus)

Definition

Tinnitus is the perception of abnormal ear or head noises. Tinnitus is unpleasant enough itself. It is also sometimes a symptom of other problems, including hearing loss, tumors, and narrowing of the blood vessels.
Noises may be high pitched and “ringing,” or sound more like a clicking. Some tinnitus is pulsatile. This means that it may be caused by the flow of blood that accompanies each heartbeat. This type of tinnitus is a result of the narrowing of the blood vessels.
The Ear
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Causes

Many diseases and conditions are associated with tinnitus, including:
Occasional episodes of tinnitus lasting at most a few minutes are quite common in normal people, especially after exposure to loud noises.

Risk Factors

Your risk of tinnitus increases with:
  • Exposure to loud noises
  • Depression
  • Stress
  • Fatigue
  • Anxiety
  • Certain medicines:
    • Aspirin
    • Quinine and its derivatives
    • Some antibiotics (aminoglycosides)
    • Some diuretics (water pills)
  • Toxins:
    • Heavy metals
    • Carbon monoxide
    • Alcohol

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
  • Ringing that comes and goes
  • 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, dizziness, change in personality, speech, or weakness in any body area
  • Starts after head or neck injury
  • Is associated with new medicine
  • Is pulsatile
  • Is associated with pain in the ear, fever, nausea, or vomiting

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. 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 (eg, breathing, dizziness)
  • The medicines that you take
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. Other tests, such as a magnetic resonance imaging (MRI) scan, may be ordered to rule out serious conditions.

Treatment

Tinnitus treatment depends on what is causing the symptoms. This may mean, for example:
  • 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
Therapy aims to eliminate or reduce bothersome sensations. Treatment may include:

Medication

No medicine has been shown to be very effective in treating tinnitus. Your doctor may still try to use some medicines to help your symptoms, though. Examples of medicines often tried include antidepressants and sedatives.
If you have Meniere's disease, your doctor may prescribe medicine 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:
  • Learn and practice stress management and relaxation techniques.
  • Biofeedback may help. Biofeedback teaches people how to control body functions they normally do not think about.
  • Consider seeing a counselor to develop new coping skills and relaxation techniques.
  • Consider joining a support group .
  • Avoid anything that makes tinnitus sensations worse, such as:
  • Exercise regularly to improve circulation.
  • Make time to relax and get enough sleep.
  • Playing a radio or a white-noise machine for about 30 minutes at bedtime may help relieve the ringing sensations at night.

Surgery

Surgery may help relieve certain causes of tinnitus if the cause of the tinnitus is treated.
  • Tinnitus caused by a tumor frequently subsides after the growth is removed.
  • If the tinnitus is due to wax build-up, it can be relieved by cleaning the ears.
  • 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 dizziness.

Prevention

You may be able to prevent tinnitus from developing with a few simple measures:
  • 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 drugs 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

Acute otitis media. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated December 13, 2011. Accessed January 7, 2012.

American Tinnitus Association website. Available at: http://www.ata.org . Accessed July 7, 2009.

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

FAQ's about tinnitus. American Speech-Language-Hearing Association website. Available at: http://www.asha.org/default.htm . Accessed July 7, 2009.

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

Tinnitus. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated December 15, 2011. Accessed January 7, 2012.

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

Tinnitus. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/tinnitus/ds00365 . Updated June 2009. Accessed July 7, 2009.

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

Revision Information

  • Reviewer: Kari Kassir, MD
  • Review Date: 09/2012 -
  • Update Date: 00/91/2012 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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