Tinnitus (Ringing in Ears)

Causes

Tinnitus is not a disease in and of itself. It is just a symptom of some underlying disease or disorder, such as high blood pressure, heart problems, high cholesterol, diabetes, hypothyroid, food allergy, otosclerosis, Meniere’s disease, noise exposure, ear infections, impacted wax, or sinus problems. However, the cause of tinnitus can be due to a serious problem like a tumor or cancer. Therefore, it is important to have a thorough medical evaluation by an Ear, Nose & Throat (ENT) physician, who may order:

• Blood tests
• Hearing tests
• MRI

A diagnostic hearing evaluation by an Audiologist is very important, since many disorders display a specific pattern that will aid the ENT physician in diagnosing the cause of the tinnitus. In some cases, the patient will have dizziness or balance problems in conjunction with tinnitus and/or hearing loss. Since the hearing mechanism and the balance mechanism are both located in the inner ear, the ENT physician may order balance tests as well.

After the medical evaluation, blood tests, hearing tests and imaging studies, ENT physicians will determine whether medication or surgery is required. Many times, if there is a substantial hearing loss, the solution is as simple as hearing aids. In addition, auditory stimulation by hearing aids may help to delay or prevent atrophy of the hearing nerve when the person has substantial hearing loss. Severe cases of tinnitus may require a combination of hearing aids, medication, vitamins, tinnitus maskers, tinnitus retraining therapy, and/or biofeedback therapy.

Symptoms

There may be additional symptoms such as:

• Light headed 
• Thumping
• Ringing
• Clicking noises

Treatment

Treatment for tinnitus:

• Earwax Removal:
  • Removing earwax blockage can decrease symptoms.
• Hearing Aids:
  • If hearing loss is severe, hearing aids can help improve tinnitus symptoms. The physician may recommend a hearing aid evaluation to determine whether an aid would help.
• Lifestyle Modifications: 
  • Avoid excessive amounts of coffee (caffeine) and smoking (nicotine).
  • If no cause for the head noise can be found:
    • Make every attempt to obtain adequate rest and avoid over fatigue.
    • Stress and anxiety can greatly increase the distress caused by tinnitus. Some patients can benefit from biofeedback and stress management training. Others have found help from books such as Relaxation and Stress Reduction Workshop, by M. Davis.
• Medication:
  • If there is an indicated of High Blood Pressure or Blood Vessel condition; change or adjust the medication.

Types of Tinnitus

There are several types of tinnitus such as:

• Brain Tinnitus:
  • Any disturbance such as swelling, pressure, or interference with circulation, may occasionally involve one or more complex hearing pathways as they enter and terminate in the brain. In most instances, symptoms are localized to one ear, and other symptoms develop which aid the physician in determining the cause and location of the disturbance.
• External Ear Tinnitus: 
  • Obstruction of the external ear canal, such as wax, foreign bodies, and swelling may produce eardrum pressure which is transmitted across the middle ear to the inner ear and hearing nerve, where it is interpreted as noise. Dilated or constricted blood vessels in the skin of the ear canal or eardrum may produce a pulsating type of hearing nerve irritation.
• Hearing Impairment: 
  • Head noise and tinnitus may or may not be associated with hearing impairment. If hearing loss coexists with tinnitus, the severity of the head noise is not an index as the future course of the hearing impairment. Hearing impairment often occurs without presence of tinnitus, and vice versa.
• Inner Ear Tinnitus: 
  • The hair cells of the inner ear are the most delicate structures of the hearing mechanism. Any condition which disturbs the fluid pressure in the inner ear capsule may produce head noises. The tiny cells which serve to transform fluid waves into nerve impulses are analogous to the cells of the retina of the eye which transform light waves onto nerve impulses, or the electrical transducers. The slightest swelling or interference with these delicate cells from any cause readily produces impairment of function and irritation. this may occur from a variety of causes, such as:
    • Local infection
    • Hereditary degeneration
    • Systemic disease with resultant toxic effects
    • Sudden exposure to a blast intensity of sound
    • Prolonged exposure to high sound levels in susceptible persons
    • Certain drugs to which the patient may be sensitive
    • Aging
    • Minute changes in the blood supply with resultant changes in nutrition (most often develops in older persons when the thread-like blood vessels near the inner ear begin to harden and thicken)
• Middle Ear Tinnitus:
  • Any disturbance in the functioning of the middle ear mechanism may result in head noise. Conditions include:
    • Swelling of the lining membranes of the middle ear due to allergy
    • Infection
    • Vascular abnormalities
  • Fluid from allergy, infection, or eustachian tube obstruction may accumulate in the middle ear chamber with resultant disturbing sensations being related to the inner ear and the auditory nerve pathways.
• Nerve Pathway Tinnitus: 
  • Pressure changes may produce swelling from both outside and within the hearing nerve. In this instance, the tinnitus occurs on one side of the head. The bony canal cannot expand very much, thus, the pressure may also disturb the balance and facial nerve as they pass through the canal. This condition, like the pressure phenomenon, occurs only on one side and doesn't mean it would occur again on either side.

Infographic