Tinnitus

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Introduction

What is tinnitus?

Tinnitus is the sound of ringing in the ears in the absence of audible noise. The sound may mimic noises, such as buzzing, ringing, clicking, hissing, clanging or wheezing. Tinnitus can have a gradual onset or occur abruptly. It is a common occurrence that can range in severity from being a nuisance to being a symptom of a medical emergency that should be evaluated immediately.

Tinnitus has no known direct cause, but it can be symptomatic of ear infections, foreign objects in the ear, allergies, high blood pressure, anemia, or a condition known as Meniere’s disease (swelling in part of the inner ear canal, causing dizziness and hearing loss). Alcohol, caffeine, and certain drugs are also contributing factors in some cases of tinnitus. Ninety percent of people with tinnitus have significant sensorineural hearing loss.

Seek immediate medical care (call 911) if the ringing in your ear begins after a head injury, or if it is accompanied by such symptoms as nausea with or without vomiting and dizziness or vertigo.

Seek prompt medical care if you have tinnitus that is persistent, recurrent, or causes you concern.

Symptoms

What are the symptoms of tinnitus?

Symptoms of tinnitus occur in the ears, mimicking the sounds of ringing, buzzing, clicking, hissing, clanging or wheezing. Tinnitus derives from the Latin verb “to ring”. The volume may be very low or high, and the sound may occur in one or both ears. You may barely be aware of your tinnitus, or it may distract you from your daily routines. Tinnitus results from the brain’s misinterpreting nerve signals as sound.

Common symptoms of tinnitus

Symptoms of tinnitus include hearing sounds that mimic:

  • Buzzing
  • Chirping
  • Clanging
  • Clicking
  • Hissing
  • Ringing
  • Roaring

Symptoms that may accompany tinnitus

Conditions that cause tinnitus may be accompanied by other symptoms including:

  • Discharge or drainage from the ear
  • Dizziness or vertigo
  • Ear pain or fullness
  • Fever
  • Headache
  • Malaise or lethargy
  • Redness, warmth or swelling

Serious symptoms that might indicate a life-threatening condition

In some cases, tinnitus can indicate a life-threatening condition, especially if it occurs following a head injury. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Confusion or loss of consciousness for even a brief moment

  • Dizziness or vertigo

  • Memory loss

  • Nausea with or without vomiting

  • Severe bleeding

Causes

What causes tinnitus?

The ear canal is lined with tiny hairs that sense movement and vibration conveyed to the brain as sound. Tinnitus occurs when these cells in your ear that respond to sound waves malfunction and transmit electrical impulses that your brain misinterprets as sound.

Tinnitus can be idiopathic, which means that it has no known cause. Alternatively, it may result from various causes, including underlying ear infections, medications, foreign objects in the ear, allergies, high blood pressure, anemia, or Meniere’s disease (swelling in part of the inner ear canal, causing dizziness and hearing loss).

Common causes of tinnitus

Common causes of tinnitus include:

  • Acoustic neuroma (benign tumor of the vestibulocochlear nerve)

  • Aging

  • Anemia

  • Blood vessel disorders

  • Ear infections

  • Ear wax buildup

  • Exposure to loud noises

  • Hearing aids

  • Meniere’s disease (swelling in part of the inner ear canal, causing dizziness and hearing loss)

  • Otosclerosis (hardening of the bones in the ear)

  • Stress

  • Temporomandibular joint (TMJ) pain

Medications that can cause tinnitus

Certain drugs may lead to tinnitus as a side effect including:

  • Antibiotics
  • Antidepressants
  • Antimalaria drugs
  • Aspirin (high doses)
  • Cancer medications

Serious or life-threatening causes of tinnitus

In rare cases, tinnitus may be caused by serious or potentially life-threatening conditions including:

  • Brain tumor
  • Head injury
  • Intracranial vascular abnormality

What are the risk factors for tinnitus?

A number of factors increase the risk of developing tinnitus. Not all people with risk factors will get tinnitus. Risk factors for tinnitus include:

  • Age over 65

  • Ear infections or ear wax blockage

  • Exposure to loud noise

  • Hearing loss attributed to age

  • History of high blood pressure, heart disease, or high cholesterol levels

  • Male gender (tinnitus is more common in men)

  • Use of medications, such as antibiotics, high-dose aspirin, cancer medications, or antimalaria drugs

Reducing your risk of tinnitus

Some risk factors for tinnitus cannot be controlled. However, you can take certain steps to reduce your risk of tinnitus including:

  • Changing medications that are linked with tinnitus. Any changes of medication must be done under the supervision of your health care provider.

  • Reducing your exposure to loud noise

  • Seeing your health care provider for diagnosis and treatment of any underlying disorders

Treatments

How is tinnitus treated?

There is no one identifiable treatment for tinnitus. However, you and your doctor can work toward identifying the underlying cause of your tinnitus. This may include assessing your medications to determine whether any are causing the symptoms, or diagnosing an underlying blood vessel disorder.

Medications for conditions causing tinnitus

Depending on the underlying cause of your tinnitus, your health care provider may prescribe medications including:

  • Antianxiety drugs to reduce stress

  • Antiarrhythmic drugs to help control heart rate

  • Antidepressants to treat depression

  • Hypertension drugs to lower blood pressure

Devices for tinnitus

Some devices may be helpful to mask tinnitus or to allow you to hear better despite your tinnitus. These include:

  • Hearing aids

  • Tinnitus masker (device similar to a hearing aid that directs a controlled noise into your ear to cover the tinnitus)

  • White noise generators

Complementary treatments

Some complementary treatments may help some people in their efforts to deal with tinnitus. These treatments, sometimes referred to as alternative therapies, are used in conjunction with traditional medical treatments. Complementary treatments are not meant to substitute for traditional medical care. Be sure to notify your doctor if you are consuming nutritional supplements or homeopathic (nonprescription) remedies as they may interact with the prescribed medical therapy.

Complementary treatments may include:

  • Acupuncture

  • Biofeedback

  • Hypnosis

  • Massage therapy

  • Nutritional dietary supplements, herbal remedies, tea beverages, and similar products

  • Yoga

What are the potential complications of tinnitus?

Left untreated, tinnitus can interfere with and potentially diminish your quality of life. Tinnitus can disrupt sleep and work, and cause you undue stress, anxiety, and depression. In addition, tinnitus may be a symptom of a serious condition, such as head injury or blood vessel disease, which may lead to serious, even life-threatening complications. Once the underlying cause of your tinnitus is diagnosed, it is important to follow the treatment plan that you and your health care provider design specifically for you.

Complications of untreated tinnitus or its underlying causes, such as head trauma or blood vessel diseases, include:

  • Adverse effects of treatment

  • Brain damage

  • Difficulty performing daily tasks

  • Difficulty sleeping

  • Mood changes, such as anxiety, depression and stress

  • Progressive hearing loss

  • Spread of cancer

  • Spread of infection

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Nov 10
  1. Tinnitus. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/003043.htm
  2. Tinnitus. FamilyDoctor.org. http://familydoctor.org/familydoctor/en/diseases-conditions/tinnitus.html
  3. Ear Ringing or Buzzing (Tinnitus). Merck Manual. https://www.merckmanuals.com/home/ear,-nose,-and-throat-disorders/symptoms-of-ear-disorders/ear-ring...



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