The Medical Minute: Tinnitus is more than just background noise

June 01, 2005

By John Messmer
Penn State Family & Community Medicine
Penn State Milton S. Hershey Medical Center
Penn State College of Medicine

Tinnitus is the name for the perception of sound in one or both ears when no source of sound is present. It's experienced by perhaps one in six Americans from all walks of life including presidents, performers and scholars, and may be particularly common in rock musicians. One in four affected people seek medical attention for it.

A common question about tinnitus is, how is it pronounced? According to the American Tinnitus Association, found at http://www.ata.org online, it can be pronounced either ti-NIGHT-us or TIN-i-tus, although they prefer the former. Many people call it ringing in the ears, but the sound can vary from a ringing sound to buzzing, clicking or rushing noises. It can be constant or intermittent, steady or variable, and in one or both ears.

Tinnitus has many possible causes, but the most common one is hearing loss from exposure to loud sounds. Sound is produced by pressure waves in the air transmitted to the eardrum, then the bones of the middle ear and finally to the fluid of the cochlea, which is the organ of hearing in the ear. The pressure waves bend microscopic hairs in the cochlea and this stimulates the auditory nerve, sending sound signals to the brain. The louder the noise, the more pressure exerted on the hair cells of the inner ear. These hairs are very delicate. A very loud sound, such as an explosion or repeated exposure to loud music or machinery, for example, can destroy them, resulting in hearing loss. It is thought that the damaged cells send signals when there is no sound, resulting in tinnitus.

There are some less common causes. Wax in the ear canal can stimulate the eardrum. Infections including viruses in the inner ear or sinus infections can cause ear noises. The temporomandibular, or jaw joint, or Eustachian tube, which equalizes ear pressure, can be a source of noise. Side effects of certain medications, particularly some antibiotics, aspirin and anti-inflammatory drugs such as ibuprofen have been implicated. Cardiovascular disease can cause pulsatile tinnitus. Ear diseases, such as Meniere's disease and inflammation and immune system diseases may cause it, as can certain tumors. Sometimes dizziness and nausea accompanies tinnitus.

If tinnitus has been present for a long time and is not accompanied by any other symptoms, it is very likely due to loss of hearing. When it occurs suddenly with dizziness and nausea in a younger, healthy person, it is probably due to a virus. It could be more serious if tinnitus develops suddenly or in only one ear. A medical evaluation is needed to sort out the various causes.

As with many medical problems, prevention is important and more effective than treatment. Any exposure to loud noises can be damaging so ear protection is necessary whenever the noise level is so loud a person must raise his or her voice to be heard. This applies even if the sound is brief, such as the noise of a gunshot. Loud music is probably one of the more important sources of loud noise, but power tools and lawn mowers can be just as bad. Ear protection can be simple foam earplugs or earmuff style protectors.

When tinnitus is caused by disease, treating the cause may eliminate it. In the case of tinnitus due to noise exposure, there is no cure, but several treatments have had some benefit. Many people notice tinnitus only when it's quiet, so having some background noise, such as a radio or TV, may cover up the sound. Masking devices resemble hearing aids and produce low level sound tuned to the frequency of the tinnitus and might suppress or eliminate the tinnitus in time. Cochlear implants and tinnitus retraining therapy are specialized treatments for more difficult cases. There are no medications, supplements or herbal products that have shown benefit for tinnitus. Some medications, foods and alcohol or nicotine have been known to increase tinnitus.

If ear noise is severe or sudden in onset, in one ear or accompanied by sudden or rapid hearing loss, severe nausea and vomiting or the loss of other senses, seek medical attention to look for more serious causes of tinnitus.

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Last Updated March 19, 2009