Overview

Tinnitus—the false perception of sound in the absence of an acoustic stimulus, a phantom noise—is one of the most common clinical syndromes in the United States, affecting 12 % men and 14% women who are sixty-five and older; which accounts for 1 in 5 people. It only rarely afflicts the young, with one significant exception: those serving in the armed forces. Tinnitus affects nearly half the soldiers exposed to blasts in Iraq and Afghanistan. Tinnitus is often described as ringing in the ears, but that’s not the only sound that qualifies. It can also present as buzzing, roaring, clicking, hissing, or a noise like crickets, among other things. A type known as pulsatile tinnitus is rhythmic, often keeping time with the person’s heartbeat.

Causes

Normally, the outer ear, known as the pinna, collects sound waves and directs them into the ear canal, which carries the sound waves to the eardrum. In turn, the eardrum vibrates, and these tremors are picked up by the three tiny bones in the middle ear: the malleus (resembling a club), the incus (shaped like an anvil), and the stapes (similar to a stirrup). These bones amplify the sound vibrations and transmit them to the inner ear, where the cochlea converts the vibrations into electrical impulses, which travel from the acoustic nerve to the part of the brain that processes sound, the auditory cortex. Tinnitus can be temporary, caused by excess wax, an infection of the inner ear, or the toxic effects of drugs like aspirin (which appears to weaken the neural signals from the ear to the brain) or those used to treat cancer. Some people with normal hearing develop spontaneous tinnitus when placed in total silence; this is believed to be a response of the auditory cortex to the abnormal absence of all ambient sounds. But the majority of people with chronic symptoms develop them in conjunction with hearing loss. With the recent proliferation of MP3 players, rates of hearing loss and tinnitus may rise sharply in the coming years.
The health related causes for tinnitus includes:

• Noise-induced hearing loss
• Ear and sinus infections
• Diseases of the heart or blood vessels
• Ménière’s disease
• Brain tumors
• Hormonal changes in women
• Thyroid abnormalities

Tinnitus is sometimes the first sign of hearing loss in older people. It also can be a side effect of medications. More than 200 drugs are known to cause tinnitus when you start or stop taking them.

People who work in noisy environments—such as factory or construction workers, road crews, or even musicians—can develop tinnitus over time when ongoing exposure to noise damages tiny sensory hair cells in the inner ear that help transmit sound to the brain. This is called noise-induced hearing loss.

Symptoms

Tinnitus involves the annoying sensation of hearing sound when no external sound is present. Tinnitus symptoms include these types of phantom noises in your ears:

• Ringing
• Buzzing
• Roaring
• Clicking
• Hissing
• Chirping
• Screeching
• Static
• Musical
• Whooshing
• Pulsing

The phantom noise may vary in pitch from a low roar to a high squeal, and you may hear it in one or both ears. In some cases, the sound can be so loud it can interfere with your ability to concentrate or hear actual sound. Tinnitus may be present all the time, or it may come and go.
There are two kinds of tinnitus.

• Subjective tinnitus is tinnitus only you can hear. This is the most common type of tinnitus. It can be caused by ear problems in your outer, middle or inner ear. It also can be caused by problems with the hearing (auditory) nerves or the part of your brain that interprets nerve signals as sound (auditory pathways).
• Objective tinnitus is tinnitus your doctor can hear when he or she does an examination. This rare type of tinnitus may be caused by a blood vessel problem, a middle ear bone condition or muscle contractions.

What Should I Do If I Have Tinnitus?

The first thing is to see your primary care doctor, who will check if anything, such as ear wax, is blocking the ear canal. Your doctor will ask you about your current health, medical conditions, and medications to find out if an underlying condition is causing your tinnitus.
If your doctor cannot find any medical condition responsible for your tinnitus, you may be referred to an otolaryngologist (commonly called an ear, nose, and throat doctor, or an ENT). The ENT will physically examine your head, neck, and ears and test your hearing to determine whether you have any hearing loss along with the tinnitus. You might also be referred to an audiologist who can also measure your hearing and evaluate your tinnitus.
Questions that a doctor might ask include:

• How or when did it start?
• Are the noises constant, intermittent, or pulsating?
• Is there any hearing loss or dizziness?
• Is there any pain or jaw clicking?
• Have you had a recent illness or injury?
• Has there been any exposure to loud noise, such as a rock concert or explosives?

