Tinnitus is a condition in which the ears detect sound when no external sound source is present. Almost everyone has had this condition at some point in life, for some it occurs randomly in the morning while for others it is sudden. Usually, it presents itself as a constant ringing that lasts for a short period after being exposed to loud music. Other people describe tinnitus as the sound of singing crickets, much like what you would hear when trying to fall asleep in a quiet room.
From the outer ear through the middle and inner ear to the brain’s auditory cortex, tinnitus can occur anywhere in the hearing canal. For some people, the noises originate in the head instead of ears. Although often described as a ringing noise, tinnitus may sound differently from one person to the next.
Many people who develop tinnitus worry that they’re going deaf, but this rarely happens. For most afflicted individuals, this condition is merely an annoyance and never develops into anything serious. In severe cases, however, tinnitus can be extremely disturbing, so much so that it reduces the quality of life.
There are two types of tinnitus, namely objective and subjective. In the latter case, only the affected patient can hear the sounds. In subjective tinnitus, a doctor can hear unwanted noises in the ears of a patient with a stethoscope when running tests.
Tinnitus: What Causes Constant Ringing in Ears?
Tinnitus can be a symptom of an underlying medical condition. It may also signify damage that has occurred in the middle ear. The resulting damage interferes with the normal way in which ears detect sound and how the brain interprets auditory signals.
In order to understand how various factors cause tinnitus, it’s important to know about basic functions of the ears. The outer ear usually picks up sound waves and passes them on to the middle ear. In the middle ear, sound detection is done by the cochlea, a coiled spiral tube lined with numerous sensitive hair cells. The final phase of transmitting sound is left to the auditory nerve, which transfers sound signals from the cochlea to the brain for interpretation.
The cochlea fails to send information as required if any part of it is damaged. If that happens, the brain looks for sensory hair cells in the ears that still function. In the process of doing so, some of the resulting signals might be over-represented in the brain, thus causing tinnitus sounds. Another school of thought is that the brain becomes confused and starts to produce its own sounds to make up for the lack of normal sound signals that a part of the cochlear is no longer producing.
Besides chronic conditions, injuries, medications and other factors can also cause damage to the cochlea and hence cause hearing related problems such as tinnitus. Below is a categorized outline of factors that are known to cause or have a connection to tinnitus.
Common Non-Medical Related Causes of Tinnitus
- The Natural Process of Aging
For many people, their hearing becomes worse as they grow older. The reason for this is that hair cells in the cochlea tend to deteriorate with age. This natural type of hearing loss is medically known as presbycusis. It mostly starts around age 60, and can lead to tinnitus. There’s not much you can do to prevent presbycusis, but quitting smoking and/or wearing ear protection gear when around loud sources of noise can help to prevent the condition from becoming more pronounced.
- Continuous Exposure to Loud Noise
Too much noise tends to overwhelm the cilia, which are the sensory hair cells that regulate flow of sound waves in your ears. Depending on the level of exposure, loud noise can cause partial or permanent damage. A short period of noise exposure beyond safe levels usually results in temporary hearing loss accompanied with a constant ringing sound in the ears. Loud equipment like chainsaws, lawn mowers, and firearms are common causes of noise related tinnitus. Listening to loud music from portable media devices such iPods and MP3 players for long hours also increase the chances of developing chronic tinnitus.
- Earwax Blockages
Earwax plays an important role in the auditory canal. It protects your ear by slowing the growth of bacteria and trapping dirt. However, when too much wax accumulates in the ears, it can cause partial hearing loss along with a constant ringing sound in the ears. If you already have tinnitus, earwax blockage can make the condition even worse by heightening unwanted sounds.
- Injuries to the Head or Neck
It’s estimated that one out of every ten people suffering from tinnitus started with this problem after suffering a neck or head injury. Injuries to the head or neck can affect the hearing center in your brain or microscopic nerve endings in the inner ear. Therefore, such injuries may be the cause of hearing loss and tinnitus.
Medical Conditions that Cause Tinnitus
- Tumors In the Neck and Head
Vascular neoplasm is a condition in which tumors arise from the endothelial cells that line the wall of blood and lymphatic vessels. When these tumors form on blood vessels of the neck and head, they can cause tinnitus.
