What is Tinnitus?
Tinnitus is the medical term for the perception of sound in one or both ears or in the head when no external sound is present. It is often referred to as “ringing in the ears,” although some people hear hissing, roaring, whistling, chirping, or clicking. Tinnitus can be intermittent or constant-with single or multiple tones-and its perceived volume can range from subtle to shattering.


What causes tinnitus?
The exact physiological cause or causes of tinnitus are not known. There are, however, several likely sources, all of which are known to trigger or worsen tinnitus.
Noise-induced hearing loss – Exposure to loud noises can damage and even destroy hair cells, called cilia, in the inner ear. Once damaged, these hair cells cannot be renewed or replaced. Hearing loss can also be caused by excessive noise exposure. Coincidentally, up to 90 percent of all tinnitus patients have some level of hearing loss.
Wax build-up in the ear canal – The amount of wax ears produce varies by individual. Sometimes, people produce enough wax that their hearing can be compromised or their tinnitus can seem louder. If you produce a lot of earwax, speak to your physician about having excess wax removed manually-not with a cotton swab, but by an ear, nose, and throat doctor.
Certain medications – Some medications are ototoxic-that is, the medications are toxic to the ear. Other medications will produce tinnitus as a side effect without damaging the inner ear. Effects, which can depend on the dosage of the medication, can be temporary or permanent. Before taking any medication, make sure that your prescribing physician is aware of your tinnitus, and discuss alternative medications that may be available.
Ear or sinus infections – Many people, including children, experience tinnitus along with an ear or sinus infection. Generally, the tinnitus will lessen and gradually go away once the infection is healed.
Jaw misalignment – Some people have misaligned jaw joints or jaw muscles, which can not only induce tinnitus, but also affect cranial muscles and nerves and shock absorbers in the jaw joint. Many dentists specialize in this temporomandibular jaw misalignment and can provide assistance with treatment.
Cardiovascular disease – Approximately 3 percent of tinnitus patients experience pulsatile tinnitus; people with pulsatile tinnitus typically hear a rhythmic pulsing, often in time with a heartbeat. Pulsatile tinnitus can indicate the presence of a vascular condition-where the blood flow through veins and arteries is compromised-like a heart murmur, hypertension, or hardening of the arteries.
Certain types of tumors – Very rarely, people have a benign and slow-growing tumor on their auditory, vestibular, or facial nerves. These tumors can cause tinnitus, deafness, facial paralysis, and loss of balance.
Head and neck trauma – Physical trauma to the head and neck can induce tinnitus. Other symptoms include headaches, vertigo, and memory loss.
Certain disorders, such as hypo- or hyperthroidism, lyme disease, fibromyalgia, and throacic outlet syndrome, can have tinnitus as a symptom. When tinnitus is a symptom of another disorder, treating the disorder can help alleviate the tinnitus.

Do children get tinnitus?
Tinnitus does not discriminate: people of all ages experience tinnitus. However, tinnitus is not a common complaint from children. Children with tinnitus are less likely than adults to report their experience, in part because children with tinnitus are statistically more likely to have been born with hearing loss. They may not notice or be bothered by their tinnitus because they have experienced it their entire lives.
Children, like people of all ages, can be at risk for tinnitus if they are exposed to loud noises. Recreational events like fairs or car races or sports games can all include high-decibels activities that can damage kids’ ears. Hearing protection is always recommended, as is a discussion about the danger of loud noises and the choices kids have to turn it down or walk away.

My neighbor has tinnitus but says it doesn’t bother her. Mine drives me nuts. Why the difference?
Not everyone experiences it to the same degree. Some people hear ringing or other noises in their ears immediately following exposure to excessive noise, like right after a concert, but the sound is temporary. Other people report hearing a slight noise all the time if they listen for it, but most of the time cannot distinguish the noise over all the other sounds in their environment. Other factors can affect the severity of the condition from patient to patient, such as different degrees of hearing loss and different kinds of noises heard. Interestingly, the loudness of the tinnitus, when measured in a laboratory setting, did not correlate to the severity of the tinnitus as rated by the patients themselves. Every person has his or her own level of tolerance to the tinnitus sounds. It is a very personal and individual experience.

