Tinnitus

Tinnitus is sound in your head or ears with no external source. It’s commonly referred to as ringing in the ear. That’s because, for many, it's a ringing sound; for others, though, it's whistling, buzzing, chirping, hissing, humming, roaring, or even shrieking. The sound may be perceived as coming from one ear or both, from inside the head, or from a distance. It may be constant or intermittent, steady, or pulsating.

Nearly everyone experiences a few brief episodes of ringing in the ears at some point in life, for example after using a lawn mower or attending a loud concert. In some people with tinnitus, however, the problem is a persistent source of distress.

The condition is strongly associated with hearing loss but can also occur in people who have normal hearing. There are no treatments that specifically target the underlying causes of chronic tinnitus, but it often becomes less noticeable and more manageable over time. There are also several ways to help tune out the noise and minimize its impact.

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What is tinnitus?

Tinnitus, commonly called ringing in the ears, is the sensation of hearing a sound in the ears that does not have an external cause. This sound is typically described as a high-pitch ringing. It can also be an annoying hiss, whistle, buzz, or hum. Tinnitus can be constant or can come and go.

Other problems may arise, such as dizziness or vertigo, pain or a plugged feeling in the ear, and nausea. Tinnitus symptoms are often associated with other symptoms such as insomnia, difficulty concentrating, depression, and irritability.

If you develop tinnitus, it's essential to see your doctor or an audiologist or otolaryngologist [ear, nose, and throat specialist, or ENT]. They will take a medical history, perform a physical examination, and do a series of tests to find the source of the problem. They will also ask you to describe the noise you hear (including its pitch and sound quality, and whether it's constant or periodic, steady or intermittent) and the times and places you hear it.

There are a few symptoms related to tinnitus that might require further evaluation.  Tinnitus that is bothersome and interferes with your function, occurs in just one ear, or sounds like a heartbeat are not common symptoms, and should be reviewed with your physician or audiologist.

Tinnitus that's continuous, steady, and high-pitched (the most common type) generally indicates a problem in the auditory system and requires hearing tests conducted by an audiologist.

What causes tinnitus?

One of the most common causes of tinnitus is damage to the hair cells in the cochlea, the part of the inner ear involved in hearing. These cells help transform sound waves into nerve signals. If the auditory pathways or circuits in the brain don’t receive the signals they’re expecting from the cochlea, the brain, in effect, “turns up the gain” on those pathways to detect the signal—similar to turning up the volume on a car radio when trying to find a station’s signal. The resulting electrical noise takes the form of tinnitus.

Tinnitus also can be a symptom of a hearing problem, such as:

  • any type of hearing loss
  • earwax buildup
  • inner ear damage from loud noises
  • middle ear damage or problems, such as infections and vascular tumors.
  • Meniere’s disease (an inner ear problem that can cause dizzy spells and hearing loss)

Some medications (especially aspirin and other nonsteroidal anti-inflammatory drugs taken in high doses) can cause tinnitus. Other drugs that may cause tinnitus include certain antibiotics, antidepressants, anticonvulsants, cancer drugs, and loop diuretics.

People also may experience short-term tinnitus after exposure to extremely loud noises such as those caused by attending a loud concert or heavy equipment.

How do you treat tinnitus?

While chronic tinnitus has no cure, treatments can offer some relief and make it more manageable. The type of treatment depends on the cause.

Some people with hearing loss and tinnitus find that both problems improve after they get a hearing aid or a cochlear implant. Tinnitus from a medication side effect will improve after you stop taking the drug or altering the dose.

Removing a wax blockage may improve ringing in the ear. Antibiotics can fight tinnitus caused by an ear infection. However, when tinnitus is caused by Meniere's disease, the tinnitus usually remains even after it's treated.

Musculoskeletal factors such as jaw clenching, tooth grinding, prior injury, or muscle tension in the neck can sometimes exacerbate tinnitus. In such cases, massage therapy may help relieve it.

Some people find relief by cutting down on caffeine and alcohol, reducing the amount of fat in their diets, and quitting smoking.

Certain therapies are also helpful. For instance:

Cognitive behavioral therapy (CBT). CBT uses cognitive restructuring and relaxation techniques to change how people think about and respond to tinnitus. CBT may not make the sound less loud, but it can make it significantly less bothersome and improve quality of life. Therapy is generally short-term; for example, weekly sessions for two to six months.

Tinnitus retraining therapy. This type of therapy is done by an audiologist. A device is inserted in the ear to generate low-level noise and environmental sounds that match the pitch, volume, and quality of the person’s tinnitus. Depending on the severity of the symptoms, treatment may last one to two years.

Masking. Masking devices, worn like hearing aids, generate low-level white noise that can reduce the perception of tinnitus and sometimes also produce less noticeable tinnitus for a short time after the masker is turned off. Another masking method is playing music or having a radio, fan, or white noise machine in the background.

Biofeedback. Biofeedback is a machine-assisted technique that helps people take control of their body responses. Electrodes attached to the skin feed information about physiological processes such as pulse, breathing, and muscle tension into a computer, which displays a visual representation of these processes on a monitor. Individuals learn to alter their physiological functions in response to the visual feedback.

People exposed to loud noises at work or home can reduce the risk of tinnitus and hearing loss by using earplugs or earmuff-like devices to protect their ears.

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