- Acoustic Neuroma
Also known as vestibular schwannoma, acoustic neuroma is a benign and usually slow growing tumor that forms on the cranial nerves connecting the brain and inner ear. Since the cranial nerves are partly responsible for relaying information related to sound, acoustic neuroma may cause ringing in the ears or hearing loss. In most cases, this non-cancerous condition causes tinnitus in one ear.
- TMJ (Temperomandibular Joint) Disorder
The temperomandibular joint connects the jaw and temporal bones of the skull. Two muscles on this joint called the tensor tympani and tensor veli-palantini connect masticating (or eating) muscles with the ear. The temperomandibular joint forms a disorder when these muscles shorten due to chewing, teeth grinding, eating, and talking. Such jaw movements put a constant pull or pressure on the auricular cavity, hence causing a sensation of fullness in the ears, tinnitus and sometimes, hearing loss.
- AVM (Arteriovenous Malformation)
Arteriovenous malformation is an entanglement of abnormal blood vessels that occurs in the coverings of the brain. Although quite rare, people who have this condition also tend to develop pulsatile tinnitus.
- Meniere’s Disease
When endolymph (inner ear fluid) builds up to excessive levels, this causes what’s called Meniere’s disease. Meniere’s disease is characterized by a collection of symptoms such as head-spinning episodes, fullness in the ear, hearing loss, and tinnitus.
Atherosclerosis is another condition that causes pulsatile tinnitus. The condition is caused by weakened blood vessels due to aging. This in turn allows you to hear your own pulse in blood vessels located close to the ears.
Hypertension increases pressure on the walls of blood vessels that transport blood to the auditory cells and tissues. If you have tinnitus, increased blood flow can make it more noticeable. Most hypertensive individuals with tinnitus report of a pulsating sound, which corresponds to the rhythmic throbbing of arteries in the head as blood is propelled through them.
- Turbulent Blood Flow
Tinnitus can also be a symptom of a narrowed carotid artery or vein. When this blood vessel in the neck narrows, it causes turbulent blood flow that’s sometimes associated with a ringing sound in the ears.
Otosclerosis is a hereditary disorder that causes progressive loss of hearing due to an overgrowth of bone inside the inner ear. Since this condition affects hearing, it may also contribute to tinnitus.
Tinnitus or ringing in the ears may be a sign of anemia. It’s not known why this symptom is associated with anemia, but research has found a link between the two disorders.
- Thyroid Dysfunction
Thyroid dysfunction causes a variety of symptoms, one of which is tinnitus. The tinnitus brought on by hyperthyroidism (an over reactive thyroid gland) is normally linked to the heart and hence pulsatile in nature. With an under reactive thyroid (hypothyroidism), tinnitus is usually present as a constant sound.
- Paget’s Disease
Paget’s disease is a condition characterized with deterioration of bone tissue. It mostly affects older people. When bone tissue in the skull begins to deteriorate, it can lead to hearing loss with tinnitus as an accompanying symptom.
Medications Linked to Tinnitus
Some treatment drugs can cause ear poisoning, or what is medically known as ototoxicity. There are more than 200 prescription and over-the-counter ototoxic medications on the market today. These drugs can cause balance disorders, unwanted noises in the ears, or hearing loss.
If a patient is exposed to loud music when on ototoxic drugs, it can amplify the damaging effects of these medications. Fortunately, the negative effects of ototoxicity are usually reversed when the drug therapy is discontinued. In other cases, however, the damage can be permanent.
Drugs known to cause permanent hearing damage include certain chemotherapy medications such as cisplatin and carboplatin, as well as a few aminoglycoside antibiotics like gentamicin.
It’s therefore important to find out whether any medications you’re taking for a particular condition cause tinnitus as a side effect. Health care providers can recommend an alternative drug if a particular treatment is ototoxic. Sometimes there’s little choice, especially when a particular medication provides the best hope for curing a life threatening disease. For cases in which ototoxic drugs cannot be avoided, an audiologist can suggest steps to manage the effects of hearing loss that result.
Other common medications that cause temporary tinnitus or worsen the condition include:
- Salicylate pain relievers – A good example is aspirin, which is a common pain reliever that’s also used to treat heart conditions. However, it can be ototoxic when taken in high doses.
