Tinnitus (“tin-knit-us” or “tin-night-us”) is the name given to sounds we hear in our heads or ears. It is very common and can be annoying or distracting. Almost 50 million people in the United States have tinnitus in their ear or ears. Tinnitus is even more common in the elderly over 65 years of age, about 1 in 3 have head noise. For about 5% of the general population tinnitus is moderately or significantly annoying, causing them to seek medical help. It may come and go or be a constant bother. It might be a soft or loud, low-pitched (roaring) or high- pitched (ringing) kind of sound. It is usually only heard by the person who has it. Many times people who have a hearing loss will have tinnitus, but your hearing may be normal and you could be affected. About 6% of people with tinnitus are affected so badly they cannot lead a normal life.

Tinnitus from outer ear problems

Anything that might close off the ear canal, such as a plug of wax, a foreign body, or even swelling in the ear canal from a swimmer’s ear can cause head noise. Swollen blood vessels of the skin of the ear canal or eardrum can cause a pulsating or “beating” kind of tinnitus. Irritation of the jaw joint in front of the ear canal is also known to cause tinnitus.

Tinnitus from middle ear problems.

Almost anything that hurts the middle ear hearing mechanism can cause noise in the ear. This includes a hole in the eardrum, swelling of the delicate lining of the middle ear from an allergy or infection, or something that affects the three thin bones in the middle ear. Repeated ear infections can cause scar tissue in the middle ear. This scarring can cause irritation of the nerve endings and cause tinnitus. Scarring can also close off tiny blood vessels in the middle ear and cause a pulsating kind of head noise. Conditions that hurt the chain of bones, such as infection, injury, arthritis, or otosclerosis (an inherited problem that causes hardening of these bones) usually cause a bothersome hearing loss that might be accompanied by head noise. Almost everyone who has flown in an airplane has felt ear fullness or pressure because of altitude changes. The pressure is from a temporary blockage of the eustachian (“you-stay-shun”) tube. This tube connects the middle ear to the back of the nose. It helps to balance the pressure between the middle ear and the outside air pressure. This same blockage can also be caused by infections and allergies. Sometimes the pressure imbalance is sensed by the brain as head noise.

Tinnitus from inner ear or hearing nerve problems

Any condition that disturbs the fluid pressure in the inner ear chambers can produce head noise. This might be from infections, allergies, or circulatory disturbances that hurt the delicate membranes covering the inner ear. The nerve pathway from the inner ear to the brain is the most delicate part of the hearing mechanism. The tiny cells that transform fluid waves into nerve impulses are like the cells of the eye retina which transforms light waves into nerve impulses. The slightest irritation of these delicate cells usually causes a hearing loss and even tinnitus. Ear infections, drugs, sudden or prolonged exposure to loud noise, and changes in the blood supply to the inner ear are some of the things that can irritate these small cells. Exposure to loud noise is probably the leading cause of tinnitus in today’s noisy world and it often damages hearing as well. The hearing nerve can also be strained by swelling from blood flow problems or stretched by brain tumors as it travels from the inner ear to the brain. In these instances, tinnitus is usually felt only in one ear and is usually accompanied by a slight to even severe loss in hearing or understanding of speech.

As we have seen, head noise might accompany hearing loss. Tinnitus, however, doesn’t cause or increase a hearing loss. Tinnitus is a symptom or indication of the problem which actually causes the hearing loss. There is no relationship between the severity of tinnitus and the amount of hearing loss one might have. The type or loudness of the noise heard is not related to the severity of tinnitus. Tinnitus is most frequently associated with:

• Hearing loss
• Otosclerosis
• Ear infections
• Acoustic neuroma
• Meniere’s syndrome
• Drugs (more than 200 prescription and non-prescription drugs list tinnitus as a potential side-effect.)

What can be done for tinnitus?

• Try to avoid things that make you anxious as they stimulate an already stressed hearing system
• Try to get adequate rest and keep from becoming overly tired
• Cut down or eliminate the use of nerve stimulants like caffeine and nicotine. Remember that coffee, tea, many soft drinks, chocolate and aspirin-containing drugs contain caffeine.
• Check with your family doctor to find out if any medicines you might be taking can make your head noise worse.
• Get your blood pressure checked by your family doctor. If it is high, seek your doctor’s help to get it under control.
• Limit your intake of sodium. This improves your circulation. Avoid salty foods and don’t add salt to your food when you cook or at the table.
• Protect your ears from excessive noise by using earplugs that can be obtained from our group or almost any drugstore. Noise can also cause a hearing loss that can’t be corrected with surgery.
• A person with hearing loss sometimes finds that a hearing aid will reduce their head noise and occasionally make it go away. Even someone with a minor hearing loss might find that a hearing aid will relieve his or her tinnitus. However, a thorough trial before the purchase of a hearing aid is recommended if the primary goal is to relieve tinnitus.
• Sedatives sometimes give temporary relief from tinnitus, particularly when someone is anxious. The use of sedatives over a long period of time can be habit forming and is strongly discouraged by our group. The use of sedatives is not a cure for tinnitus.
• Consider using tinnitus retraining therapy if your tinnitus is annoying.

Tinnitus is usually more bothersome when you are in a quiet room. We recommend using a low-level background noise generator. The continuous use of background noise at a level below your head noise will eventually help habituate, or decrease the intensity of the tinnitus sound that you hear. Most people prefer using a natural sound such as a babbling brook or the sound of rain. Noise machines are sold in a variety of stores and catalogs. Others find that using a fan or humidifier will provide enough noise to help decrease their tinnitus.

There is no cure for tinnitus, even when it might be caused by pressure from a tumor. When the tumor is removed, we have found that the head noise present before surgery is still present about half the time after surgery. Some people with a hearing loss notice the intensity of their tinnitus is decreased when their hearing loss is improved by surgery, or more frequently, when they get a hearing aid. Regardless of what you might have heard or read, our group does not know of any medication that is effective in decreasing your tinnitus.

Tinnitus Retraining Therapy (TRT)

Tinnitus Retraining Therapy (TRT) is a relatively new and exciting treatment program for tinnitus sufferers. Based on the neurophysiologic model of tinnitus, it combines education and counseling with noise therapy to reduce the debilitating effects of tinnitus on an individual. TRT is not a cure for tinnitus but it has been helpful to thousands of tinnitus sufferers. Research continues to try and solve this common and sometimes debilitating problem. Our group is committed to providing state-of-the-art care for our patients; as soon as more effective treatments become available, we will use them.