Symptoms, Causes, Treatment, and More
10 July 2019
Do you hear annoying ringing, buzzing, roaring, or hissing sounds that no one else can hear? You are not alone. You are experiencing tinnitus, one of the most common health conditions in the United States. Over 50 million Americans experience some type of tinnitus, and while there is no cure, there are many effective treatment options.
Table of Contents
What are the symptoms of tinnitus?
Tinnitus is the perception of sound by a person when no external source of noise can be identified. Tinnitus is often described as “ringing”, “buzzing”, “roaring”, or “hissing”.¹
This perceived sound can be classified in one of two ways, subjective or objective. Subjective tinnitus is only heard by the patient. A medical professional can help the patient describe and quantify the tinnitus using different sounds or narrow band noise at different levels, as well as loudness levels which are uncomfortable.
Another aspect of tinnitus is the emotional and physical toll it can bring to a patient’s life. These symptoms can identified and quantified using specific questionnaires such as the Tinnitus Handicap Inventory or the Tinnitus Severity Index.² These questionnaires are clinically validated and can help both the patient and hearing healthcare professional recognize the burden of tinnitus and then create a treatment plan.
Objective tinnitus is a very rare form of tinnitus which can be heard via stethoscope by a medical professional. This type of tinnitus is caused by irregularities in the vascular system, and is often pulsatile or rhythmic and frequently mimics the patient’s heartbeat.³
What are the causes of tinnitus?
Doctor, why do I have tinnitus? What exactly is tinnitus? Where does it come from? What causes it? How can I get rid of it! We hear these questions every day, often, multiple times per day! For patients, tinnitus can be a troubling diagnosis with numerous underlying causes. Tinnitus is strongly associated with hearing loss and in most cases, we believe that tinnitus stems from damage to the outer hair cells of the cochlea. These sensory receptor cells can become damaged leading to less auditory stimulation reaching the brain. This lack of auditory stimulation leads the brain to create sound ‘tinnitus’ to fill in the ‘empty space’. Other known causes of tinnitus include, but are not limited to; medication, stress, muscle tension, central pathology, and noise exposure. When tinnitus is associated with medication, it often times will diminish when the medication is stopped. It should also be noted that medication inducted tinnitus can worsen if the medication dosage is increased. Some of the medications that can cause tinnitus include, but are not limited to; some antibiotics, anti-depressants, aspirin, quinine, some forms of chemo therapy, quinine, and diuretics. When stress and muscle tension are the cause of tinnitus, treating those conditions will often times lead to a reduction in tinnitus.
Tinnitus can further be classified in 2 different ways, subjective tinnitus, the most common form of tinnitus, and objective tinnitus, a rarer form of tinnitus. Subjective tinnitus can only be heard by the individual perceiving it, while objective tinnitus can also be heard by a doctor during an otologic evaluation. The cause of objective tinnitus can be vascular in nature. In cases like this, vascular flow is audible and would warrant further medical work up. Objective tinnitus may also result from middle ear myoclonus. Middle ear myoclonus is potentially related to the tensor tympani or the stapedius tendon.
The case history is a very important part of the evaluation to attempt to diagnose the cause of a patient’s tinnitus. It is necessary to clearly state symptoms and characteristics of tinnitus during this otologic evaluation. The more information that your doctor obtains, the more likely they will be to establish a correct diagnosis. Some of the questions you will encounter could include the following:
- Is your tinnitus constant or pulsatile? – Pulsatile tinnitus can be vascular in nature and indicate an underlying problem, warranting a further medical evaluation.
- What does your tinnitus sound like? – Common answers will be; buzzing, hissing, chirping, and ringing. It is worth noting that what tinnitus sounds like, is a reflection of how a patient perceives their tinnitus, and perception varies from individual to individual.
- How is your hearing? – tinnitus is most commonly associate with age related sensorineural hearing loss, and this should always be ruled out in the presence of tinnitus.
- Have you had a history of noise exposure? – Noise exposure is also a known risk factor for tinnitus.
- Do you clench your jaw or grind your teeth? – These behaviors that put tension on the temporomandibular joint are also known risk factors for tinnitus.