- Certain antidepressants
- Quinine – Helps in the treatment of malaria and other health conditions
- Diuretics – Used in the treatment of certain renal and heart conditions
- Cancer medications – The most common being mechlorethamine and vincristine
- Antibiotics – Examples include vancomycin, erythromycin, polymyxin B and neomycin
During treatment with any ototoxic drug, you should monitor your hearing and balance system. Create a baseline record of your hearing and balance before starting any treatment. An audiologist can perform hearing tests and document results to help you with this process. This will enable you to report any hearing changes, early onset of tinnitus or balance issues as soon as they appear.
By keeping track of auditory functions when taking ototoxic drugs, you can make important decisions with the help of your doctor to stop or change the drug therapy before it causes permanent hearing damage.
Who Gets Tinnitus?
Tinnitus affects everyone, especially when the ears are exposed to loud sounds. A good example of when it happens is just after attending a loud concert or listening to loud music. This often leaves a ringing sound in the ears. In most cases, the ringing noise is only acute and goes away within minutes. However, when tinnitus lasts more than 6 months, it becomes a chronic condition.
It’s estimated that chronic tinnitus affects about 1 in every 5 people. Although anyone can get tinnitus, some people are more susceptible to develop this condition. Here are some of the factors that increase the risk of developing long-term tinnitus:
- Exposure to Loud Noises
When ears are exposed to loud noises for prolonged periods, this gradually damages the sensory hair cells inside the auditory canal. Soldiers, musicians as well as construction and factory workers are some of the people who are at risk of developing tinnitus due to working in noisy environments.
With age, nerve fibers in the hearing canal begin to decline. This sets the stage for partial hearing loss, which in turn may lead to tinnitus.
- Race and Gender
For some reason, tinnitus is frequently identified in white people. Cases are particularly high amongs white men who are older than 65.
- Smokers and Those with Cardiovascular Issues
People who smoke as well as those who have cardiovascular problems, hearing impairments, or PSTD (post-traumatic stress disorder) are likely to experience tinnitus.
The main symptom of tinnitus is the sound of certain noises in the ears or head. People with this condition often report of hearing a ringing sound in the ears. However, other individuals with tinnitus hear sounds like:
- Electric buzzing
Since no external source makes these sounds, tinnitus noises are sometimes referred to as “phantom sounds”. The sounds can be sporadic (i.e. they come and go) or present all the time. Continuous tinnitus may cause distress depending on the noise levels. Pitches of tinnitus noises tend to vary from low to loud and you may hear it in either one or both ears. In most cases, the sounds are more pronounced in a quiet background but they can still be heard over loud external noises. Some people find that the intensity of these noises changes when they move their jaws, head, eyes, or shoulders.
Sometimes individuals with tinnitus can hear their own pulse or muscle contractions. The sound made in this case is known as pulsatile tinnitus. The pulsating noise usually comes from changes in the auditory canal, movement of muscles close to ears, or blood flow issues in the face or neck.
How is Tinnitus Treated?
If you have ringing in your ears, it’s important to see a doctor and have the condition evaluated. An ear specialist will perform tests to find out whether an undying cause is contributing to tinnitus. Your doctor will also look through your medical history and ask questions about current use of medications, past and present exposure to noise, as well as the type of sounds that you hear in your ears.
Further MRI and CT scans may be required if you’re diagnosed with pulsatile tinnitus. These tests check for blood vessel abnormalities or tumors. The right treatment will depend on whether there is a cause for tinnitus or not.
Any condition found to be the cause of tinnitus will be treated. For instance, medications may be switched if current prescription drugs are contributing to the condition. Alternatively, excess wax can be removed or blood vessel conditions will be corrected.
Some drugs may also be prescribed to help ease tinnitus noises. For instance, if ringing in your ears worsens with stress, your physician can recommend lifestyle changes. An alternative option is to use tricyclic antidepressants and anti-anxiety medications such as notriptyline, Xanax, or amitriptyline. However, drug therapy is not always the best way to treat tinnitus because some people don’t respond well to medications. Depending on the drugs used for tinnitus treatment, there may be side effects. These include fatigue, nausea, constipation and/or blurry vision.
Tinnitus most likely lessens or goes away once the underlying condition is resolved. Sometimes doctors will not be able to find any underlying condition that can be linked to tinnitus. In such cases, you can opt to try alternative therapies in lieu of conventional medication.
For example, noise suppression machines provide relaxing sounds known as white noise, which help to dull the ringing, buzzing, or roaring sounds that are associated with tinnitus. Other treatments for tinnitus include the use of a sound masking device, hearing aids, or cochlear implants that restore lost hearing.