What Are the Causes of Tinnitus?
Tinnitus is strongly associated with hearing loss and in most cases, audiologists 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 medication, stress, muscle tension, central pathology, and noise exposure. When tinnitus is associated with medication, it often times diminishes 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 certain 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.
Subjective vs objective tinnitus
Tinnitus can further be classified in two 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 tinnitus case history
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? 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 ear-related symptoms? 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.
Thank you for your help. In 2018 i had right eye retina surgery with 10 anesthetics. First time in my life i woke up with static hissing pulsing sensation. Kept face down for 7 days head noise got better but my head didnt feel right. After 7 days the worst top head pain in my life between my head on top. Between top of forehead and crown of head very sharp pain took 800 mg of advil gel everyday for 14 days. My head still didnt feel right like a weird sensation around head then this noise came 1 month later from inside my head. Then it traveled to my right ear ..terrible loud at night 24/7..quiet room creates its own sound, now i hear 24/7 a spring noise of hissing goes with my heart mainly in right ear and sometimes a eeee that goes through the brain to rhe left ear. 2021 i had an emergency appendectomy the same anesthesiologist he said he would leave off lidocaine i did not have the same issue but unfortunately it didn't take the affliction away. Can you please tell me who or what kind of doctor can help me. When it really gets loud its hard for me to even want to survive since the only peace i get is going to bed and taking an over the counter sleep aid. I have a bad cold so it intensified the noise to more piercing and crickets in the head. Any suggestions are very much welcomed i am in.alabama. i am a member of the tinnitus groups on facebook people try to help one another. I have had mri, mrv, mra with and w/o contrast, ct of temporal bones and mrv of neck and ultrasound of neck. And i have had 7 hearing i hate it my hearing is fine. The left ear i have 25 more decibles before i even reach a substantial loss. Its pure torture putting the headset on..i woke up after surgery hearing noise