What are the common causes of tinnitus. How does tinnitus affect daily life. What are effective treatments for managing tinnitus symptoms. Can lifestyle changes help reduce tinnitus severity. Are there any natural remedies for tinnitus relief.

The Nature and Prevalence of Tinnitus

Tinnitus, often described as a ringing or buzzing sound in the ears, is a common condition affecting millions of people worldwide. This persistent noise, which has no external source, can manifest in various forms – from whistling and chirping to humming and roaring. The sound may seem to originate from one or both ears, inside the head, or even from a distance. Its nature can be constant or intermittent, steady or pulsating.

In the United States alone, an estimated 50 to 60 million individuals suffer from tinnitus, with a higher prevalence among those over 55 years old. This condition is strongly associated with hearing loss, although it rarely indicates serious health problems or impending deafness.

Types of Tinnitus

• Subjective tinnitus: Only perceivable by the affected individual
• Objective tinnitus: Can be heard by others, often related to vascular or muscular issues
• Pulsatile tinnitus: Rhythmic sounds coinciding with the heartbeat

Is tinnitus always a chronic condition. While many experience temporary tinnitus after exposure to loud noises, chronic tinnitus is diagnosed when symptoms persist for more than six months. The course of chronic tinnitus can be unpredictable, with symptoms remaining stable or worsening over time. In approximately 10% of cases, tinnitus significantly interferes with daily life, necessitating professional intervention.

Causes and Risk Factors of Tinnitus

Understanding the underlying causes of tinnitus is crucial for effective management and treatment. While the exact mechanisms are not fully understood, several factors have been identified as potential triggers or contributors to tinnitus development.

Common Causes of Tinnitus

1. Noise-induced hearing loss
2. Age-related hearing loss (presbycusis)
3. Ototoxic medications
4. Earwax blockage
5. Middle ear infections or tumors
6. Meniere’s disease
7. Head or neck injuries

How does noise exposure contribute to tinnitus. Prolonged exposure to loud noises can damage the delicate hair cells in the cochlea, disrupting the normal auditory pathway. This disruption can lead to abnormal neural activity, resulting in the perception of phantom sounds characteristic of tinnitus.

The Role of Auditory Pathways in Tinnitus

Tinnitus can originate at any point along the auditory pathway, from the outer ear to the brain’s auditory cortex. When hair cells in the cochlea are damaged, the brain may not receive the expected signals from these cells. In response, the brain may “turn up the gain” on auditory pathways, similar to increasing the volume on a radio to find a weak signal. This amplification of neural activity can manifest as the perceived sounds of tinnitus.

Symptoms and Impact of Tinnitus on Daily Life

The symptoms of tinnitus can vary greatly among individuals, both in terms of the perceived sound and its impact on quality of life. While some people may find their tinnitus to be a minor annoyance, others may experience significant distress and disruption to their daily activities.

Common Tinnitus Symptoms

• Persistent ringing, buzzing, or whistling sounds
• Difficulty concentrating or sleeping
• Increased irritability or anxiety
• Sensitivity to loud noises
• Dizziness or balance problems (in some cases)

How does tinnitus affect sleep quality. Many individuals with tinnitus report difficulties falling asleep or staying asleep due to the constant noise in their ears. This sleep disturbance can lead to daytime fatigue, mood changes, and decreased cognitive performance.

Psychological Impact of Tinnitus

The persistent nature of tinnitus can take a toll on an individual’s mental health. Some people may experience anxiety, depression, or stress related to their tinnitus symptoms. In severe cases, tinnitus can lead to social isolation and a reduced quality of life.

Diagnosis and Evaluation of Tinnitus

Proper diagnosis of tinnitus is essential for developing an effective treatment plan. Healthcare providers use a combination of medical history, physical examination, and specialized tests to evaluate tinnitus and identify any underlying causes.

Diagnostic Procedures for Tinnitus

1. Comprehensive medical history
2. Physical examination of the ears, head, and neck
3. Audiological evaluation
4. Imaging studies (in some cases)
5. Blood tests to rule out systemic disorders

What specific tests are used to diagnose tinnitus. Audiological evaluations, including pure tone audiometry and tympanometry, help assess hearing function and identify any hearing loss associated with tinnitus. In some cases, imaging studies such as MRI or CT scans may be recommended to rule out structural abnormalities or tumors.

Treatment Options and Management Strategies for Tinnitus

While there is no cure for chronic tinnitus, various treatment options and management strategies can help minimize its impact on daily life. The goal of treatment is to reduce the perception of tinnitus and improve overall quality of life.

