Tinnitus

Definition

 

Tinnitus is typically described as the sensation of ringing in the ears and affects about 1 in 5 of the population. It can occur either in 1 ear or both ears and in many cases no exact cause is found. It is more common in men, smokers and with advancing age.

 

Symptoms

 

True tinnitus often presents with a sound in the ears which can take many different forms. These sounds can be constant or intermittent and are often described as follows –

 

Low-pitch ringing

Conditions that can cause low-pitched ringing in one ear include Meniere's disease. Tinnitus may become very loud before an attack of vertigo — a sense that you or your surroundings are spinning or moving.

 

High-pitch ringing

Exposure to a very loud noise or a blow to the ear can cause a high-pitched ringing or buzzing that usually goes away after a few hours. However, if there's hearing loss as well, tinnitus may be permanent. Long-term noise exposure, age-related hearing loss or medications can cause a continuous, high-pitched ringing in both ears. Acoustic neuroma can cause continuous, high-pitched ringing in one ear.

 

Buzzing

 

Humming

These sound fluctuations are usually vascular in origin, and you may notice them when you exercise or change positions, such as when you lie down or stand up.

 

Clicking

Muscle contractions in and around your ear can cause sharp clicking sounds that you hear in bursts. They may last from several seconds to a few minutes

 

Hissing

 

Throbbing 

Blood vessel problems, such as high blood pressure, an aneurysm or a tumour, can cause blockage of the ear canal or eustachian tube and can amplify the sound of your heartbeat in your ears (pulsatile tinnitus).

 

Music-like

 

Other sounds

Stiff inner ear bones (otosclerosis) can cause low-pitched tinnitus that may be continuous or may come and go. Earwax, foreign bodies or hairs in the ear canal can rub against the eardrum, causing a variety of sounds.

 

 

 

Causes

 

Age

 

For many people, hearing worsens with age, usually starting around age 60. Hearing loss can cause tinnitus. The medical term for this type of hearing loss is presbycusis.

 

Loud noise

 

Loud noises, such as those from heavy equipment, chain saws and firearms, are common sources of noise-related hearing loss. Portable music devices, such as MP3 players or iPods, also can cause noise-related hearing loss if played loudly for long periods. Tinnitus caused by short-term exposure, such as attending a loud concert, usually goes away; both short and long-term exposure to loud sound can cause permanent damage.

 

Damage to inner ear hair cells

 

Tiny, delicate hairs in your inner ear move in relation to the pressure of sound waves. This triggers cells to release an electrical signal through a nerve from your ear (auditory nerve) to your brain. Your brain interprets these signals as sound. If the hairs inside your inner ear are bent or broken, they can "leak" random electrical impulses to your brain, causing tinnitus.

 

Ear wax blockage

 

Earwax protects your ear canal by trapping dirt and slowing the growth of bacteria. When too much earwax accumulates, it becomes too hard to wash away naturally, causing hearing loss or irritation of the eardrum, which can lead to tinnitus.

 

Ossicle disorders

 

Stiffening of the bones in your middle ear (otosclerosis) may affect your hearing and cause tinnitus. This condition, caused by abnormal bone growth, tends to run in families.

 

Other causes of tinnitus include:

 

Ménière’s disease

 

Tinnitus can be an early indicator of Meniere's disease, an inner ear disorder that may be caused by abnormal inner ear fluid pressure.

 

TMJ disorders

 

Problems with the temporomandibular joint, the joint on each side of your head in front of your ears, where your lower jawbone meets your skull, can cause tinnitus.

 

Head injuries or neck injuries

 

Head or neck trauma can affect the inner ear, hearing nerves or brain function linked to hearing. Such injuries generally cause tinnitus in only one ear.

 

Acoustic neuroma

 

This noncancerous (benign) tumour develops on the cranial nerve that runs from your brain to your inner ear and controls balance and hearing. Also called vestibular schwannoma, this condition generally causes tinnitus in only one ear.

 

Eustachian tube dysfunction

 

In this condition, the tube in your ear connecting the middle ear to your upper throat remains expanded all the time, which can make your ear feel full. Loss of a significant amount of weight, pregnancy and radiation therapy can sometimes cause this type of dysfunction.

 

Muscle spasms in the inner ear

 

Muscles in the inner ear can tense up (spasm), which can result in tinnitus, hearing loss and a feeling of fullness in the ear. This sometimes happens for no explainable reason, but can also be caused by neurologic diseases, including multiple sclerosis.

 

 

Blood vessel disorders linked to tinnitus

 

In rare cases, tinnitus is caused by a blood vessel disorder. This type of tinnitus is called pulsatile tinnitus. Causes include:

 

•Atherosclerosis

 

With age and buildup of cholesterol and other deposits, major blood vessels close to your middle and inner ear lose some of their elasticity — the ability to flex or expand slightly with each heartbeat. That causes blood flow to become more forceful, making it easier for your ear to detect the beats. You can generally hear this type of tinnitus in both ears.

 

•Head and neck tumours

 

A tumour that presses on blood vessels in your head or neck (vascular neoplasm) can cause tinnitus and other symptoms.

 

•High blood pressure

 

Hypertension and factors that increase blood pressure, such as stress, alcohol and caffeine, can make tinnitus more noticeable.

 

•Turbulent blood flow

 

Narrowing or kinking in a neck artery (carotid artery) or vein in your neck (jugular vein) can cause turbulent, irregular blood flow, leading to tinnitus.

 

•Malformation of capillaries

 

A condition called arteriovenous malformation (AVM), abnormal connections between arteries and veins, can result in tinnitus. This type of tinnitus generally occurs in only one ear.

 

Medications that can cause tinnitus

 

A number of medications may cause or worsen tinnitus. Generally, the higher the dose of these medications, the worse tinnitus becomes. Often the unwanted noise disappears when you stop using these drugs.

 

Medications known to cause or worsen tinnitus include:

 

•Antibiotics, including polymyxin B, erythromycin, vancomycin (Vancocin HCL, Firvanq) and neomycin

 

•Cancer medications, including methotrexate (Trexall) and cisplatin

 

•Water pills (diuretics), such as bumetanide (Bumex), ethacrynic acid (Edecrin) or furosemide (Lasix)

 

•Quinine medications used for malaria or other health conditions

 

•Certain antidepressants, which may worsen tinnitus

 

Aspirin taken in uncommonly high doses (usually 12 or more a day)

 

In addition, some herbal supplements can cause tinnitus, as can nicotine and caffeine.

 

 

 

 

 

 

 

Article written by Dr Aleesha Dhillon
Disclaimer: This article is solely for information purposes. It is not to replace a consultation with a qualified health professional. It should not be used for the diagnosis or treatment of medical conditions. The article is based on the opinions of the author who retains copyright. You are advised to make your own health decisions based on your research and alongside a qualified health professional. Please consult a doctor if you have any health concerns.

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