- If your tinnitus has recently changed in severity or characteristic, have you had a significant stress event recently or a change in your hearing? –Stress in our daily lives can exacerbate tinnitus, it can make it seem louder, more constant, of a different pitch, and more troublesome. A change in the tinnitus experience can also be symptomatic of a change in underlying hearing function.
- Are there other otologic (ear related) symptoms that you have been experiencing, including, but not limited to, dizziness, vertigo, ear clogging, pressure, numbness, or tingling. –Tinnitus coupled with vertigo and or hearing loss, can be an indication of an inner ear problem (pathology). A patient may also present with tinnitus along with other symptoms when experiencing a sudden sensorineural hearing loss, acoustic neuroma (vestibular schwanoma), otitis media (middle ear infection) a TIA or CVA (stroke).
- Where do you hear your tinnitus? Is it in both ears, your head, or just one ear? If tinnitus is only heard in one ear, it can be a symptom of an asymmetric sensorineural hearing loss, among other things. It would warrant a further medical evaluation.
Once all information has been collected and assessed, you doctor will hopefully be able to identify the specific underlying cause of tinnitus and attempt to establish a treatment plan.
What are the consequences of untreated tinnitus?
Many people with tinnitus incorrectly assume that their health is compromised, and this leads to undue anxiety. The fear associated with an unknown, uncontrollable sound in the ear activates the limbic system, which triggers an emotional response – panic, distress, and sometimes depression. Symptoms of depression such as decreased appetite or sex drive can ensue. Tinnitus may even trigger feelings of PTSD (post-traumatic stress disorder). Feelings of anger, self-guilt, hopelessness, and irritability can arise, which may lead a person to feel miserable overall. Tinnitus sufferers may even avoid situations that they think might provoke their tinnitus, which becomes a form of social anxiety. The tinnitus sufferer may also feel lonely and assume that others do not understand what they are going through.
Since tinnitus is often accompanied by hearing loss, communication impairment is also a common consequence of untreated tinnitus. While hearing loss decreases the volume and clarity of everyday sounds, tinnitus distracts the listener and serves to further confuse the sounds they are trying to hear. This can lead to difficulty at work and put a strain on interpersonal relationships. Untreated tinnitus can also cause difficulty falling asleep or staying asleep, which further causes sluggishness and lack of productivity during the day.
Do I have tinnitus?
Ringing in the ears has happened to everyone – maybe it was after a loud concert or party, or maybe during a home renovation. But for some people, it never goes away.
Tinnitus is a condition where you hear constant or recurring noise in your ears. While ringing is the most common, it can be any sound, such as clicking, buzzing, whistling, or hissing. It varies in intensity as well. For some people, it is hardly noticeable. For others, it is so loud that it interferes with normal life.
Here are some questions to ask yourself if you suspect you may have tinnitus:
- Could the noises be exterior noises? - Are you running an air conditioner or heater with a fan? Do you live near a busy road with traffic? Does your refrigerator make noise? Check for symptoms in various settings and locations to ensure that it is not coming from your environment.
- Do I hear noises that no one else is hearing? - Another way to check that the noises you are hearing are caused by tinnitus is to ask your friends and family if they are also hearing noises. Since the noises of tinnitus are created by our brain – they are not actual external sound waves, no one else can hear them.
- What does the noise sound like? - Tinnitus can take many forms, including ringing, roaring, clicking, chirping, whooshing, buzzing, humming, or a heartbeat. It can seem to be in one ear or both, or like it is coming from a distance. The noise may be steady, intermittent, or pulsating. It can be constant or recurring at different times throughout the day, or even every few days.
- Can I identify a triggering event, such as a concert or head trauma? - Tinnitus is often caused by a loud noise or event, such as a concert, gun-shot, or construction noises. Serious injury to your head or neck can also trigger the condition. If the ringing started due to an event such as these, it is likely tinnitus.
- Did I start or stop any medication? - Certain medications may trigger tinnitus. There are over 200 drugs that can cause the condition, such as ibuprofen, naproxen, antibiotics, diuretics, aspirin, and chemotherapy medications. Tinnitus from medication usually occurs when starting or stopping medication. This is why talking to your doctor about all possible side effects is important when starting and stopping medications.
