What is tinnitus? What causes it? How can it be managed? Get the facts about this common condition and learn effective ways to minimize its impact.

Understanding Tinnitus: What Is It?

Tinnitus, also known as “ringing in the ears,” is the perception of a sound that only you can hear. It is not caused by an external source, but rather originates within the auditory system. The sound can take various forms, such as ringing, whistling, buzzing, chirping, hissing, humming, or even shrieking. The sound may appear to come from one ear, both ears, inside the head, or from a distance.

Tinnitus can be either subjective, meaning only you can hear the noise, or objective, meaning someone else can also hear the sound. Pulsatile tinnitus, which is a rhythmic sound in sync with your heartbeat, is an example of objective tinnitus and may indicate a more serious underlying condition.

Causes of Tinnitus

There are several common causes of tinnitus, including:

• Loud Noise Exposure: Attending a loud concert or being exposed to other sources of intense noise can trigger temporary tinnitus.
• Medications: Certain medications, particularly high doses of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), can cause tinnitus that goes away when the drug is discontinued.
• Hearing Loss: Damage to the hair cells in the cochlea, often due to aging or exposure to loud noise, can lead to tinnitus.
• Meniere’s Disease: This disorder of the inner ear can cause tinnitus, along with hearing loss, vertigo, and a feeling of pressure in the affected ear.
• Impacted Earwax: Buildup of earwax can cause tinnitus by blocking sound waves from reaching the eardrum.
• Middle Ear Problems: Conditions such as middle ear infections or vascular tumors can also contribute to tinnitus.

The Auditory Pathway and Tinnitus

To understand how tinnitus arises, it’s helpful to know how the auditory system works. Sound waves travel through the ear canal to the middle and inner ear, where hair cells in the cochlea transform the sound waves into electrical signals that are then transmitted to the brain’s auditory cortex via the auditory nerve.

When the hair cells are damaged, for example, by loud noise or ototoxic drugs, the circuits in the brain don’t receive the signals they’re expecting. This disruption in the auditory pathway stimulates abnormal activity in the neurons, resulting in the perception of sound – tinnitus.

Coping with Chronic Tinnitus

While there is no cure for chronic tinnitus, there are several ways to manage the condition and minimize its impact on everyday life:

1. Educate Yourself: Understanding that tinnitus is not a sign of a serious health problem can help alleviate anxiety and make the condition more manageable.
2. Masking the Sound: Using background noise, such as a fan or white noise machine, can help “mask” the tinnitus and make it less noticeable.
3. Cognitive-Behavioral Therapy: This type of therapy can help you change the way you think about and react to tinnitus, reducing its emotional impact.
4. Sound Therapy: Devices that emit low-level sounds can help retrain the brain to ignore the tinnitus noise.
5. Stress Management: Techniques like meditation, yoga, and deep breathing can help reduce the stress and anxiety that can exacerbate tinnitus.

Seeking Medical Attention

If you experience any new or worsening tinnitus, especially if it’s pulsatile (in sync with your heartbeat), you should consult a medical professional. While tinnitus rarely indicates a serious underlying condition, it’s essential to rule out any underlying medical issues, such as a tumor or blood vessel damage.

The Unpredictable Course of Tinnitus

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.

However, for many people, tinnitus becomes less noticeable and more manageable over time. By understanding the condition, learning coping techniques, and seeking medical attention when necessary, individuals with tinnitus can find ways to minimize the impact on their daily lives.

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

Tinnitus (Ringing in Ears): Types, Causes, Treatment, Prevention

Ear damage and exposure to loud noises are common causes of ringing or humming sounds in your ear (tinnitus). Lesser-known causes include medications and thyroid disease.

Tinnitus is the medical term for “ringing in the ears.”

It’s not a condition in and of itself. Instead, it can be a symptom of a medical condition or another issue. For many people, though, tinnitus appears on its own and isn’t accompanied by other symptoms or issues.

If you have tinnitus, you may hear more than just ringing. You may also hear:

• buzzing
• roaring
• clicking
• whistling
• hissing

Although you hear these sounds in your ears, there’s no external source of the sounds. For this reason, the sounds of tinnitus are also known as phantom sounds.

Tinnitus can be frustrating. Sometimes, the sounds of tinnitus can interfere with other sounds around you. In addition, anxiety and stress can aggravate tinnitus, which can make you feel worse all around.

You may experience tinnitus in one ear or both ears. People of all ages can develop tinnitus, but it’s more common in older adults.

Tinnitus can be either objective or subjective.

