Tinnitus

Introduction
Signs and Symptoms
Causes
Screening and Diagnosis
Treatment

• Noise in your ear, such as ringing, buzzing, roaring, whistling or hissing
• Hearing loss

The noise may vary in pitch from a low roar to a high squeal, and you may hear it in one or both of your ears. In some cases, the sound can be so loud it interferes with your ability to concentrate or hear properly.

Earwax buildup may worsen tinnitus. Excess wax in your ear canal can reduce your ability to hear outside noises and amplify internal noises.

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Causes

Inside your inner ear, thousands of auditory cells maintain an electrical charge. Microscopic hairs form a fringe on the surface of each auditory cell. When they're healthy, these hairs move in relation to the pressure of sound waves. The movement triggers the cell to discharge electricity through the auditory nerve. Your brain interprets these signals as sound.

If the delicate hairs inside your inner ear are bent or broken, they move randomly in a constant state of irritation. Unable to hold their charge, the auditory cells "leak" random electrical impulses to your brain as noise.

Damage to auditory cells in your inner ear most commonly results from:

• Age-related hearing loss (presbycusis). This process usually begins around age 60.
• Noise-related damage to your inner ear. This erosion of your hearing ability may result from excessive exposure to loud noise over a long period of time. Tractors, chain saws and weapons are common sources of noise-related hearing loss. Portable music devices, such as MP3 players or iPods, may become a common source of noise-related hearing loss in the future if people play these devices loudly for long periods.

Other causes of tinnitus may include:

• Long-term use of certain medications. Aspirin used in large doses and certain types of antibiotics can affect inner ear cells. Often the unwanted noise disappears when you stop using these drugs.
• Changes in ear bones. Stiffening of the bones in your middle ear (otosclerosis) may affect your hearing.
• Injury. Trauma to your head or neck can damage your inner ear.

Certain disorders of your blood vessels can cause a type of tinnitus called pulsatile tinnitus. These may include:

• Atherosclerosis. With age and buildup of cholesterol and other fatty deposits, major blood vessels close to your middle and inner ear lose some of their elasticity - the ability to flex or expand slightly with each heartbeat. That causes blood flow to become more forceful and sometimes more turbulent, making it easier for your ear to detect the beats.
• High blood pressure. Hypertension and factors that increase blood pressure, such as stress, alcohol and caffeine, can make the sound more noticeable. Repositioning your head usually causes the sound to disappear.
• Turbulent blood flow. Narrowing or kinking in a carotid artery or jugular vein can cause turbulent blood flow and head noise.
• Malformation of capillaries. A condition called A-V malformation, which occurs in the connections between arteries and veins, can result in head noise.
• Head and neck tumors. Tinnitus may be a symptom of a tumor in your head or neck.

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Screening and Diagnosis

You and your doctor can discuss your signs and symptoms, when they started, their severity and what can make them worse. Also helpful to your doctor is information about your other health conditions, such as high blood pressure and whether you're taking any medications.

Your doctor will also examine your ears to see if an accumulation of earwax may be causing or contributing to the ringing in your ears. In addition, your doctor will attempt to hear noise with a stethoscope over the area of your head and neck around the ear. If damage to your inner ear is the cause of your tinnitus, you may have subjective tinnitus, meaning that only you can hear it. But if your doctor can hear noise from a vascular disorder, you have objective or pulsatile tinnitus.

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Treatment

Treatment of tinnitus depends on the cause.

If the ringing in your ears is due to age-related hearing loss or damage to your ears by exposure to excessive noise, no treatment can reduce the noise. Treatment consists mostly of managing the problem. Your doctor can discuss with you steps you can take every day to reduce the severity of the noise or to better cope with the noise.

If the ringing in your ears is due to another health condition, your doctor may be able to take steps that could reduce the noise, such as removing impacted earwax. Tinnitus resulting from a vascular condition often can be corrected by fixing the underlying problem. If a medication you're taking appears to be the cause of tinnitus, your doctor may recommend discontinuing the drug or switching to a different medication.

Varying success for medications
Many medications have been tried to relieve tinnitus with varying degrees of success. Tricyclic antidepressants, such as amitriptyline and nortriptyline, have been used with some success, but these medications have troublesome side effects, such as dry mouth, blurred vision and constipation.

Two recent clinical trials found that the migraine medications gabapentin (Neurontin) and acamprosate (Campral), a drug used to treat alcoholism, are effective in relieving tinnitus for some people.

Treatments with limited results
Some other treatments that have been tried, but which have had inconsistent results, are:

• Acupuncture
• Hypnosis
• The herb ginkgo
• Cochlear implant, an electronic hearing device
• Electrical stimulation
• Medications, such as benzodiazepines (nervous system depressants) and baclofen (a muscle relaxant)
• Hyperbaric oxygen chamber, a therapy to get a high level of oxygen in your blood
• Zinc