Medical Treatments for Tinnitus

• Hearing aids (for tinnitus associated with hearing loss)
• Sound therapy devices
• Cognitive Behavioral Therapy (CBT)
• Tinnitus Retraining Therapy (TRT)
• Medications (in some cases)

How does sound therapy help with tinnitus. Sound therapy involves the use of external noise to alter the perception of or reaction to tinnitus. This can include white noise machines, nature sounds, or specially designed sound generators that help mask or distract from the tinnitus sound.

Lifestyle Modifications for Tinnitus Management

In addition to medical treatments, certain lifestyle changes can help reduce the severity of tinnitus symptoms:

1. Stress reduction techniques (e.g., meditation, yoga)
2. Regular exercise
3. Avoiding triggers (e.g., loud noises, certain foods)
4. Improving sleep hygiene
5. Limiting caffeine and alcohol intake

Can dietary changes affect tinnitus symptoms. While research is ongoing, some individuals report improvements in their tinnitus symptoms after reducing their intake of caffeine, alcohol, and high-sodium foods. However, the effectiveness of dietary changes can vary from person to person.

Coping Strategies and Self-Help Techniques for Tinnitus

Learning to cope with tinnitus is an essential part of managing the condition. Various self-help techniques can help individuals reduce the impact of tinnitus on their daily lives and improve their overall well-being.

Mindfulness and Relaxation Techniques

• Progressive muscle relaxation
• Deep breathing exercises
• Guided imagery
• Mindfulness meditation

How can mindfulness help with tinnitus management. Mindfulness practices can help individuals develop a different relationship with their tinnitus, reducing emotional reactivity and stress associated with the condition. Regular practice may lead to decreased tinnitus-related distress and improved quality of life.

Support Groups and Counseling

Joining a tinnitus support group or seeking counseling can provide valuable emotional support and practical coping strategies. Sharing experiences with others who understand the challenges of living with tinnitus can be incredibly beneficial for many individuals.

Prevention and Risk Reduction for Tinnitus

While not all cases of tinnitus can be prevented, there are several steps individuals can take to reduce their risk of developing the condition or exacerbating existing symptoms.

Noise Protection Strategies

1. Use hearing protection in loud environments
2. Limit exposure to loud noises
3. Take regular breaks when exposed to prolonged noise
4. Keep music and TV volumes at moderate levels

What are the recommended noise exposure limits. The National Institute for Occupational Safety and Health (NIOSH) recommends limiting noise exposure to 85 decibels (dB) or less for 8 hours a day to prevent hearing damage and reduce the risk of tinnitus.

Healthy Lifestyle Choices

Maintaining overall health can help reduce the risk of developing tinnitus or minimize its impact:

• Regular cardiovascular exercise
• Balanced diet rich in antioxidants
• Adequate sleep and stress management
• Regular hearing check-ups

Can certain vitamins or supplements help prevent tinnitus. While research is ongoing, some studies suggest that vitamins B12 and D, as well as zinc and magnesium, may play a role in maintaining ear health. However, it’s important to consult with a healthcare provider before starting any supplement regimen.

Emerging Research and Future Directions in Tinnitus Treatment

The field of tinnitus research is rapidly evolving, with scientists and clinicians exploring new approaches to understanding and treating this complex condition. Several promising areas of research offer hope for improved tinnitus management in the future.

Neurostimulation Techniques

• Transcranial magnetic stimulation (TMS)
• Vagus nerve stimulation
• Deep brain stimulation

How do neurostimulation techniques work for tinnitus. These approaches aim to modulate neural activity in brain regions associated with tinnitus perception. By applying targeted stimulation, researchers hope to disrupt the abnormal neural patterns that contribute to tinnitus symptoms.

Gene Therapy and Regenerative Medicine

Advances in gene therapy and regenerative medicine offer potential for repairing or regenerating damaged hair cells in the inner ear. This could potentially address the underlying causes of tinnitus in cases related to hearing loss.

Pharmacological Interventions

Researchers are investigating new drug targets and developing novel pharmaceutical interventions for tinnitus. These may include drugs that modulate neurotransmitter activity or target specific neural pathways involved in tinnitus perception.

What are some promising drug candidates for tinnitus treatment. While still in early stages, drugs targeting GABA receptors, potassium channels, and NMDA receptors have shown potential in preclinical studies. However, more research is needed to establish their safety and efficacy in humans.

As research in these areas progresses, individuals living with tinnitus can look forward to potentially more effective and tailored treatment options in the future. In the meantime, a combination of existing treatments, lifestyle modifications, and coping strategies can help many people effectively manage their tinnitus symptoms and improve their quality of life.