If other people can also hear certain noises in your ears, then you have objective tinnitus. Objective tinnitus is rare.

Subjective tinnitus is much more common. You’re the only one who can hear the ringing, roaring, and other sounds of subjective tinnitus.

Pulsatile tinnitus is one form of subjective tinnitus. It may result from abnormal blood vessels in and around your ears. The sounds may have the same rhythm as your heartbeat.

Damage to the inner ear is a common cause of tinnitus.

Your middle ear picks up sound waves. The conduction of those sound waves prompts your inner ear to transmit electrical impulses to your brain.

You can only hear these sounds after your brain accepts the electrical signals and translates them into sound. Sometimes, your inner ear sustains damage, altering how your brain processes sound.

Damage to the tiny bones in your middle ear or your eardrums can also interfere with the proper conduction of sound. Tumors in the ear or on the auditory nerve may cause tinnitus as well.

Regular exposure to very loud sounds can cause tinnitus in some people. People who use jackhammers, chainsaws, or other heavy equipment are more likely to have it.

Listening to loud music through headphones or earbuds or at a concert may lead to temporary tinnitus.

Medical conditions

Medical conditions that can cause tinnitus include:

• ear infections
• an overabundance of earwax, which alters the way you hear
• age-related hearing loss
• muscle spasms in your middle ear
• Meniere’s disease, which is an inner ear condition that affects hearing and balance
• thyroid disease
• high blood pressure
• high cholesterol
• head and neck injuries
• temporomandibular joint (TMJ) disorders, which also cause chronic pain in your head and jaw

Rare causes include aneurysms and palatal myoclonus (muscle spasms in the roof of the mouth).

Medications that cause tinnitus

Medication use can also cause tinnitus and hearing damage. This is known as ototoxicity (ear poisoning).

These medications include:

• very large doses of aspirin
• loop diuretic medications, such as bumetanide (Bumex)
• antimalarial drugs, such as chloroquine
• certain antibiotics, such as erythromycin (Eryc, Ery-Tab) and gentamicin
• certain anticancer drugs, such as vincristine

Diagnosing tinnitus can be tricky. This is because you’re typically the only person who can hear the sounds it creates.

A primary care physician or a specialist called an audiologist will attempt to diagnose tinnitus by examining your ears and conducting a hearing test.

The doctor will transmit sounds — to one ear at a time — through a set of headphones. You’ll respond by raising your hand or making a similar gesture when you hear each sound.

The doctor may be able to diagnose any hearing loss by comparing what you can hear to what people of your age and sex should be able to hear.

The doctor may also use imaging tests, such as CT scans or MRIs, to see if you have irregularities or damage. Standard plain film X-rays don’t always show tumors, blood vessel disorders, or other abnormalities that can affect your hearing.

In some cases, a doctor may not be able to identify what’s causing your tinnitus.

The doctor will treat any underlying medical conditions causing your tinnitus. If medications are contributing to your tinnitus, the doctor may have you switch to different ones to restore your hearing.

They’ll also remove any excess earwax and address any blood vessel issues.

There are various other tinnitus treatments and remedies. Some are described below.

Sound-based therapies

Noise-canceling machines can help dull the ringing, buzzing, or roaring by providing relaxing noises to mask your ear sounds. You can also try a masking device that is inserted into your ear and works similarly to a hearing aid.

Lifestyle changes

Reducing your stress can also help you manage tinnitus. Stress doesn’t cause ringing in the ears but can make it worse. Engaging in a hobby or talking with a trusted friend or family member are just a few ways to reduce stress.

Also, avoid exposure to loud noises. This will help lessen the severity of your tinnitus.

Drug therapy

Drug therapy can help reduce those pesky sounds in your ears, too.

In some cases, anti-anxiety medications or tricyclic antidepressants can reduce the sounds.

This is because these medications alter your nervous system and brain signals, which can affect your hearing. They can also help you manage other effects of tinnitus, such as insomnia and emotional problems.

Examples of these medications include:

• alprazolam (Xanax)
• amitriptyline
• nortriptyline (Pamelor)

Medications are typically reserved for people with more severe symptoms that are affecting their quality of life.

Not everyone responds to drug therapy, and the side effects can be bothersome.

Side effects of medications used to treat tinnitus may include:

• nausea
• fatigue
• constipation
• blurry vision
• heart problems, in rare cases

When people take these medications to treat tinnitus, it’s known as off-label drug use.

Off-label drug use

Off-label drug use means a drug that’s approved by the Food and Drug Administration (FDA) for one purpose is used for a different purpose that hasn’t yet been approved.