- Do I have an ear infection, cold, or sinuses? - Upper respiratory congestion, infections, or ear wax buildup can cause pressure in your ear, leading to tinnitus. In these cases, treatment could cure or greatly reduce the tinnitus symptoms.
- Do I have migraines? - Migraines are best known for pulsating pain, nausea, and sensitivity to light and sounds. But they can also come with ear pain, reduced or muffled hearing, or tinnitus. If your tinnitus occurs with the onset of your migraines, treatment will likely reduce tinnitus symptoms as well.
If you think you have tinnitus, you should seek an evaluation by an audiologist. They will be able to help with evaluation and management.
What are the types of tinnitus?
Tinnitus, that pesky noise in your ears that seems only to appear when you need to concentrate, is an annoyance as well as a symptom of an underlying condition such as hearing loss, noise exposure or that something may be off medically. Tinnitus is the perception of a sound that can only heard by the person experiencing it, and it occurs when there is no other source of sound nearby that can account for it. It is an annoying sound that may appear in one ear or both ears, be constant or intermittent, and be high-pitched or low-pitched. Most people think of and describe tinnitus as “ringing” in the ears, but the truth is that tinnitus can manifest in an array of sounds including “buzzing,” “roaring,” “clicking,” “rushing” and “hissing.” For some people, tinnitus causes distress and can wreak havoc on a person’s emotional and physical well-being.
While most people who experience tinnitus also experience a hearing loss, not everyone who experiences tinnitus will have hearing loss. Individuals may also notice that tinnitus appears suddenly or develops slowly over time. Regardless of when it shows up, how it is described or what it is attributed to, there are two main types of tinnitus: subjective tinnitus and objective tinnitus. These are very different and the type of tinnitus can help determine its etiology.
Subjective tinnitus is the most common type of tinnitus and sometimes it is referred to as “phantom” tinnitus. The reason for the term “phantom tinnitus” is that only the person experiencing it can hear it. Some of the common causes of subjective tinnitus include noise induced hearing loss, presbycusis, or hearing loss attributed to aging, middle ear infections and even impacted cerumen, or wax, in the ears.
Common risk factors for subjective tinnitus other than hearing loss include:
- Noise exposure
Less common risk factors for subjective tinnitus that may be ear related include:
- Meniere’s disease
- Temporomandibular joint disease
- Acoustic neuroma
- Head injury
It is also common for people to experience subjective tinnitus from certain medications. While there are many medications that may list tinnitus as a side effect, it is important to note that not all people who take these medications will experience tinnitus. The most common ones include:
- Non-steroidal anti-inflammatory drugs (NSAIDS) - Aspirin, ibuprofen and naproxen are over the counter medications often used for pain relief.
- Aminoglycoside antibiotics - Used to treat life-threatening illnesses
- Diuretics - Used in the treatment of hypertension (high blood pressure)
- Chemotherapeutic agents - Used to combat certain types of cancer
- Quinine - Used to treat malaria
The other type of tinnitus is called objective tinnitus, often referred to as pulsatile tinnitus and less frequently as vascular tinnitus. Pulsatile tinnitus is less common that phantom tinnitus and is usually an indication of a medical condition involving blood flow disturbances, especially in the head and neck region. With this type of tinnitus, physicians and other individuals, as well as the individual can hear it and it usually sounds like a whooshing or throbbing.
Common medical conditions that can cause pulsatile tinnitus include:
- Hypertension (high blood pressure)
- Head and neck tumors
- Atherosclerosis (narrowing of the arteries)
- Twisted arteries in the head and neck area
Less common causes of pulsatile tinnitus include:
- Multiple sclerosis
- Iron deficiency
In either case of tinnitus, subjective (phantom) and/or objective (pulsatile/vascular), it is important to report it to and investigate it with the appropriate medical professional, particularly if it is interfering with your daily life. Audiologists can help individuals suffering from subjective tinnitus to classify and quantify the type, while physicians can assist in finding medical conditions that may be causing objective tinnitus.
