Tinnitus

Tinnitus

If you hear buzzing, ringing, roaring, whistling, chirping, hissing or other unexplainable sounds in your ears, you likely have tinnitus. Informally known as ringing in the ears, the general definition of tinnitus is the perception of sound or noise in the ears without any obvious acoustic stimulation. 

15%

Tinnitus impacts about 10–15% of the population.

Tinnitus impacts about 10–15% of the population, with nearly 50 million Americans experiencing some symptoms. Of those, about 20 million people struggle with chronic tinnitus that negatively impacts their lives, while 2 million people experience extremely debilitating symptoms. 

This fluctuation depends on various factors, such as stress levels, emotional well-being, anxiety, depression, cervical spine issues, and temporomandibular disorders, among others.

For many people, tinnitus isn’t constant and may vary considerably from moment to moment.

Clinically, tinnitus is often classified by two types:

Subjective

By far the most common type, this involves the perception of sound heard only by the individual. Associated with both sensorineural and conductive hearing loss, this results from disruption or alteration of the auditory pathway. Somatic tinnitus (also called somatosensory tinnitus) is a subtype in which body movements such as clenching the jaw, turning the eyes, or applying pressure to the head and neck alters the frequency or intensity of the noise.

Objective

This type, which is extremely rare, involves actual noise coming from the ear canal, generated by structures near the ear. The noise may be loud enough for a hearing care professional to audibly notice when examining the patient. The noise occurs near the middle ear and usually involves vascular flow from blood vessels, resulting in an audible, often pulsating sound.

FAQs about tinnitus

What does tinnitus sound like?

People with tinnitus have compared the sounds they hear to cicadas, crickets, wind, running tap water, grinding steel, escaping steam, fluorescent lights, and running car engines. Perceived sounds and loudness are different for everyone. 

How does tinnitus impact a person’s daily life?

For some people, like actor William Shatner (aka Captain Kirk), the noise from tinnitus was so dreadful, it caused feelings of desperation. “It was like listening to the hiss of a TV that’s not been tuned to a channel. I thought I’d go deaf or nuts,” he said.

During his personal struggle with tinnitus, Shatner became an expert on the subject and a spokesperson for the American Tinnitus Association.

Tinnitus is associated with varying degrees of distress that interfere with quality of life. The following issues were reported by members of a tinnitus self-help group:

  • Falling asleep (57%)
  • Persistence of tinnitus (49%)
  • Understanding speech (38%)
  • Despair, frustration, or depression (36%)
  • Annoyance, irritation, or inability to relax (35%)
  • Poor concentration or confusion (33%)

What causes tinnitus?

Tinnitus is a symptom of a variety of underlying diseases, with hearing loss the most common cause, followed by excessive noise exposure. About 75% of new cases are associated with emotional stress as the trigger rather than inner ear issues. About 40% of individuals diagnosed with tinnitus cannot identify any potential cause at the onset of their symptoms. Underlying causes are generally classified as otologic (related to the ear), neurologic, infectious, or medication-related. Tinnitus without any diagnosed cause is called idiopathic.

Otologic Causes

  • Noise-induced sensorineural hearing loss (damage to the inner ears and/or auditory pathway)
  • Presbycusis (age-related hearing loss)
  • Otosclerosis (abnormal growth of the small bone in the middle ear called the stapes)
  • Impacted earwax
  • Eustachian tube dysfunction (tube that links the back of your nose to the middle ear)
  • Sudden deafness (also called sudden sensorineural hearing loss)
  • Meniere's disease
  • Ear barotrauma (pressure-related tissue injury), common in divers and people who fly frequently

Neurologic Causes

  • Head injury
  • Whiplash or other cervical spine (neck) issues
  • Multiple sclerosis
  • Acoustic neuroma (also called vestibular schwannoma)
  • Vascular tumors of the middle ear (e.g. glomus jugulare)

Infectious Causes

  • Otitis media (infection that causes inflammation of the middle ear)
  • Lyme disease
  • Meningitis
  • Syphilis

Ototoxic Medications

The term ototoxic is used for medications that cause hearing loss and/or tinnitus as a side effect. More than 200 drugs (prescription and over-the-counter) used to treat pain, serious infections, cancer, heart disease, and kidney disease have been linked to hearing loss and tinnitus, which can be temporary or permanent. The most common medications associated with ototoxicity include:

  • Salicylates (e.g. aspirin)
  • Nonsteroidal anti-inflammatory drugs
  • Aminoglycoside antibiotics (e.g. neomycin and streptomycin)
  • Loop diuretics
  • Chemotherapy drugs (especially those containing platinum)
  • Tricyclic antidepressants (e.g. amitriptyline and imipramine)

Noise-Induced Tinnitus

Small temporary changes in the ear’s outer hair cells following noise exposure can trigger tinnitus by increasing the sound processing of the central auditory system. Occasional exposure to loud noise (e.g. loud rock concert) can cause temporary tinnitus that typically clears up within 16 to 48 hours. Tinnitus appears to be the most common symptom of noise-induced hearing loss (NIHL) among musicians. A German study found professional musicians are 57% more likely to develop tinnitus than any other profession. Below is a list of famous pop and rock stars who have experienced ringing in their ears:

  • Eric Clapton
  • Anthony Kiedis
  • Chris Martin
  • Moby
  • Ozzy Osbourne
  • Trent Reznor
  • Barbra Streisand
  • Pete Townshend (also completely deaf in one ear)
  • Neil Young

Barbra Streisand told the Hearing Health Foundation, “When I went to have my hearing tested, I had supersonic hearing. I hear more. It’s annoying because I long to hear silence. That’s one of the reasons that I always felt different as a kid. I was in the sixth grade when I started to hear these strange noises, and I would put scarves around my head to try to block them out.” 