However, a doctor can still use the drug for that purpose. This is because the FDA regulates the testing and approval of drugs but not how doctors use drugs to treat their patients. So your doctor can prescribe a drug however they think is best for your care.

Hearing aids

People who have hearing loss in addition to tinnitus may use hearing aids. The sound amplification can help you if you’re having trouble hearing normal noises.

There are a few steps you can take to help prevent tinnitus.

To start, try to protect your ears from loud noises.

Keep a close eye on the volume levels of your television, radio, and personal music player. Wear ear protection around noises louder than 85 decibels (dBA), which is the noise level associated with city traffic.

Cover your ears if you’re surrounded by loud music or construction noise and you don’t have proper ear protection (such as earplugs).

In addition, avoid medications that may cause your tinnitus symptoms to recur.

Also, schedule regular hearing tests with a doctor so they can promptly detect and diagnose any structural problems in your inner or middle ear.

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 0018
• 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.

Problems with the heart and blood vessels

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 impact of tinnitus

Because tinnitus is purely a subjective sensation, it can be difficult to diagnose, so following the recommendations of your audiologists 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.

Modern hearing aids are equipped with a sound generator function, such as white noise or ocean noise, the intensity of which the user can independently control using a smartphone thanks to a mobile application for iPhone and Android.

Find out more about modern digital hearing aid models that help manage tinnitus.

Khairulina Svetlana Ivanovna

Otorhinolaryngologist-audiologist of the first category. Work experience: since 2007. Conducts reception of adults and children from birth.

Reception of adults and children:

Minsk, Independence Avenue, 83

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Center for Good Hearing

Noise in the ears and head (tinnitus)

What is tinnitus like

Tinnitus (tinnitus) is the sensation of sound in the ear that occurs without any external stimuli.

Noise can appear in one ear or both at once, be permanent or temporary, loud or muffled, monotonous or pulsating.

Up to 45% of adults experience tinnitus from time to time, and 8% experience it constantly.

For some people, buzzing or ringing in the ears does not cause discomfort: it appears and disappears, and the person may not even pay attention to it. But sometimes the noise is so intrusive that it becomes difficult to concentrate on work tasks, communicate with people or fall asleep.

Depending on the cause, tinnitus can be completely cured or corrected so that it does not interfere with normal life.

Objective and subjective tinnitus

Distinguish between objective (vibratory) and subjective (non-vibratory) tinnitus.

Objective tinnitus is rare. It occurs against the background of diseases that provoke vibrations in certain parts of the body: involuntary contractions of the muscles of the middle ear, tremor of the soft palate. Objective noise is called because it can be heard by other people, such as a doctor during a physical examination.

Subjective noise not audible to others. It occurs against the background of irritation of the hearing organs, deterioration of the blood supply to the inner ear, as a result of acute inflammation, cerebrovascular accidents, some chronic diseases (including inflammatory ones), medication or injuries. This is the most common form of tinnitus, accounting for up to 99% of cases.

Causes of tinnitus

Most often, tinnitus occurs due to damage to the elements of the ear (inner, middle or outer), damage to the nerve cells of the brain that perceive and decipher sound, or disruption of the auditory nerve, through which information about sound is transmitted from the ear to the brain.

Tinnitus can be caused by damage to the elements of the ear, the auditory nerve, or to the part of the brain responsible for sound perception

Up to 85% of patients reporting tinnitus have documented hearing loss. This means that most of the cases of tinnitus are associated with ear pathology.

At the same time, hearing loss may be less noticeable, especially if the damage is not very strong or develops gradually over several months, so tinnitus is often the first sign of such pathologies.

Quite often, tinnitus appears against the background of age-related hearing impairment.

But a symptom may not be associated (or not directly associated) with pathologies of the hearing organs: for example, it may occur with vascular, neuromuscular, endocrine and other disorders, as well as with head and neck injuries.

Pathologies of the inner ear

Injuries, inflammations, neoplasms and other pathologies can disrupt the functioning of the inner ear, the auditory nerve or the part of the brain responsible for recognizing sound – this leads to hearing loss, distorted perception of sounds and tinnitus.

If tinnitus is accompanied by dizziness or sound distortion, the cause is most likely a malfunction of the inner ear, vestibulocochlear nerve or its centers in the brain.