Tinnitus: Ringing in the ears and what to do about it

Constant noise in the head— such as ringing in the ears—rarely indicates a serious health problem, but it sure can be annoying. Here’s how to minimize it.

Tinnitus (pronounced tih-NITE-us or TIN-ih-tus) is sound in the head with no external source. For many, it’s a ringing sound, while for others, it’s whistling, buzzing, chirping, hissing, humming, roaring, or even shrieking. The sound may seem to come from one ear or both, from inside the head, or from a distance. It may be constant or intermittent, steady or pulsating.

Almost everyone has had tinnitus for a short time after being exposed to extremely loud noise. For example, attending a loud concert can trigger short-lived tinnitus. Some medications (especially aspirin and other nonsteroidal anti-inflammatory drugs taken in high doses) can cause tinnitus that goes away when the drug is discontinued. When it lasts more than six months, it’s known as chronic tinnitus. As many as 50 to 60 million people in the United States suffer from this condition; it’s especially common in people over age 55 and strongly associated with hearing loss. Many people worry that tinnitus is a sign that they are going deaf or have another serious medical problem, but it rarely is.

Most tinnitus is subjective, meaning that only you can hear the noise. But sometimes it’s objective, meaning that someone else can hear it, too. For example, if you have a heart murmur, you may hear a whooshing sound with every heartbeat; your clinician can also hear that sound through a stethoscope. Some people hear their heartbeat inside the ear — a phenomenon called pulsatile tinnitus. It’s more likely to happen in older people, because blood flow tends to be more turbulent in arteries whose walls have stiffened with age. Pulsatile tinnitus may be more noticeable at night, when you’re lying in bed and there are fewer external sounds to mask the tinnitus. If you notice any new pulsatile tinnitus, you should consult a clinician, because in rare cases it is a sign of a tumor or blood vessel damage.

The course of chronic tinnitus is unpredictable. Sometimes the symptoms remain the same, and sometimes they get worse. In about 10% of cases, the condition interferes with everyday life so much that professional help is needed.

While there’s no cure for chronic tinnitus, it often becomes less noticeable and more manageable over time. You can help ease the symptoms by educating yourself about the condition — for example, understanding that it’s not dangerous. There are also several ways to help tune out the noise and minimize its impact.

What’s going on?

Most people who seek medical help for tinnitus experience it as subjective, constant sound like constant ringing in the ears or a buzzing sound in the ear, and most have some degree of hearing loss. Things that cause hearing loss (and tinnitus) include loud noise, medications that damage the nerves in the ear (ototoxic drugs), impacted earwax, middle ear problems (such as infections and vascular tumors), and aging. Tinnitus can also be a symptom of Meniere’s disease, a disorder of the balance mechanism in the inner ear.

Tinnitus can arise anywhere along the auditory pathway, from the outer ear through the middle and inner ear to the brain’s auditory cortex, where it’s thought to be encoded (in a sense, imprinted). One of the most common causes of tinnitus is damage to the hair cells in the cochlea (see “Auditory pathways and tinnitus”). These cells help transform sound waves into nerve signals. If the auditory pathways or circuits in the brain don’t receive the signals they’re expecting from the cochlea, the brain in effect “turns up the gain” on those pathways in an effort to detect the signal — in much the same way that you turn up the volume on a car radio when you’re trying to find a station’s signal. The resulting electrical noise takes the form of tinnitus — a sound that is high-pitched if hearing loss is in the high-frequency range and low-pitched if it’s in the low-frequency range. This kind of tinnitus resembles phantom limb pain in an amputee — the brain is producing abnormal nerve signals to compensate for missing input.

Most tinnitus is “sensorineural,” meaning that it’s due to hearing loss at the cochlea or cochlear nerve level. But tinnitus may originate in other places. Our bodies normally produce sounds (called somatic sounds) that we usually don’t notice because we are listening to external sounds. Anything that blocks normal hearing can bring somatic sounds to our attention. For example, you may get head noise when earwax blocks the outer ear.

Evaluate and treat underlying problems

If you develop tinnitus, it’s important to see your clinician. She or he will take a medical history, give you a physical examination, and do a series of tests to try to find the source of the problem. She or he will also ask you to describe the noise you’re hearing (including its pitch and sound quality, and whether it’s constant or periodic, steady or pulsatile) and the times and places in which you hear it. Your clinician will review your medical history, your current and past exposure to noise, and any medications or supplements you’re taking. Tinnitus can be a side effect of many medications, especially when taken at higher doses (see “Some drugs that can cause or worsen tinnitus”).