Tests may include:

• a complete examination of the ear, head, neck, and torso
• hearing tests
• laboratory blood tests
• imaging studies

Treatment

The first step is to treat any underlying cause of tinnitus. This may involve:

• prompt care for an ear infection
• discontinuing any ototoxic medications
• treating any temporomandibular joint (TMJ) problems, which affect the joint betwen the jaw bone and the cheek bone

There is no cure for most cases of tinnitus. Most people become accustomed to it and learn to tune it out. Ignoring it rather than focusing on it can provide relief.
When this does not work, the individual may benefit from treatment for the effects of tinnitus, insomnia, anxiety, hearing difficulties, social isolation, and depression. Dealing with these issues can significantly improve a person’s quality of life.

Home Remedies

Here are some other things a person can do to manage tinnitus and its effects.
Sound therapy uses external noise to mask the individual’s perception of tinnitus. Low-level background music, white noise, or specialized ear maskers can help. The choice of sound should be pleasant to the individual. Masking devices offer temporary relief, and the awareness of tinnitus returns when the sound therapy is turned off. Hearing aids are a common type of sound therapy. They amplify environmental sounds and redirect attention to those noises instead of the tinnitus.
Tinnitus retraining therapy (TRT) involves retraining the auditory system to accept the abnormal sounds of tinnitus as natural rather than disruptive. It involves help from a trained professional and wearing a device that emits low-level white noise. Ongoing counseling sessions can help people cope with the tinnitus. This therapy’s success is proportionate to the severity of the tinnitus and the individual’s overall mental health. Follow-up studies suggest that TRT provides relief for around 80 percent of people with tinnitus.
Other techniques to mitigate the impact of tinnitus includes:

• Get your blood pressure checked. If it is high, get your doctor’s help to control it
• Exercise daily to improve your circulation
• Get adequate rest and avoid fatigue
• Use physical (sound machine) and mental techniques to push the perception of tinnitus to the background; the more you think about the tinnitus, the louder it will seem. If you cannot do this on your own, seek help as outlined above.

Researchers' Efforts

In 2009, the National Institute on Deafness and Other Communication Disorders (NIDCD) sponsored a workshop that brought together tinnitus researchers to talk about the condition and develop fresh ideas for potential cures. During the course of the workshop, participants discussed a number of promising research directions, including:

• Electrical or magnetic stimulation of brain areas involved in hearing. Implantable devices already exist to reduce the trembling of Parkinson’s disease and the anxieties of obsessive-compulsive disorder. Similar devices could be developed to normalize the neural circuits involved in tinnitus.
• Repetitive transcranial magnetic stimulation (rTMS). This technique, which uses a small device placed on the scalp to generate short magnetic pulses, is already being used to normalize electrical activity in the brains of people with epilepsy. Preliminary trials of rTMS in humans, funded by the NIDCD, are helping researchers pinpoint the best places in the brain to stimulate in order to suppress tinnitus. Researchers are also looking for ways to identify which people are most likely to respond well to stimulation devices.
• Hyperactivity and deep brain stimulation. Researchers have observed hyperactivity in neural networks after exposing the ear to intense noise. Understanding specifically where in the brain this hyperactivity begins and how it spreads to other areas could lead to treatments that use deep brain stimulation to calm the neural networks and reduce tinnitus.
• Resetting the tonotopic map. Researchers are exploring how to take advantage of the tonotopic map, which organizes neurons in the auditory cortex according to the frequency of the sound to which they respond. Previous research has shown a change in the organization of the tonotopic map after exposing the ear to intense noise. By understanding how these changes happen, researchers could develop techniques to bring the map back to normal and relieve tinnitus.