Inner ear disorders causing tinnitus:

• sensorineural hearing loss – hearing impairment (including imperceptible to the patient) caused by damage to the elements of the inner ear, auditory nerve or part of the brain responsible for the perception of sound;
• acoustic neuroma small, benign lesion that irritates the auditory nerve;
• acoustic injury – damage caused by exposure to very loud sounds (over 120 dB) on the ear, which is accompanied by hemorrhage in the cochlea, displacement or deformation of the elements of the inner ear;
• vibration injury – damage caused by prolonged or strong vibration exposure – in production, construction or transport – which provokes degenerative processes in the cochlea and other elements of the inner ear;
• otosclerosis – damage to the labyrinth of the inner ear, caused by the growth of bone tissue due to metabolic disorders;
• Meniere’s disease – non-infectious inflammation, which is accompanied by excessive accumulation of fluid in the inner ear;
• labyrinthitis – inflammation of the elements of the inner ear caused by a bacterial or viral infection.

Pathologies of the middle ear

Tinnitus can be caused by trauma, inflammation or growths in the middle ear.

Most often, the symptom occurs in connection with damage to the eardrum or a violation of intra-ear pressure.

Immersion in water can cause damage to the inner or middle ear due to pressure changes

Middle ear disorders causing tinnitus:

• barotrauma – damage to the middle or inner ear due to a sudden change in pressure – can occur during flight in an airplane, diving to great depths, when a palm strikes the ear, or an explosion nearby;
• Eustachian tube dysfunction (connects the middle ear to the nasopharynx) – a pathology in which there is increased pressure and noise in the ear;
• obstruction of the ear canal by wax buildup or cerumen, foreign objects or water causes increased pressure inside the ear;
• otitis media and other ear infections lead to swelling of the tissues, narrowing of the ear canals and changes in pressure inside the ear;
• otosclerosis – hardening and proliferation of bone tissue, as a result of which the mobility of the elements of the middle ear is impaired;
• tumors of the tympanic cavity – benign or malignant neoplasms in the middle ear region may interfere with the functioning of the elements of the middle ear, lead to an increase in intra-ear pressure or to defects in the tympanic membrane;
• myoclonus is a short-term contraction of the muscles of the middle ear due to neuromuscular diseases (for example, trigeminal neuralgia or epilepsy). This pathology leads to objective tinnitus.

Pathologies of the external ear

Disturbances at the level of the outer ear are usually accompanied by muscular pathologies or narrowing of the ear canal.

External ear pathologies causing tinnitus:

• neoplasms of a benign or malignant nature in the external part of the ear canal can cause tissue destruction and distortion of perceived sound;
• exostoses bony growths in the external auditory canal that may obstruct or distort sound in the ear;
• otitis externa is an acute infectious disease, which is accompanied by severe swelling of the ear canal, closing its lumen.

Other possible causes of tinnitus

Tinnitus can be caused by pathologies that are not directly related to the organs that are responsible for hearing. It can be circulatory disorders, metabolism, work of the musculoskeletal system. In this case, the noise is caused by a deterioration in tissue nutrition, an increase in pressure on the walls of blood vessels, or muscle spasms.

Non-ear causes of noise:

• benign or malignant tumors of the head and neck – may disrupt the nutrition and blood circulation of the elements of the hearing organ or cause their irritation, leading to incorrect operation;
• head and neck injuries – can lead to damage to the auditory nerve or the area of ​​the brain responsible for recognizing sounds. Injuries are characterized by the development of noise in one ear;
• neuropsychiatric disorders , including schizophrenia. Depressive states are accompanied by an imbalance of neurotransmitters – substances responsible for the correct transmission of nerve impulses. This can lead to the appearance of subjective extraneous sounds. In addition, tinnitus in some mental disorders may be part of auditory hallucinations;
• neurodegenerative and demyelinating diseases of the central nervous system: multisystem atrophy, chronic encephalopathy of various nature, multiple sclerosis may be accompanied by disruption of the hearing centers;
• pathologies of the temporomandibular joint , which connects the lower jaw to the skull, can also cause noise because the joint is very close to the ear;
• vascular disorders – hypertension or, conversely, a tendency to hypotension, atherosclerosis, impaired straightness of the course of blood vessels – all these conditions disrupt the blood supply to the inner ear, which leads to the appearance of pathological impulses from the auditory nerve;
• certain chronic conditions diabetes mellitus, thyroid disorders, migraine, anemia, rheumatoid arthritis or lupus;
• taking certain medications – non-steroidal anti-inflammatory drugs, antibiotics, chemotherapy, decongestants and antidepressants. As a rule, the noise disappears after the drug is discontinued.