Musculoskeletal factors — jaw clenching, tooth grinding, prior injury, or muscle tension in the neck — sometimes make tinnitus more noticeable, so your clinician may ask you to tighten muscles or move the jaw or neck in certain ways to see if the sound changes. If tight muscles are part of the problem, massage therapy may help relieve it.

Tinnitus that’s continuous, steady, and high-pitched (the most common type) generally indicates a problem in the auditory system and requires hearing tests conducted by an audiologist. Pulsatile tinnitus calls for a medical evaluation, especially if the noise is frequent or constant. MRI or CT imaging may be needed to check for a tumor or blood vessel abnormality.

Your general health can affect the severity and impact of tinnitus, so this is also a good time to take stock of your diet, physical activity, sleep, and stress level — and take steps to improve them. You may also be able to reduce the impact of tinnitus by treating depression, anxiety, insomnia, and pain with medications or psychotherapy.

If you’re often exposed to loud noises at work or at home, it’s important to reduce the risk of hearing loss (or further hearing loss) by using protectors such as earplugs or earmuff-like or custom-fitted devices.

Managing tinnitus

In addition to treating associated problems (such as depression or insomnia), there are several strategies that can help make tinnitus less bothersome. No single approach works for everyone, and you may need to try various combinations of techniques before you find what works for you. If you have age-related hearing loss, a hearing aid can often make tinnitus less noticeable by amplifying outside sounds.

There is no FDA-approved drug treatment for tinnitus, and controlled trials have not found any drug, supplement, or herb to be any more effective than a placebo. That includes ginkgo biloba, which is sometimes promoted for this purpose. Some patients believe that acupuncture helps, but it too has been found to be no better than a placebo.

The most effective approaches are behavioral strategies and sound-generating devices, often used in combination. They include the following:

Cognitive behavioral therapy (CBT). CBT uses techniques such as cognitive restructuring and relaxation to change the way patients think about and respond to tinnitus. Patients usually keep a diary and perform “homework” to help build their coping skills. Therapy is generally short-term — for example, weekly sessions for two to six months. CBT may not make the sound less loud, but it can make it significantly less bothersome and improve quality of life.

Tinnitus retraining therapy (TRT). This technique is based on the assumption that tinnitus results from abnormal neuronal activity (see “What’s going on?”). The aim is to habituate the auditory system to the tinnitus signals, making them less noticeable or less bothersome. The main components of TRT are individual counseling (to explain the auditory system, how tinnitus develops, and how TRT can help) and sound therapy. A device is inserted in the ear to generate low-level noise and environmental sounds that match the pitch, volume, and quality of the patient’s tinnitus. Depending on the severity of the symptoms, treatment may last one to two years.

When TRT was developed in the 1980s by neuroscientist Dr. Pawel Jastreboff, it was designed to be administered according to a strict protocol. Today, the term TRT is being used to describe modified versions of this therapy, and the variations make accurate assessment of its effectiveness difficult. Individual studies have reported improvements in as many as 80% of patients with high-pitched tinnitus.

Masking. Masking devices, worn like hearing aids, generate low-level white noise (a high-pitched hiss, for example) that can reduce the perception of tinnitus and sometimes also produce residual inhibition — less noticeable tinnitus for a short time after the masker is turned off. A specialized device isn’t always necessary for masking; often, playing music or having a radio, fan, or white-noise machine on in the background is enough. Although there’s not enough evidence from randomized trials to draw any conclusions about the effectiveness of masking, hearing experts often recommend a trial of simple masking strategies (such as setting a radio at low volume between stations) before they turn to more expensive options.

Biofeedback and stress management. Tinnitus is stressful, and stress can worsen tinnitus. Biofeedback is a relaxation technique that helps control stress by changing bodily responses. Electrodes attached to the skin feed information about physiological processes such as pulse, skin temperature, and muscle tension into a computer, which displays the output on a monitor. Patients learn how to alter these processes and reduce the body’s stress response by changing their thoughts and feelings. Mindfulness-based stress reduction techniques may also help.

Not all insurance companies cover tinnitus treatments in the same way, so be sure to check your coverage. If you’re willing to enroll in a research study, you may be able to receive a cutting-edge treatment free. (For more information, go to www.clinicaltrials.gov, and enter the search term “tinnitus.”)

Image: Casarsa_Guru/Getty Images

What Is Tinnitus? — Causes and Treatment

What is tinnitus?

Tinnitus (pronounced tih-NITE-us or TIN-uh-tus) is the perception of sound that does not have an external source, so other people cannot hear it.

