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
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. Tinnitus management
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.Tinnitus management
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. Tinnitus management
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.Tinnitus management
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. Tinnitus management
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.Tinnitus management
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.Tinnitus management
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.
• 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.
• Sleep problems
• Trouble concentrating
• Memory problems
• Anxiety and irritability
• Problems with work and family life
To help identify the cause of your tinnitus, your doctor will likely ask you about your medical history and examine your ears, head and neck. Common tests include:
Hearing (audiological) exam
During the test, you’ll sit in a soundproof room wearing earphones that transmit specific sounds into one ear at a time. You’ll indicate when you can hear the sound, and your results will be compared with results considered normal for your age. This can help rule out or identify possible causes of tinnitus.
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Your doctor may ask you to move your eyes, clench your jaw, or move your neck, arms and legs. If your tinnitus changes or worsens, it may help identify an underlying disorder that needs treatment.
Depending on the suspected cause of your tinnitus, you may need imaging tests such as CT or MRI scans.
Your doctor may draw blood to check for anemia, thyroid problems, heart disease or vitamin deficiencies.
• Clicking – This type of sound suggests that muscle contractions in and around your ear might be the cause of your tinnitus.
• Pulsing, rushing or humming – These sounds usually stem from blood vessel (vascular) causes, such as high blood pressure, and you may notice them when you exercise or change positions, such as when you lie down or stand up.
• Low-pitched ringing – This type of sound may point to ear canal blockages, Meniere’s disease or stiff inner ear bones (otosclerosis).
• High-pitched ringing – This is the most commonly heard tinnitus sound. Likely causes include loud noise exposure, hearing loss or medications. Acoustic neuroma can cause continuous, high-pitched ringing in one ear.
An earwax blockage can decrease tinnitus symptoms.
Treating a blood vessel condition
Underlying blood vessel conditions may require medication, surgery or another treatment to address the problem.
If your tinnitus is caused by noise-induced or age-related hearing loss, using hearing aids may help improve your symptoms.
Changing your medication
If a medication you’re taking appears to be the cause of tinnitus, your doctor may recommend stopping or reducing the drug, or switching to a different medication.
White noise machines
These devices, which produce a sound similar to static or environmental sounds such as falling rain or ocean waves, are often an effective treatment for tinnitus. You may want to try a white noise machine with pillow speakers to help you sleep. Fans, humidifiers, dehumidifiers and air conditioners in the bedroom also produce white noise and may help make tinnitus less noticeable at night.
Worn in the ear and similar to hearing aids, these devices produce a continuous, low-level white noise that suppresses tinnitus symptoms.
Tinnitus retraining therapy (TRT)
TRT is an individualized program that is usually administered by an audiologist or at a tinnitus treatment center. TRT combines sound masking and counseling from a trained professional. Typically, you wear a device in your ear that helps mask your tinnitus symptoms while you also receive directive counseling. Over time, TRT may help you notice tinnitus less and feel less distressed by your symptoms.
Cognitive behavioral therapy (CBT) or other forms of counseling
A licensed mental health professional or psychologist can help you learn coping techniques to make tinnitus symptoms less bothersome. Counseling can also help with other problems often linked to tinnitus, including anxiety and depression. Many mental health professionals offer CBT for tinnitus in individual or group sessions, and CBT programs are also available online.
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