Head trauma can lead to damage to the auditory nerve

Noise or ringing in the head does not always indicate systemic disorders in the body. Under certain circumstances, a local functional impairment occurs on the part of the hearing organ, or a person can more clearly hear blood flow, muscle contractions or joint movements.

Complications. What causes constant tinnitus

Depending on the form, tinnitus can occur episodically without causing discomfort, or it can greatly affect the quality of life, causing irritability, cognitive decline, insomnia and other undesirable consequences.

Complications that can be caused by tinnitus:

• fatigue,
• irritability,
• insomnia,
• inability to concentrate on tasks,
• memory impairment,
• depressive states,
• anxiety,
• headache.

Diagnosis of pathologies accompanied by tinnitus

Tinnitus is not always dangerous: it can talk about anatomical features or accompany natural physiological processes in the body, such as aging. But in some cases, hum, ringing, whistling, squeaking or rustling in the ears indicates serious pathologies – degenerative, inflammatory processes in the hearing organs, tumor neoplasms, vascular and heart disorders, or neurological diseases. In this case, timely diagnosis will help to start treatment sooner, prevent dangerous malfunctions of systems and organs, or even save a life.

Since tinnitus can be a symptom of a variety of pathologies, finding its cause can be difficult. Diagnostics includes work with one or more specialists, laboratory and instrumental methods of examination.

Which doctors to contact

In most cases, the symptom is associated with ear pathology, so it is recommended to start the examination with an otolaryngologist (ENT doctor) – this is especially true if tinnitus is accompanied by hearing loss. If tinnitus is combined with dizziness, it is better to contact an otoneurologist – a specialist working at the junction of two specialties (ENT and neurology).

The doctor will perform a physical exam and a series of tests to look for or rule out damage to the outer, middle, and inner ear, as well as to the auditory nerve and the area of ​​the brain responsible for hearing sound. If ear pathologies are not detected, the doctor will refer to other specialists – a neurologist, cardiologist, endocrinologist, maxillofacial surgeon.

Physical examination

The purpose of the examination is to exclude manifestations of certain pathologies. Each specialist is responsible for his area.

An ENT doctor examines the ear and surrounding areas for visible abnormalities.

Cardiologist detects external signs of diseases of the cardiovascular system (for example, calculates body mass index and evaluates waist circumference), measures pulse and pressure.

A neurologist evaluates the functions of systems directly or indirectly related to the organ of hearing: balance, eye movements, the muscular frame and the musculoskeletal system, detects or excludes muscle spasms, curvature, checks reflexes, the work of cranial nerves.

An endocrinologist examines a patient for manifestations of endocrine pathologies – diabetes mellitus, thyroid dysfunction, and others.

Dentist or oral surgeon checks temporomandibular joint (TMJ) function.

A psychotherapist tests for anxiety, depression, and other mental disorders.

Laboratory diagnostics

To diagnose ear pathologies and disorders of the main organs and systems, general and biochemical blood tests are prescribed. They allow you to exclude the inflammatory process and evaluate the state of metabolism, the function of internal organs.

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To exclude autoimmune pathologies, an erythrocyte sedimentation rate test, a hemostasiogram, tests for antinuclear antibodies, rheumatoid factor are prescribed.

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The doctor may prescribe additional tests to exclude pathologies of the cardiovascular system, to evaluate the functioning of the thyroid gland.

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Instrumental diagnostics

To identify ear pathologies and determine the nature of the disorders, the doctor prescribes instrumental studies: audiometry, magnetic resonance imaging (MRI), computed tomography (CT).

Audiometry is a study performed using a special device (audiometer) that allows you to assess the conduction of sound in all parts of the ear and determine the nature and degree of hearing loss in a patient. Based on the results, an audiogram is formed.

Audiometry is one of the hardware methods for diagnosing hearing loss

Magnetic resonance imaging (MRI) and computed tomography (CT) of the temporal bones allow you to assess the condition of the mastoid processes, internal auditory canals, cochlea and auditory nerve. Magnetic resonance imaging (MRI) and computed tomography (CT) of the brain, including those using special scanning modes, help to assess the safety and blood supply of the hearing centers.

Additionally, the doctor may prescribe dopplerography of the vessels of the head and neck – this is necessary to exclude hearing pathologies associated with circulatory disorders.

Also instrumental methods of research (MRI, CT, ultrasound) can be used to exclude disturbances in the functioning of internal organs, the development of tumor processes.

Treatment. What to do about tinnitus

Treatment for tinnitus depends on what caused the pathology. One-time or long-term drug therapy, surgery, or even prosthetics may be required.

