Ringing in the Ears

Causes

Sound waves cause vibration or pressure on small structures in the ear. This creates signals that are sent to the brain. Damage to this system may cause signals to go to the brain when sound is not present. It may be caused by one or more of the following:

• Damage to inner ear hair cells
• Damage to the inner ear from being around loud sounds—this may last only a few minutes
• Ear bone changes such as stiffening of bones in the middle ear
• Ear wax build-up
• Age-related hearing loss
• Damage to ear drum or nerves

Pulsatile tinnitus is caused by the flow of blood. It happens with each heartbeat.

Different health problems can cause tinnitus or make it or worse. An exact cause may not be found.

Risk Factors

Things that may increase your chances of tinnitus are:

• Work or activity that has loud noises
• Wax or an object in the ear canal
• Stress
• Fatigue
• Smoking
• Certain medicine, such as aspirin, antibiotics, or diuretics
• Toxins, such as heavy metals, carbon monoxide, or alcohol
• Certain health issues, such as:
  • Ear infection
  • Meniere disease
  • Allergies
  • High or low blood pressure
  • Diabetes
  • Depression or anxiety
  • Tumors
  • Thyroid problems
  • Temporomandibular joint disorder
• Blood vessel problems, such as an aneurysm, fistula, or hardening of the arteries
• Fluid in the ear
• Ruptured eardrum
• Injury to the head or neck

Symptoms

Tinnitus symptoms may:

• Include ringing, roaring, buzzing, clicking, whistling, or hissing sounds
• Occur in short bursts, pulses, or as ongoing noise
• Vary in intensity or stay the same
• Include single or multiple tones
• Worsen at night or when there are fewer distractions
• Include a sensation of inside movement, such as blood pulsing or muscles moving

Hearing loss or vertigo may also be present.

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam will be done. The doctor will ask about:

• Sensations that you have
• Things that may make the sensation better or worse
• Medicines you take
• History of trauma or injuries

The doctor will look at your ear canal with a scope. You may have a complete hearing test. A CT or MRI scan may be done. These can help figure out the cause of the tinnitus.

Other tests that may be done are:

• Tympanogram
• Auditory brain response

Treatment

When possible, the cause will be treated. This may stop the tinnitus.

Other treatments will help get rid of or reduce sensations that bother you. Steps may include:

Medicine

Tricyclic antidepressants may help treat severe tinnitus. It may ease symptoms.

Mechanical Devices

Devices include:

• Hearing aid—may ease tinnitus and improve hearing in some.
• Tinnitus masker—a device that makes a low level of white noise such as falling rain or ocean waves. It can help cover up sensations.

Lifestyle and Self-care Measures

Steps that may help ease the noise include:

• Stress management and relaxation steps
• Biofeedback
• Repetitive transcranial magnetic stimulation
• Cognitive behavioral therapy
• Support group
• Regular exercise
• Getting enough sleep
• Playing a radio or a white-noise machine for about 30 minutes at bedtime to ease ringing sensations

Avoid things that makes tinnitus sensations worse such as:

• Loud noises
• Alcohol
• Smoking
• Salt
• Caffeine

Prevention

To help reduce your chances of tinnitus:

• Avoid being around very loud noises.
• Wear earplugs in noisy places.
• Wear earmuffs when mowing the grass or using any other loud machinery.
• Learn and practice stress management.
• Limit use of medicine that damages hearing.