In the meantime, know that tinnitus is real but manageable, and not unique to any one person. While most people who experience tinnitus have hearing loss, if you do experience it suddenly, it does not mean you will “go deaf” or lose your hearing, or that it will get worse. So if you experience that irritating, annoying noise in your ears, whether it is “buzzing,” “roaring,” “clicking,” “rushing” and “hissing” don’t allow it to control your life. Seek help from the appropriate professional and get a handle on it before it gets a handle on you!
How is tinnitus treated?
Rather than “treating” tinnitus, the goal is to help a patient manage their tinnitus. After the underlying causes of tinnitus have been identified, there are several therapies which have been found efficacious in reducing or eliminating the perceived tinnitus and its associated distress.
- Hearing Aids. Many patients who report tinnitus have underlying hearing loss. If the hearing loss is treated effectively with hearing instruments, the tinnitus is also reduced.
- Counseling. Counseling programs can educate patients on what causes the brain to create tinnitus sounds, and can help patients learn coping strategies including changing the way one thinks about tinnitus and relaxation techniques.
- Sound Generators. Many patients find soothing sounds such as wind, water, or birds to be a relaxing and help diminish the sound of the tinnitus they perceive. There are table top sound generators, smart phone apps, and many modern hearing instruments also include settings are essentially sound generators. These generators have been shown to help mask or minimize the perceived tinnitus sound.¹
- General Wellness. Patients with tinnitus may find that changes in diet, exercise, and relaxation affect their perception of tinnitus.
- Behavioral Therapy. There are several types of therapy that have been found to be helpful for patients suffering with severe tinnitus. These include cognitive behavioral therapy, mindfulness-based stress reduction, tinnitus activities treatment, and progressive tinnitus management.²
- TMJ and other Physical Treatments. In very few cases, tinnitus is caused by physical dysfunction in the temporomandibular joint, obstructions in the ear canal, or head and neck injuries. Treatment of these underlying physical symptoms can bring relief of tinnitus symptoms.³
How do I relieve and cope with tinnitus?
If you are suffering from tinnitus, you may already know that it can be debilitating. Tinnitus is described as a perception of noise or ringing when no such external physical noise is present. In other words, you hear something that isn’t there, a notion that can be disturbing all on its own. Depending on how loud or often that noise is experienced though, it can also lead to fatigue, stress, sleep problems, depression, and other serious issues. The most important thing you can do to start alleviating and coping with tinnitus is to see a doctor, typically an ENT or an audiologist.
Because tinnitus is a symptom and not a condition, it is important for your doctor to determine the underlying cause for your having tinnitus. This will ultimately allow your doctor to choose the appropriate treatment methods for ameliorating the symptoms. In almost all cases the doctor will perform a comprehensive hearing exam. This is the main and most important step in determining what may be contributing to your tinnitus. Once this assessment has taken place, an appropriate treatment plan can then be recommended. The typical treatments include one or many the following techniques for alleviating and coping with tinnitus:
- Hearing aids – hearing loss is the most common cause of tinnitus. This happens naturally as the brain attempts to replace the frequencies it can no longer hear naturally. Typical treatment is hearing aids. Most sufferers of tinnitus report amelioration and often complete recovery from tinnitus when the brain and ears are being stimulated with actual noise through the hearing aids.
- Masking devices – these devices are worn on the ear and work by generating low level noise to cover up the tinnitus. Typically an audiologist will work with you to determine the correct pitch and noise level that is needed. These devices can also be combined with hearing aids.
- Therapy – tinnitus retraining may be employed alone or in conjunction with the other solutions. The therapy combines the use of sound therapy devices and counseling over time to help cope with the effects of tinnitus.
- Medication – some medications, not limited to, but including anti-depressants, have been shown to alleviate tinnitus.
- Diet changes – dietary changes can be recommended to any tinnitus sufferer. Foods that are high in sodium have been linked to increases in the frequency and strength of tinnitus. It is recommended for tinnitus sufferers to avoid eating foods that are high in sodium.