The most common treatment for tinnitus is symptomatic.

Conservative therapy

If ear damage is detected during diagnosis, it is important to start treatment as soon as possible: this will stop or slow down the development of destructive processes and prevent tinnitus from progressing.

Depending on the diagnosis and the affected area, the doctor may prescribe antibiotics and painkillers to relieve inflammation, corticosteroid tablets or injections to stop destructive processes, as well as drugs that help improve blood circulation and tissue nutrition. Topical application of non-hormonal and hormonal drugs in the form of drops is also possible.

If acute or chronic processes in the body are identified that could provoke tinnitus, the doctor will prescribe their treatment or correction: antidepressants in case of depression, antispasmodics for muscle spasms, drugs that reduce blood pressure, for hypertension, or hormone therapy for impaired thyroid function.

In some cases, physiotherapy is prescribed – electrophoresis (administration of drugs through the skin using direct electric current), magnetotherapy (impact on tissues using a magnetic field). Mud applications on the ear area and acupuncture are also used. These measures help to normalize the functioning of the ear and neighboring regions and reduce the severity of tinnitus.

Regardless of the origin of tinnitus, sedative drugs, anti-anxiety drugs, antidepressants are effective in reducing it. The specific drug is selected by the doctor.

Surgical treatment

Surgical treatment of tinnitus is used if the pathology is caused by benign or malignant neoplasms. In this case, the removal of an overgrown tissue area can normalize the functioning of the ear and save the patient from noise.

Cochlear Implant

If tinnitus is caused by significant hearing loss, a cochlear implant may be indicated. The therapeutic effect is achieved through direct electrical stimulation of the auditory nerve and acoustic masking.

The cochlear implant has an external (receiving) and an internal (analyzing) element: in fact, it replenishes the function of the ear

Rehabilitation and psychotherapy

Tinnitus can quite strongly affect all areas of the patient’s life – prevent them from concentrating on work tasks, make it more difficult to communicate with other people, interfere with sleep or enjoy usual activities. Therefore, if a symptom cannot be corrected, a person needs to undergo special “training” in order to adapt to new conditions.

Psychotherapy, including cognitive behavioral therapy, plays an important role in this matter. It allows you to smooth out the negative impact of tinnitus on quality of life, reduce anxiety and the risk or severity of panic attacks, and also helps you accept your new features and learn to live with them without getting angry or giving up your usual activities.

In parallel with psychotherapy, it is recommended to add background noise to everyday life: turn on soft music during the day, and fall asleep to white noise or audio recordings with the sounds of the forest, sea or rain. If music distracts from work, devices like a mini fountain or humidifier can help mask the noise. Gradually, the psyche adapts and the person stops noticing tinnitus.

Prevention. Risk factors for tinnitus

There is no specific prevention of noise or tinnitus: many diseases, including genetic ones, cannot be prevented. But there are a number of factors that a person can influence in order to prevent the development of pathology.

Factors that increase the likelihood of tinnitus:

• loud sound : short-term or long-term exposure of the ear to loud sounds (above 120 dB) may cause acoustic injury and provoke the development of tinnitus;
• vibration : similar to acoustic trauma, prolonged exposure to vibration can lead to the development of ear pathologies and tinnitus;
• alcohol abuse and smoking : cause spasms, vasoconstriction and greatly increase the risk of tinnitus;
• unhealthy lifestyle : if a person sleeps poorly, eats unhealthy food, sits a lot and moves little, his blood pressure rises, muscle tone is disturbed, immunity decreases – all this increases the likelihood of developing tinnitus;
• past infectious and inflammatory diseases (purulent otitis media, meningitis, influenza).

Prognosis for tinnitus

In most cases, timely and adequate treatment leads to the fact that tinnitus ceases to disturb the patient and he returns to normal life – he can again concentrate on work, communicate with friends, fall asleep normally.

As a rule, treatment and adaptation take from 3 months to 1.5 years. At the same time, the success of treatment directly depends on how soon it was started.

Even with minor tinnitus, it is important to see a doctor and start therapy to prevent deterioration.

Factors affecting treatment outcome:

• early initiation of therapy: the sooner the pathology is identified and treatment initiated, the more likely it is to be effective;
• age: the treatment of hearing pathologies in the elderly can be difficult due to age-related changes in tissues and organs;
• cause of tinnitus: some pathologies are treatable, while others can only be corrected or the patient can adapt to new conditions;
• gender: tinnitus occurs more frequently in men than in women.