Tinnitus is commonly described as a ringing sound, but some people hear other types of sounds, such as roaring or buzzing. Tinnitus is common, with surveys estimating that 10 to 25% of adults have it. Children can also have tinnitus. For children and adults, tinnitus may improve or even go away over time, but in some cases, it worsens with time. When tinnitus lasts for three months or longer, it is considered chronic.

The causes of tinnitus are unclear, but most people who have it have some degree of hearing loss. Tinnitus is only rarely associated with a serious medical problem and is usually not severe enough to interfere with daily life. However, some people find that it affects their mood and their ability to sleep or concentrate. In severe cases, tinnitus can lead to anxiety or depression.

Currently, there is no cure for tinnitus, but there are ways to reduce symptoms. Common approaches include the use of sound therapy devices (including hearing aids), behavioral therapies, and medications.

What are the symptoms of tinnitus?

The symptoms of tinnitus can vary significantly from person to person. You may hear phantom sounds in one ear, in both ears, and in your head. The phantom sound may ring, buzz, roar, whistle, hum, click, hiss, or squeal. The sound may be soft or loud and may be low or high pitched. It may come and go or be present all the time. Sometimes, moving your head, neck, or eyes, or touching certain parts of your body may produce tinnitus symptoms or temporarily change the quality of the perceived sound. This is called somatosensory (pronounced so-ma-toe-SENSE-uh-ree) tinnitus.

Most cases of tinnitus are subjective, meaning that only you can hear the sounds. In rare cases, the sound pulsates rhythmically, often in time to your heartbeat. In these cases, a doctor may be able to hear the sounds with a stethoscope and, if so, it is considered to be objective tinnitus. Often, objective tinnitus has an identifiable cause and is treatable.

What causes tinnitus?

While the exact causes of tinnitus are not fully understood, it has been linked to the following:

• Noise exposure. Many people experience tinnitus after being exposed to loud noise in a workplace setting or at a sporting event or concert. Tinnitus is also the most common service-related disability among veterans because of loud noise they may have experienced from gunfire, machinery, bomb blasts, or other similar sources.
• Hearing loss. Hearing loss, which can be caused by factors such as aging or exposure to loud noise, is strongly associated with tinnitus. Some people with hearing loss, however, never develop tinnitus.
• Medications. Tinnitus can be a side effect of taking certain medications, especially if they are taken at high doses. Medications associated with tinnitus include non-steroidal anti-inflammatory drugs (e.g., ibuprofen, naproxen, and aspirin), certain antibiotics, anti-cancer drugs, anti-malaria medications, and antidepressants.
• Earwax or an ear infection. Blockage of the ear canal by earwax or by fluid from an ear infection can trigger tinnitus.
• Head or neck injuries. A head/neck injury can damage structures of the ear, the nerve that carries sound signals to the brain, or areas of the brain that process sound, causing tinnitus.

Less common tinnitus risk factors include:

• Ménière’s disease. Tinnitus can be a symptom of Ménière’s disease, an inner ear disorder that can also cause balance problems and hearing loss.
• Jaw joint problems. The joint that connects the lower jaw to the skull is close to the ear. Jaw clenching or tooth grinding can damage surrounding tissue, causing or worsening tinnitus.
• Tumor-related disorders. A vestibular schwannoma (acoustic neuroma) is a benign tumor on a nerve that leads from the inner ear to the brain. Acoustic neuromas and other head, neck, and brain tumors can cause tinnitus.
• Blood vessel problems. High blood pressure, atherosclerosis, or malformations in blood vessels, especially if they are in or close to the ear, can alter blood flow and cause tinnitus.
• Chronic conditions. Diabetes, migraines, thyroid disorders, anemia, and certain autoimmune disorders such as lupus and multiple sclerosis are among the chronic conditions that have been linked to tinnitus.

While there are many possible causes of tinnitus, some people develop it for no known reason.

What creates the perception of noise in the ears?

One leading theory is that tinnitus can occur when damage to the inner ear changes the signal carried by nerves to the parts of your brain that process sound. A way to think about this is that while tinnitus may seem to occur in your ear, the phantom sounds are instead generated by your brain, in an area called the auditory cortex.

Other evidence shows that abnormal interactions between the auditory cortex and other neural circuits may play a role in tinnitus. The auditory cortex communicates with other parts of the brain, such as the parts that control attention and emotions, and studies have shown that some people with tinnitus have changes in these nonauditory brain regions.

How is tinnitus diagnosed?

If you have tinnitus, first see your primary care doctor, who will check for earwax or fluid from an ear infection that could be blocking your ear canal. Your doctor will also ask about your medical history to find out if an underlying condition or a medication may be causing your tinnitus.

