Tinnitus

Overview

Tinnitus manifests as the perception of sound, such as ringing, in one or both ears without any external sound source. Typically, this internal noise is inaudible to others. Affecting approximately 15% to 20% of individuals, tinnitus is more prevalent among the elderly.

Often, tinnitus arises from an underlying issue, which might include age-associated hearing loss, damage to the ear, or circulatory system disorders. In numerous cases, addressing the root cause or employing strategies that diminish or conceal the noise can alleviate the symptoms of tinnitus, making it less intrusive.

Symptoms

Tinnitus is commonly characterized by a ringing sensation in the ears, despite the absence of external auditory stimuli. Nevertheless, it can manifest as various other phantom noises within the ears, such as:

• Clicking
• Hissing
• Buzzing
• Roaring
• Humming

The majority of individuals experiencing tinnitus encounter subjective tinnitus, where only the affected individual perceives the noise. The sounds associated with tinnitus vary in pitch, ranging from a low rumble to a high-pitched squeal, and may affect one or both ears. Sometimes, the noise can be so pronounced that it interferes with concentration or the ability to hear external sounds. Tinnitus can be constant or fluctuate intermittently. In rare cases, it may present as a rhythmic pulsation or swooshing sound, often synchronized with the heartbeat, known as pulsatile tinnitus. If you have pulsatile tinnitus, your doctor may be able to detect the noise during a physical examination, a phenomenon termed objective tinnitus. If tinnitus significantly disrupts your daily life, it’s advisable to consult your doctor.

Schedule a visit with your doctor if you develop tinnitus following an upper respiratory infection, such as a cold, and the symptoms persist for more than a week, it’s recommended to seek medical attention. Seek medical attention promptly if: 

• You experience vertigo or hearing loss in addition to tinnitus. 
• Your tinnitus is causing you to feel depressed or anxious. 

Causes

 Tinnitus, characterized by ringing or other noises in one or both ears, can be triggered or exacerbated by various health issues. Often, the exact cause of tinnitus remains unidentified. However, several common factors have been associated with its onset:

• Hearing loss: The inner ear contains delicate hair cells that move in response to sound waves, initiating electrical signals transmitted to the brain via the auditory nerve, which interprets them as sounds. Aging or exposure to loud noises can damage these cells, leading to erratic electrical impulses that the brain perceives as tinnitus.
• Ear infections or blockages: Accumulations of fluid, earwax, dirt, or foreign objects in the ear canals can obstruct them, altering ear pressure and potentially leading to tinnitus.
• Head or neck trauma: Injuries to the head or neck can impact the inner ear, the auditory nerves, or the brain’s hearing functions, often resulting in tinnitus in one ear.
• Medications: Certain medications, including NSAIDs, some antibiotics, cancer treatments, diuretics, antimalarial drugs, and antidepressants, can trigger or worsen tinnitus. Typically, higher doses intensify the condition, which usually subsides upon discontinuing the medication.

Other, less common triggers of tinnitus include:

• Meniere’s disease: This inner ear disorder, potentially caused by abnormal fluid pressure, often presents tinnitus as a preliminary symptom.
• Eustachian tube dysfunction: Persistent expansion of the tube connecting the middle ear to the upper throat can lead to a sensation of fullness in the ear.
• Ear bone changes: Otosclerosis, the stiffening of middle ear bones due to abnormal growth, can impair hearing and cause tinnitus. This condition is often hereditary.
• Inner ear muscle spasms: Spasms in the ear muscles can lead to tinnitus, hearing loss, and a feeling of ear fullness, sometimes without a clear cause but possibly linked to neurological diseases, including multiple sclerosis.
• Temporomandibular joint (TMJ) disorders: Issues with the TMJ, located in front of the ears at the point where the lower jawbone connects with the skull, can lead to tinnitus.
• Acoustic neuroma and other tumors: A benign tumor on the cranial nerve, known as an acoustic neuroma, along with other tumors in the head, neck, or brain, can cause tinnitus.
• Blood vessel disorders: Conditions such as atherosclerosis, high blood pressure, or abnormal blood vessels can alter blood flow, affecting tinnitus.
• Other chronic conditions: Diabetes, thyroid disorders, migraines, anemia, and autoimmune diseases like rheumatoid arthritis and lupus have been linked to tinnitus.

Risk factors

While tinnitus can affect anyone, certain factors may elevate your risk: 

• Age. The quantity of nerve fibers in your ears that are still functional decreases with age, perhaps leading to hearing issues that are frequently linked to tinnitus.
• Gender. It is more common for men to get tinnitus.
• Use of alcohol and tobacco. Individuals who smoke are more likely to experience tinnitus. Tinnitus risk is also increased by alcohol consumption.
• Exposure to loud noise. Common causes of noise-related hearing loss include loud noises from machinery, chainsaws, and weapons. Long-term loud music playback on portable music players, including MP3 players, can also result in noise-induced hearing loss. Particularly vulnerable are those who labor in noisy settings, such as construction and manufacturing workers, musicians, and soldiers.
• Specific medical conditions. Your risk of developing tinnitus is increased by obesity, heart issues, high blood pressure, and a history of arthritis or head injuries.