- Lifestyle changes – while it is shown that tinnitus can lead to stress, one of the best ways shown to reduce tinnitus is simply to reduce the amount of stress in your life from external factors. Not all stress can be eliminated, but making small changes can improve your tinnitus as well as your overall health.
- Support groups – Tinnitus is a very common symptom that many people suffer from. For that reason tinnitus support groups are available in or near most big cities. Having a group of people to meet with who are dealing with the same issues is often a big help in coping and generally reducing stress. This is often a good forum as well for people to share ideas for what is helping them to cope.
If you are suffering from tinnitus, there is help out there for you. It is usually just a matter of finding the right doctor. Don’t suffer in silence, get help today!
How is tinnitus prevented?
Tinnitus is most commonly a symptom of untreated hearing loss. Preventing hearing loss and preventing tinnitus follow the same strategies.
- Avoid exposure to loud noises
- If exposure cannot be prevented, wear appropriate hearing protection
- Keep your blood pressure in a normal range
- Keep blood sugar in a normal range
- Eat a healthy diet, avoid substances known to aggravate tinnitus
- Discuss medications with your physician, be aware of side effects and ask for alternatives if tinnitus is noted after beginning a new medication.
Celebrities with tinnitus
Sometimes it’s hard to remember that celebrities are people, too. And just like everyone else, they can also experience that constant ringing in their ears that plagues so many of us. In fact, because tinnitus often develops because of exposure to loud noises, actors and musicians may even be more prone to tinnitus than the rest of us!
Here’s a list of celebrities that suffer from tinnitus:
- Ronald Reagan - Before he was President, Ronald Reagan was an actor. While shooting the film Code of the Secret Service in 1939, a blank pistol was shot near his ear, causing tinnitus.
- Steve Martin - Steve Martin suffered a similar fate as Ronald Reagan. His tinnitus was caused by a gun fight scene while filing Three Amigos.
- William Shatner - While shooting Star Trek, William Shatner stood too close to the speakers during an explosion, causing immediate ringing in his ears that did not go away. He spoke to the American Tinnitus Association about his experiences with tinnitus, which you can watch here.
- Rush Limbaugh - Not all celebrities develop tinnitus due to the hazards of their job. Rush Limbaugh has tinnitus in his right ear.
- Eric Clapton - Eric Clapton’s lifetime of playing the guitar and performing has left him with hearing loss and tinnitus. Since developing these problems, he has used hearing aids and ear protection to prevent any further damage.
- Trent Reznor - The lead singer of rock band Nine Inch Nails has also developed tinnitus due to years of practicing and performing his music. He has even written songs about the struggle of living with this condition, such as “The Becoming”.
- Phil Collins - In 2011, the music legend Phil Collins ended his performance career due to his hearing loss and tinnitus. He was in the music industry for over 40 years, performing and attending thousands of shows, so it is no surprise that this took a toll on his hearing.
- Anthony Kiedis - The front man of Red Hot Chili Peppers, Anthony Keidis, also suffers from hearing loss and tinnitus due to his music career. He wrote about it in his autobiography, pinpointing a tour with Nirvana as the start of his tinnitus and hearing loss.
- Chris Martin - Chris Martin of legendary band Coldplay suffers from tinnitus. When speaking of his condition, he said, “Looking after your ears is unfortunately something you don’t think about until there’s a problem”. He and the rest of the band now use ear plugs to protect themselves.
- Whoopi Goldberg - Whoopi Goldberg, actress, comedian, and talk-show host, has tinnitus, but not from her job. Instead, Goldberg attributes her hearing loss and tinnitus from years of listening to loud music in headphones.
- Gerard Butler - Unlike many other celebrities on this list, the actor Gerard Butler has had lifelong tinnitus due to a childhood surgery on his right ear. It left his ear partially deformed, resulting in tinnitus, hearing loss, and a slightly crooked smile.
- Barbra Streisand - Barbra Streisand has had tinnitus since she was nine years old, and she doesn’t know exactly what caused it. She waited years before seeking help and treatment, but now she has learned how to better manage it.
If you have tinnitus, these celebrities show us that life and careers go on in spite of hearing challenges. The best thing you can do is meet with an audiologist to discuss how to prevent further damage and manage your current conditions.