Tinnitus

Tinnitus is noise originating in the ear rather than in the environment.

Tinnitus is common, affecting 15% of people over 45 and about 25% of people over 65. The distraction created by the noise greatly distresses some people. Fortunately, certain measures can make tinnitus more tolerable.

Causes

Hearing loss is the most common cause of tinnitus. In addition, most disorders that affect hearing can cause tinnitus, including accumulated earwax, Ménière's disease, fluid in the middle ear, and acoustic neuroma (a type of tumor). Disorders that do not involve the ear, for example, anemia, hardening of the arteries (atherosclerosis), and heart murmurs, can also cause tinnitus. Drugs that can cause hearing loss can also cause tinnitus. High doses of aspirin are a common cause of tinnitus.

In many cases, the cause of tinnitus is unknown.

Symptoms and Diagnosis

People with tinnitus use a seemingly endless list of words to describe what they hear. The noise may sound like bells or crickets, or it may be a ringing, a buzzing, a roaring, a whistling, or a hissing sound. Some people hear combinations of sounds. Usually the noise is continuous and affects both ears. The noise may pulsate if it is caused by anemia, atherosclerosis, or heart murmurs. Tinnitus becomes more prominent when surroundings are quiet or when the person is not focusing on something else. Thus, tinnitus tends to be most disturbing when trying to fall asleep.

If the cause of tinnitus is not clear, tests may be needed. Because subtle hearing loss can cause tinnitus, doctors usually perform hearing tests. Magnetic resonance imaging (MRI) of the head or computed tomography (CT) of the area of the skull that contains the ear (temporal bone) is often performed in those who have symptoms in only one ear, who sense a pulsating to their tinnitus, or who also have hearing loss in only one ear. Blood tests may be required, for example, to exclude anemia. Sometimes an ultrasound of the arteries in the neck is performed to find evidence of disorders such as atherosclerosis (narrowing of the arteries).

Outlook and Treatment

Attempts to silence the sounds are often unsuccessful. However, certain techniques can make tinnitus more bearable. Sometimes a cause can be found and tinnitus can be relieved. For example, tinnitus due to hearing loss often subsides if a person uses a hearing aid. Substituting a new drug for one that has been causing tinnitus (such as aspirin) or reducing the dose may relieve the condition as well.

Background sounds often offer temporary distraction from tinnitus. For example, music may help during the waking hours. At night, neutral sounds may help. Neutral sounds are the sounds most easily ignored as background noises. They can be produced by a white-noise generator (a machine that generates noise at every pitch simultaneously) or an FM radio tuned to a frequency between stations. If tinnitus is bothersome constantly, a tinnitus masker may help. This device, which generates neutral sounds, is worn in the ear like a hearing aid.

If none of these measures relieves tinnitus, biofeedback may help. Biofeedback is a technique in which a person learns to gain control over unconscious bodily functions (in this case, the triggers that cause tinnitus). Biofeedback involves a process of trial and error and is taught by a professional.