Is tinnitus hereditary?
There appears to be a predisposition based on heredity for some people when they are exposed to loud sounds, but whether or not tinnitus is genetically indicated is not certain. Scientists working on the Human Genome Project, for example, have not discovered a “tinnitus gene,” but they have identified genes that are responsible for a few rare varieties of hearing loss, temporomandibular joint (TMJ) dysfunction, Ménière’s Disease, and acoustic Neuroma. These conditions frequently include tinnitus as a side effect, which suggests that there might be a connection. For now, however, a connection between your mother’s tinnitus and your tinnitus is still unknown.

Can a one-time exposure to loud noise cause tinnitus?
Noise is damaging if you must shout to be heard, if your ears hurt, or if your hearing is lessened immediately following noise exposure. The noise exposure could occur just one time or over months or years. The level of noise can affect the degree of hearing loss. For example, sounds of 100 decibels experienced for more than 15 minutes can cause hearing loss. Sounds of 110 decibels experiences for more than a minute can cause hearing loss.
A one-time exposure to loud noise is not guaranteed to cause tinnitus or permanent hearing loss, since people’s ears vary in sensitivity. It is also possible that the damage from noise exposure might not be noticeable for many years.

Does tinnitus cause depression?
In some cases, yes. The chronic sound of tinnitus can cause difficulty with sleep, concentration, reading, interpersonal relationships, and other everyday activities – all of which can lead a person, especially one who is predisposed to it, towards a state of depression.
In a 2003 study on depression and tinnitus, researchers found that most people with tinnitus were neither depressed nor seriously bothered by their tinnitus. But the patients who were depressed were far more disabled by their tinnitus than the non-depressed patients. If depression is a problem for you, it would be wise to seek help from a mental health professional.

What is pulsatile tinnitus?
Pulsatile tinnitus is a rhythmic, pulsing sound most often in time with the heartbeat. It can usually -– but not always — be heard objectively through a stethoscope on the patient’s neck or through a microphone placed inside the ear canal. While it is not a common form of tinnitus, it has some well-known causes: hypertension, a heart murmur, Eustachian tube disorder, a glomus tumor, an abnormality of a vein or artery, and others. Very often, this kind of tinnitus can be treated.
If you are experiencing pulsatile tinnitus, it is always a good idea have a medical examination.

Is there anything I can do to protect myself from tinnitus?
First, protect your hearing. At work, make sure Occupational Safety & Health Administration (OSHA) regulations are met: hearing protection is required under OSHA for any job in which noise levels exceed 90 decibels over the course of an eight-hour workday. Many hearing specialists counsel that this sound level is too high, and for some people, 90 decibels is still too loud. Further, as noise levels increase, the recommended time of exposure decreases. OSHA mandates that workplaces with excessive noise levels must protect workers by implementing a continuing, effective hearing conservation program. In other words, wear your earplugs or earmuffs, limit the amount of time you spend in noisy environments, and follow hearing conservation guidelines established by your employer.
Recreational noise also has an impact on your hearing. The next time you are around a noise that bothers your ears—for example, a sporting event, concert, or while hunting—wear hearing protection, which can reduce noise levels 15 to 20 decibels. For extremely loud situations, earmuffs over earplugs might be necessary. Be aware of other activities or situations that include loud noises, like hair drying or lawn-mowing. Make it easy for yourself to protect your ears by hanging earmuffs over the lawn mower handle, or keeping ear plugs in the bathroom next to your hair dryer. Repeated exposure to loud noises can have a cumulative, damaging effect on your hearing.
If your physician prescribes you medications, be sure to ask if the prescribed medications are ototoxic, or harmful to the ears, or if the drugs are associated with tinnitus as a side effect. This information is easily obtained in the Physicians Desk Reference.

Can anything make tinnitus worse?
Exposure to loud noises, as mentioned earlier, can have a negative effect on your hearing and exacerbate tinnitus. Be sure to protect yourself with earplugs, earmuffs, or by simply not taking part in noisy events.
Some medications can make tinnitus worse. Tell all of your physicians—not just your ear, nose, and throat doctor—about all prescription and over the counter medications you are currently taking or have recently taken.
Many people find that alcohol, nicotine, and caffeine can worsen their tinnitus, as can eating certain foods. Some people find that foods with a high sugar content or any amount of quinine (tonic water) make their tinnitus seem louder. Monitor how you respond to different stimuli, and find a healthy balance where you do not eliminate all the foods that you love, but also where you do not unnecessarily exacerbate your tinnitus.
Finally, stress and fatigue can affect your tinnitus. Make time to relax, and understand that life events can manifest themselves in your body in the form of increased tinnitus. Of course, this is easier said than done. Finding a good support network can help.

Tinnitus Treatment