Next, you may be referred to an otolaryngologist (commonly called an ear, nose, and throat doctor, or an ENT). The ENT will ask you to describe the tinnitus sounds and when they started, and will examine your head, neck, and ears. You might also be referred to an audiologist, who can measure your hearing and evaluate your tinnitus.

The ENT may order imaging tests, especially if your tinnitus pulsates. Imaging tests such as magnetic resonance imaging (MRI), computed tomography (CT), or ultrasound can help reveal whether a structural problem or underlying medical condition is causing your tinnitus.

What treatments can help tinnitus?

When tinnitus has an underlying physiological cause, such as earwax or jaw joint problems, addressing the cause can eliminate or greatly reduce symptoms. But for many people, symptoms can persist for months or even years. There are several ways to lessen the impact of tinnitus. Below are some of the treatments that your doctor may recommend.

What types of tinnitus-related research are scientists conducting?

Investigators at the National Institutes of Health (NIH) and at other research centers across the country, many supported by NIDCD, are working to better understand what causes tinnitus and to develop new treatment strategies. Evidence suggests that tinnitus is caused by changes in neural networks in the brain, so many research efforts are aimed at testing the benefit of magnetic or electrical stimulation of the brain.

Here are some examples of current research topics:

• Electric stimulation. Cochlear implants have been shown to suppress tinnitus, in addition to restoring functional hearing in those with severe-to-profound hearing loss, but they are not suitable for the majority of tinnitus sufferers who have significant acoustic hearing. Researchers are using non-invasive electric stimulation on parts of the inner ear to suppress tinnitus while not damaging acoustic hearing.
• Bimodal stimulation. Acoustic stimulation may be combined with other types of electric stimulation on the tongue, head or neck areas, or vagus nerve to provide long-term relief for tinnitus.
• Repetitive transcranial magnetic stimulation (rTMS). In this painless, noninvasive procedure, short magnetic pulses are delivered to the brain using a device called an electromagnetic coil. Preliminary trials of rTMS have yielded mixed results, so researchers are now studying the ideal coil placement and frequency of patient visits.
• Deep brain stimulation (DBS). This procedure is normally used to treat people with certain types of movement disorders or neuropsychiatric conditions. Some people being treated with DBS found that the procedure unexpectedly reduced their tinnitus symptoms. Unlike rTMS, DBS is invasive and involves surgery to implant electrodes deep within the brain. While early results on the use of DBS for tinnitus have been encouraging, more research is needed to determine if the procedure is warranted for treating tinnitus alone.
• Medications. While there are currently no medications approved by the U.S. Food and Drug Administration for treating tinnitus, researchers are testing a number of options.
  • Researchers have identified a drug that reduces tinnitus in mice, and they are working to develop second-generation versions that may one day prove effective in people.
  • Researchers are studying how tinnitus is linked to hyperactivity in central auditory neurons following damage to the cochlea, the structure in the inner ear that senses sound. Scientists are working to determine the cellular mechanisms that cause increased activity, and to identify drugs that may control it and relieve tinnitus symptoms.
• Genetic risk factors. Tinnitus and hearing impairment affect many older people. Scientists are reviewing a large genetic database of people with tinnitus and age-related hearing loss to identify genetic risk factors for both conditions. Determining genetic associations with age-related hearing impairment and tinnitus may have a broad impact on risk prediction, prevention, screening, and treatment.
• Personalized treatment. Tinnitus symptoms are diverse, with different people hearing different sounds in different patterns. The results of brain imaging studies in people with tinnitus also vary considerably from person to person. Using data gathered from study participants who are tracking their tinnitus using a smartphone app, along with brain imaging data, scientists are working to characterize the many forms that the condition can take. They aim to describe distinct tinnitus profiles and to identify the most effective treatment approaches for each one.

Where can I find additional information about tinnitus?

NIDCD maintains a directory of organizations providing information on the normal and disordered processes of hearing, balance, taste, smell, voice, speech, and language.

For more information, contact us at:

NIDCD Information Clearinghouse
1 Communication Avenue
Bethesda, MD 20892-3456
Toll-free voice: (800) 241-1044
Toll-free TTY: (800) 241-1055
Email: [email protected]

Publication No. 10-4896
February 2023

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Tinnitus, ringing in the ears – symptoms, causes, treatment

What is tinnitus?

The word tinnitus comes from the Latin tinnire, “to tinkle” , but tinnitus can sound more like a hum, hiss, chirp or a thin squeak.

About 40% of adults experience tinnitus from time to time. About 8% suffer from it often or constantly. For 1% of people, tinnitus is a serious problem that interferes with a normal life. It almost never affects children and very often elderly people with hearing loss.

