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Tinnitus: Causes, Symptoms, Treatment And Prevention

Tinnitus (a.k.a: Ringing in the Rars) is not a disease by itself but is a symptom of some underlying ear problem like infection or damage to the (internal) ear. The characteristic symptom of tinnitus is a constant ringing or buzzing sound in the ear, without the actual noise from the external environment. Tinnitus may be present continuously or intermittently.


Determination of the cause of tinnitus plays a vital role in preparing the treatment plan. Tinnitus is a widespread condition and occurs mostly in men. The incidence of the disease increases with the advancing age.

Causes of Tinnitus:

Tinnitus mainly occurs due to the damage to the internal ear. Any injury to the inner ear may trigger the nerves in the ear, which transmits random sound signals to the brain, causing tinnitus.

Some of the other conditions that cause tinnitus include:

  • Prolonged exposure to loud sounds
  • Age-related hearing disability
  • Excessive accumulation of ear wax or blockage of ear
  • Abnormal bone growth or stiffening of bones in the middle ear
  • Head or neck injuries and tumors
  • Increase in the pressure of inner ear
  • Problems in the joints lying at the front of the ears (temporomandibular joints)
  • Development of benign tumours in the inner ear
  • Hormonal changes in women
  • High blood pressure
  • Higher dose of some medications like antibiotics and antidepressants
  • Medications for treatment of cancer, like vincristine

Types of Tinnitus:

Tinnitus is of two types. They are:

Subjective Tinnitus: The constant buzzing or ringing sound is audible only to the patient and not to others (even doctors cannot hear it).  The main cause of this tinnitus is brain-related reactions to hearing loss. This is the most common type of tinnitus almost 99% of cases reported with tinnitus are of subjective type.

Objective Tinnitus: The constant ringing sound can be heard by the doctor, during physical examination of a patient. This ringing may be due to a middle ear infection or involuntary and continuous muscle contractions. This type of tinnitus occurs very rarely and is seen in about 1% of all the tinnitus cases.

Symptoms of Tinnitus:

People with tinnitus, develop the following clinical manifestations:

  • Ringing sounds in the ear
  • Buzzing in the ear
  • Whistling sounds in the ear
  • Roaring sounds in the ear
  • Headache
  • Ear pain
  • Decrease in the hearing capacity or loss of hearing
  • Irritability or lack of concentration in daily activities
  • Sleep disturbances (sleep apnea)
  • Psychological depression

Risk Factors for Tinnitus:

Presence of any or all of the following factors increases the risk of tinnitus in most of the patients. The common risk factors are listed here:

  • Advanced age
  • Being male
  • Underlying primary diseases like high blood pressure
  • Exposure to loud noises either at work or at home
  • Hearing loss
  • Ear infections or damage to the internal ear

Complications of Tinnitus:

Individuals with tinnitus may experience many difficulties in their daily life. Some of them are mentioned below:

  • Stress
  • Irritability
  • Anxiety
  • Inability to concentrate on the work
  • Sleep disturbances
  • Psychological depression
  • Social isolation

Diagnosis of Tinnitus:

Early diagnosis helps in appropriate and timely management of tinnitus. Diagnosis of tinnitus involves:

Physical Examination: It includes details about the present medical condition, its symptoms and physical analysis of the head, neck and ear region to find out any abnormalities that may result in tinnitus.

Hearing Tests or Audiometry: This test is performed to examine the patient’s sense of hearing, by using an audiometer to send sounds of different frequencies into one single ear. This test aims to evaluate the perception of various sounds by the patients.

Otoscopy: The test is performed to examine the structures in the middle ear and inner ear, especially the eardrum, using an otoscope.

Rhinoscopy: The test is performed to look for the nose and its internal structures like nasal septum and sinuses. The test involves passing an endoscope through the nose, to visualize the nasal passages.

Examination of Cranial Nerves: The test helps to diagnose any disturbances in the functioning of vestibule-cochlear nerves.

Specific Movements Test: The test helps to rule out any underlying disorders causing tinnitus. During this test, the patient is asked to clench his teeth tightly or move arms, legs and neck to assess worsening of the symptoms of tinnitus.

Blood Tests: The tests help to evaluate primary diseases like thyroid or other hormonal problems, resulting in tinnitus.

Computerized tomography scans (CT) and Magnetic resonance imaging (MRI) scan: These brain scans are performed to study for any abnormal growth of tissues or tumors in the brain.

Treatment of Tinnitus:

Treatment of tinnitus is mostly symptomatic in nature. Treatment includes:

Masking Devices: These devices either reduce or mask the sounds of tinnitus, by creating a constant low sound in the ears of the patients. It is effective as the constant ringing sound is more bothersome than a continuous low-pitch sound. Patients also experience the reduction of tinnitus effect for a shorter time, even after the removal of the masks.

Hearing aids or cochlear implants are also beneficial in treating tinnitus.

Tinnitus Retraining Therapy: It is a therapy to retrain the brain to avoid thinking about tinnitus. Psychological counselling and masking devices are combined to divert the patient’s anxiety about tinnitus. Treatment aims to divert the attention of an individual’s brain towards other sounds and decrease the fear of tinnitus.

Biofeedback and neurofeedback are useful in identifying tinnitus through regular visual feedbacks. The patient is then prepared to avoid activities or body functions that trigger these symptoms of tinnitus.

Medications: Drugs only help to reduce the symptoms, but do not cure them. Some of the drugs like alprazolam are helpful to some extent.

Other methods of treatment include clearing of any wax in the ears, treating underlying conditions either with medicines or through surgeries. Acupuncture and acoustic (auditory nerve) stimulation are also useful in the treatment of tinnitus.

Prevention of Tinnitus:

The only way to prevent tinnitus is by avoiding damage to the internal ear. Precautions to avoid tinnitus include:

  • Protecting from loud noises at work by wearing earplugs or masks
  • Protecting from everyday sounds at home like that of noise from a hair dryer or air cooler
  • Protecting from hearing loss during the process of ageing
  • Reducing anxiety and blood pressure
  • Practising stress relief techniques like yoga
  • Avoiding certain medications like aspirin in large quantities

Tinnitus is not a life-threatening condition, but early diagnosis and treatment are essential to prevent severe psychological complications like anxiety or depression.

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