How is tinnitus diagnosed?

Tinnitus is diagnosed based on a physical exam of your ears, a basic neurological exam, and symptoms, coupled with a review of your current and past medical history. For example, you’ll be asked if tinnitus is distressing enough to cause significant anxiety, depression, or sleeplessness and about current and past medication use.

Physical ear exam: Your ear canal will be inspected for discharge, foreign bodies, or earwax and your eardrum will be checked for signs of acute/chronic infection (redness and inflammation) or a tumor (red or bluish mass). A stethoscope may be used to listen to vascular noise located near the carotid arteries, jugular veins, and adjacent to your ear.

Neurological exam: During this exam, cranial nerves will be tested along with your peripheral strength, sensation, and reflexes. Accompanying neurologic symptoms such as dizziness or vertigo may indicate underlying conditions.

Medical history: You’ll be asked how long you’ve experienced tinnitus, whether it impacts one or both ears, if it is a constant or intermittent, and about risk factors for tinnitus. These include exposure to loud noise, sudden pressure change (from diving or air travel), history of ear or central nervous system infections or trauma, radiation therapy to the head, and recent major weight loss (risk of Eustachian tube dysfunction).

Other testing: Individuals with tinnitus should undergo a comprehensive audiologic evaluation to determine the presence, degree, and type of hearing loss. If tinnitus only affects one ear, magnetic resonance imaging (MRI) should be done to rule out an acoustic neuroma, a benign tumor that grows on the eighth acoustic nerve. Or if there is a visible sign of a vascular tumor in the middle ear, you’ll be referred to a subspecialist and likely undergo a CT scan or an MRI with contrast medium to confirm or rule out this diagnosis.

What are the treatment options for tinnitus?

While there is currently no cure, it may be reassuring to know that several proven therapies can help if you’re struggling with severe and/or chronic tinnitus. These treatments focus on reducing the perceived intensity, ever-presence, and burden of tinnitus.

Sound therapies: This treatment method relies on external noise to alter a person’s perception or reaction to tinnitus. Depending on the type of device, a combination of masking, distraction, habituation, and neuromodulation strategies are used to ease symptoms. Current approaches utilize sound masking devices, hearing aids, modified-sound/notched-music devices, combination devices, and sound/sleep apps.

Behavioral therapies: Focused on a person’s emotional reaction to tinnitus, several different options appear to be effective for some people with burdensome tinnitus. Benefits include a consistent reduction in tinnitus-related distress, anxiety, and depression, as well as improvement in individuals’ overall quality of life. Specific techniques include:

  • Cognitive behavioral therapy
  • Mindfulness-based stress reduction
  • Acceptance and commitment therapy
  • Tinnitus activities treatment
  • Progressive tinnitus management
  • Tinnitus retraining therapy

Tinnitus retraining therapy is the treatment method Shatner credited for enabling him to resume an active lifestyle. The primary goal of TRT is to change your reactions to sounds evoked by tinnitus. This is accomplished through teaching/counseling aimed at reclassifying tinnitus signals to neutral stimuli; and sound therapy, which decreases tinnitus signals by enhancing background sounds. A noise-generating device is worn like a hearing aid 8-10 hours a day for up to two years, thereby helping to retrain your brain. Although this method can ease the debilitating effects of tinnitus, it doesn’t work for everyone and takes dedication and hard work to be effective.

Experimental therapies: Several cutting-edge therapies have shown promise in clinical trials. Some of these methods are already used to treat a variety of other conditions. For example, deep brain stimulation (DBS) is an approved treatment for movement disorders such as Parkinson’s disease, as well as treatment-resistant epilepsy seizures and obsessive-compulsive disorder. Vagus nerve stimulation is approved for certain cases of treatment-resistant depression and epilepsy. Other potential, still experimental approaches for tinnitus include:

  • Repetitive transcranial magnetic stimulation
  • Transcranial direct current stimulation
  • Brain surface implants

Animal studies have shown that specific nerve cells in the brain, called fusiform cells, signal phantom sounds to the rest of the brain. A home device that supplied stimulation through electrodes and earphones was tested on 20 human patients, who used the device 30 minutes a day for four weeks. The study showed that fusiform cell activity can be tamed using a combination of sounds and mild electrical stimulation of the skin. While the volume of tinnitus returned after one week, the improvement in quality of life lasted as long as several weeks. Individuals with somatic tinnitus and the associated ability to temporarily change their symptoms by clenching their jaws, sticking out their tongues, or turning or flexing their necks appeared to benefit the most from the combination of audio and electrical stimuli.

Tinnitus

I was in the 6th grade when I started to hear these strange noises, and I would put scarves around my head to try to block them out. When I went to have my hearing tested, I had supersonic hearing.

Barbara Streisand

from Hearing Health Foundation

Recent research breakthroughs

A groundbreaking study conducted at the University of Montreal uncovered insights regarding the conceptual theory known as central auditory gain and possible connection between tinnitus and hyperactivity in the brain and auditory pathways. When people with normal hearing wear earplugs, their hearing sensitivity increases, but when they wear noise generators, their sensitivity to sound decreases. This is the first study to show that gain adaptation occurs at the highest level of the auditory system, the cortex, with no observable changes in lower auditory pathway levels (e.g. inner ear, brainstem, and auditory nerve responses). Although additional studies are needed, these findings could represent a major step forward in developing new tinnitus treatment strategies.

The next step

To manage your tinnitus and lessen its impact on your life, start by getting a proper diagnosis, then work with a licensed hearing care professional to devise the best treatment options and coping strategies for your unique situation.

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