This noise is not associated with external sounds and is “heard” better in silence than with external noise. Tinnitus lasts for a long time (more than 5 minutes) and should be distinguished from a short, transient sound that lasts a few seconds or occurs after a strong sound stimulus. Such noise is in no way connected with the mechanical processes occurring in the ear, its cause is in the nerve cells.

IMPORTANT! Information from the article cannot be used for self-diagnosis and self-treatment! Only a doctor can prescribe the necessary examinations, establish a diagnosis and draw up a treatment plan for a consultation!

Why does tinnitus occur?

There are two theories about its origin.

1) Due to the constant high level of noise in the life of a city dweller, cells in the inner ear are constantly dying, turning sounds into nerve impulses. They do not die immediately, but for some time they are in a “death” state. They can still send information to the brain, but are no longer able to generate impulses specific to each sound. The result is “noise”.

2) According to another theory, tinnitus is something like phantom pains. The auditory cortex of the brain “remembers” that information about external sounds should be transmitted through the auditory pathways, but the corresponding auditory cells have already died, and the brain “has to” find information that is similar to sound impulses. This information travels along pathways through the mood center, which is why tinnitus sufferers have such a hard time with noise. Gradually, as a result of incorrect adaptation, this path becomes the main one for the brain, and the person, as it were, gets used to hearing noise.

What can cause tinnitus?

• Tinnitus is usually caused by hearing loss from constant exposure to loud noises (tractor, lawn mower, loud music on headphones) or acoustic trauma.
• Otitis media, atherosclerosis, traumatic brain injury, cervical osteochondrosis, and hearing loss due to aging or other causes can contribute to tinnitus.
• Much less commonly, tinnitus can be a symptom of diabetes, kidney disease, or head or neck tumors.
• Some drugs cause tinnitus: quinine, non-steroidal anti-inflammatory drugs, paracetamol, diuretics (furosemide…), a number of antibiotics (gentamicin, streptomycin, etc.), certain types of chemotherapy, some psychiatric drugs (amitriptyline, sertraline, anafranil, etc.). e.)

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How to “measure” strength tinnitus?

Since this is a subjective sensation, it cannot be measured in decibels. In fact, the most important thing is how much tinnitus causes discomfort to its “happy” owner.

Therefore, a qualitative scale is used that rates tinnitus from “mild” to “catastrophic”, based on whether the person hears it all the time, whether it interferes with sleep or does something that requires silence.

Severe tinnitus leads to nervous tension, insomnia, inability to concentrate and even depression.

How to cure tinnitus?

There is no cure for tinnitus. Drugs of different groups have been studied, including antiepileptics, antidepressants, tranquilizers, but none of them is able to significantly reduce tinnitus.

Based on the theory that the brain does not adapt properly to the death of nerve cells that conduct auditory impulses, tinnitus is treated with a method called tinnitus retraining therapy (TRT). This is a type of cognitive-behavioral therapy in which a person is taught to be distracted from the noise, to relax, not to hear it. Gradually, a positive feedback is formed, the brain “unlearns” to use the wrong way of conducting impulses, and the noise level really decreases.

In addition to training, the TRT course uses sound therapy individually selected by means of noise measurement – a person is empirically selected “white noise”, which he should listen to from time to time. It can be the sound of the sea, the wind or the rustle of leaves. Such noise is evaluated in the subcortical auditory pathways as a neutral sound, its perception is quickly blocked and it does not reach the cortex, and tinnitus is blocked along with it – the patient ceases to be aware of it.

Both parts of therapy are equally important, but the first is the main one: the patient must stop paying attention to tinnitus, learn to live with it and reduce its significance. The TRT method allows you to completely remove tinnitus in terms of three months to two years.

If you suffer from nocturnal tinnitus, there are Tinnitus Therapy Pro and Tinnitus Therapy Lite mobile apps to help relieve it while you sleep. Applications offer so-called sound maskers (white noise and others), as well as sound tracks developed by doctors lasting 8 hours. There are other apps and tracks, paid and free, that can make life easier and “mask” tinnitus that occurs day or night.

causes and treatment, how to diagnose

Tinnitus (from Latin tinnītus “ringing”) is the sensation of sound in one or both ears in the absence of an external source of sound. This sensation is mostly described as ringing in the ears, but the sounds can also be hissing, humming, clicking, or buzzing. Noise, hum or ringing in the ears can be strong, mild or moderate, constant or intermittent. The perception of tinnitus is individual.

