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Health Information | 09/30/2021

Tinnitus: Why Your Ears Are Ringing

By  Dr. Ralph Iannuzzi
If you’ve ever attended a concert or been exposed to loud noises, chances are you’ve experienced ringing, buzzing, or clicking in your ears afterward. Medically known as tinnitus, this common condition can be annoying or frustrating, but it is luckily not life-threatening. Around 10% of Americans have experienced some form of tinnitus for at least 5 minutes in the last year, so it’s important to recognize the symptoms and understand your treatment options.

Symptoms and Diagnosis

Tinnitus is not caused by any external sound, so only the person experiencing the noise can hear it. The noises heard vary in tone and volume depending on the person and the severity of the case. These sounds can either be constant or sporadic.

Some cases of tinnitus are so severe that the loud noises interfere with the individual’s ability to hear external sounds or complete daily tasks. Sometimes, this can result in feelings of depression or anxiety, which you should discuss with your doctor. You should also contact your doctor if you experience hearing loss or dizziness, as these are rare but potentially serious symptoms.

The most common symptom is ringing in one or both ears that sounds like it’s coming from inside the head or far away. Other symptoms include noises such as buzzing, chirping, clicking, hissing, roaring, sirens, whistling, or wind.

Tinnitus is often diagnosed solely based on symptoms; however, your doctor might also perform a hearing (audiological) exam, examine your facial and body movements, or order imaging and lab tests.

Causes of Tinnitus

Several factors can trigger or worsen tinnitus, but the exact cause is not clear. Some of the most common contributing factors include:

Hearing loss: Age-related hearing loss, known as presbycusis, results from damage to the delicate hair cells in the inner ear called the cochlea. This damage can occur from age or regular exposure to loud sounds and can cause random electrical impulses to be sent to your brain, resulting in tinnitus.

Ear infection or blockage: When ear canals become blocked with a buildup of fluid, earwax, or dirt, an ear infection can occur, or the pressure in your ear can change, causing tinnitus.

Medication: Some high doses of medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), certain antibiotics, certain cancer drugs, water pills, antimalarial drugs, and antidepressants have been shown to cause or worsen tinnitus.

Head or neck injury: Head and neck trauma can affect the inner ear, damaging hearing nerves or brain functions linked to hearing. This type of trauma can result in tinnitus, typically only on the side of the head that was injured.

Less common causes include:

Chronic conditions: Conditions such as diabetes, thyroid problems, migraines, anemia, rheumatoid arthritis, and lupus have all shown connections to tinnitus.

Temporomandibular joint (TMJ) disorders: TMJ disorders and teeth grinding can cause tinnitus, and the two are often closely linked.

Meniere’s disease: Meniere’s disease is an inner ear disorder caused by abnormal inner ear fluid pressure and can result in tinnitus early in the disease.

Eustachian tube dysfunction: This condition causes the tube connecting the middle ear to the upper throat to remain expanded at all times, creating a full feeling in the ear and resulting in tinnitus.

Otosclerosis: Otosclerosis is the stiffening of the bones in the middle ear caused by abnormal bone growth, which can affect hearing and cause tinnitus.

Muscle spasms: Muscle spasms in the inner ear can result in tinnitus, hearing loss, and a feeling of fullness in the ear. These spasms that occur when the ear muscles suddenly tense up sometimes happen for no explainable reason but can also be a symptom of neurologic diseases, including multiple sclerosis.

Blood vessel disorders: Conditions that affect the 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, resulting in new or worsened tinnitus.

Acoustic neuroma or other head and neck tumors: Acoustic neuroma, a noncancerous tumor that develops on the cranial nerve, can cause tinnitus along with other head, neck, and brain tumors.

Diagnosing Tinnitus

Diagnostic evaluation for tinnitus includes a careful examination by your doctor to assess possible causes. Frequently, an evaluation by an otolaryngologist (ENT) will include an audiogram (hearing test). On occasion but much less frequently, more advanced testing may be necessary, including a CT or MRI scan.

Treatment Options

Treatment for tinnitus depends on the patient, severity of the case, the frequency of sounds, and its impact on everyday life. Earwax removal, hearing aids, medication changes, and treating blood vessel conditions are common first steps doctors take with patients.

When tinnitus is persistent, noise suppression and counseling are often effective at managing symptoms. White noise machines and in-ear masking devices produce a continuous, low-level sound that suppresses symptoms and may help patients fall asleep.

Tinnitus retraining therapy (TRT) is an individualized program administered by an audiologist or at a tinnitus treatment center, combining sound masking techniques and counseling. Over time, TRT helps patients regain everyday functioning. Cognitive-behavioral therapy (CBT) and other forms of counseling can also help patients learn coping techniques to ease frustration, anxiety, and depression caused by tinnitus. There are also a variety of apps available for your smartphone that can help with sound masking.

Lastly, some data exists that supports the use of B-complex vitamins as well as melatonin for the treatment of tinnitus. The likelihood of success varies from individual to individual, and the decision to try these should always be discussed with your doctor.

In the vast majority of patients, tinnitus is a benign condition, however annoying it can be. Serious medical conditions are rarely the cause. Although there is no medical cure for tinnitus, researchers are constantly working on new treatments to help patients manage symptoms. Above all, it’s important to stay calm at the onset of symptoms, as stress can make symptoms worse. If you’re concerned about ringing in your ears, your Atrius Health provider can answer questions and help you develop a customized treatment plan.

About The Author

Dr. Ralph Iannuzzi

Dr. Ralph Iannuzzi is an otolaryngologist (ear, nose, and throat or ENT physician) at Atrius Health. Dr. Iannuzzi received his medical degree from the University of Massachusetts Medical School and completed his surgical internship at St. Elizabeth’s Medical Center and ENT residency at the Massachusetts Eye and Ear Infirmary. Since joining Atrius Health in 2008, Dr. Iannuzzi has served as chief of the Atrius Health ENT department, chief of cosmetics, chief of allergy and associate chair for specialties. He has served on the Board of Trustees for the organization. He is an assistant professor at Harvard Medical School, Senior Surgeon at Mass Eye and Ear and was previously an assistant professor at the University of Massachusetts Medical School.

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