Although tinnitus is heard in the ears, it occurs in the nerve circuits of the brain, which causes us to hear sounds in the head. It is not yet known exactly what is going on in the brain to create the illusion of a sound that is not actually there. Tinnitus is the most common disorder affecting 10 to 15% of the world’s population.

Causes of noise or ringing in the ears

The appearance of tinnitus can be caused by prolonged exposure to loud noises or certain lifestyle habits. Ringing in the ears can also occur in healthy people and for no apparent reason. However, in many cases, the appearance of noise or ringing in the ears is associated with hearing loss.

Causes that can trigger tinnitus can be divided into the following groups:

Medical

• Diabetes
• Anemia
• Allergy
• Otosclerosis
• Meniere’s disease
• Earwax plug
• Head and neck tumors
• Low serotonin 9 0034
• Blood pressure problems
• Thyroid problems (hypothyroidism).
• Diseases of the outer, middle or inner ear.

Hearing impairment

According to statistics, 80-85% of patients suffering from tinnitus have some degree of hearing impairment. Despite the fact that tinnitus is not the cause of hearing impairment, but its impact negatively affects concentration, performance, because constant sounds in the head are distracting and prevent you from concentrating on really important sound information. Annoying noise distracts from daily tasks and interferes with meaningful communication with family, friends and loved ones.

Head injury and brain disease
Head injury, such as a concussion, can damage the inner ear and cause tinnitus. Also, neurological diseases, such as multiple sclerosis, can lead to tinnitus, and acoustic tumors of the auditory or vestibular nerve, by putting pressure on the nerve endings, can create tinnitus. In this case, the treatment of tinnitus should begin with an appeal to a neurologist.

Heart and blood vessel problems

If your tinnitus is pulsating, it may be due to a problem with your blood vessels.

Drugs that cause tinnitus

The most common drugs that cause tinnitus are non-steroidal anti-inflammatory drugs (eg, aspirin, gentamicin), diuretics, some antibiotics, and cancer drugs. If you experience tinnitus after starting a drug or changing its dosage, contact your healthcare provider right away to determine further treatment.

Risk factors for tinnitus

Often tinnitus occurs in people with hearing impairment of different ages, but the elderly and those whose professional activities are associated with high-level noise exposure are at risk.

Age-related hearing loss

Hearing loss due to aging is called presbycusis and begins at age 60. The greater the hearing loss, the more likely it is that tinnitus will occur. To prevent the appearance of annoying noise, you must first contact an audiologist for a hearing diagnosis in order to assess its severity (i.e., at what frequencies a decrease is observed) and then select a method for correcting the identified violations.

Loud noise exposure

Regular exposure to loud noise in professional activities (airport workers, factories, construction sites, city transport drivers, military, hunters) is a common cause of hearing loss and tinnitus. Wearing earplugs at work will help protect your hearing.

Lifestyle
Listening to music at high volumes for extended periods of time or frequent concerts can also cause permanent hearing damage. Excessive alcohol consumption, smoking, abuse of foods and drinks containing caffeine can cause tinnitus. Frequent fatigue and stress can also be risk factors.

If you have tinnitus, start your treatment journey by contacting a hearing care professional who specializes in diagnosing tinnitus to help determine the underlying cause. If common causes of tinnitus are ruled out, your doctor will refer you to another specialist for further evaluation and treatment.

How to reduce the effects of tinnitus

Since tinnitus is purely subjective, it can be difficult to diagnose, so following the advice of your hearing care professional on your own can help alleviate the condition:

• Avoid tobacco, coffee, cola, tea;
• Learn to relax, arrange a relaxing minute for yourself;
• Try to control your blood pressure, measure it regularly;
• Avoid loud noise and use earplugs for occupational protection;
• Try to eat less salt, because. its use is one of the causes of circulatory disorders;
• Exercise regularly, exercise improves blood circulation, which helps reduce tinnitus;
• Use a hearing aid. It not only helps with hearing loss, but also has a masking effect that will help you get rid of annoying tinnitus and reduce its impact on daily life.

Hearing loss and tinnitus

Noise or ringing in the ears or head often cannot be treated, but the good news is that tinnitus can be controlled. The latest technological solutions in the field of audiology and deafness come to the rescue. Clinical studies show that digital hearing aids are not only effective in addressing hearing loss, but also help reduce the impact of tinnitus and provide overall relief.
Amplification of environmental sounds through the hearing aid provides activation of the auditory part of the nervous system, which reduces the perception of tinnitus. With constant exposure to amplified environmental sounds, the auditory part of the nervous system is rebuilt, which has a beneficial effect on the function of nervous activity, restoring it and weakening hypersensitivity to auditory sensations.