Tinnitus or ringing in the ears - what it is, causes, symptoms, diagnosis and treatment
Find out the most frequent causes of tinnitus, how it is diagnosed and which are the most effective treatment methods.
What tinnitus is
Tinnitus, or the sensation of ringing in the ears, can be described as a mostly subjective manifestation, perceived by the patient as an abnormal noise in the ear, without an external source (including when everything around is quiet), so other people cannot hear it. It can be unilateral (felt in one ear only) or bilateral, when it affects both ears.
The noises can take the form of clicking, humming, ringing, buzzing, hissing or can sometimes be felt as a sensation of pulsing. Its intensity varies from high to low.
Although it is often not a reason for concern, tinnitus has the potential to become a real nuisance, negatively affecting quality of life, especially when it becomes a constant sensation.
This tinnitus (noise in the ears) is not a condition in itself, but a symptom encountered in numerous extremely diverse conditions, from asthma to anxiety or thyroid conditions.
It is also worth mentioning that ringing in the ears is a relatively common problem, affecting around 20% of the population, with a higher frequency among older people and among those who use firearms.
IMPORTANT
A sudden onset, with very high intensity noise, recorded in one ear only, can be an indicator of a severe condition such as a stroke. In this situation, we recommend that you see a doctor urgently.
Types of tinnitus
There are several criteria by which we can classify tinnitus:
[1] By duration
- Acute tinnitus
- Chronic tinnitus - it means the persistence of the noise over a period of at least 3 months
[2] By its character
- Subjective tinnitus - it is the most frequent type, the noises being heard only by the patient
Among the most frequent causes of subjective tinnitus are conditions of the inner, middle or outer ear or pathologies that affect either the auditory nerve or the neurological components that process and transmit the electrical signals as sounds.
It can in turn be classified into several distinct subtypes, according to the sensation described by the patient:
- Pulsatile tinnitus - the noises come at the same time as the heartbeat and most often indicate a treatable vascular pathology
- Tonal tinnitus - the patient hears the sounds constantly, at a set frequency, the only variation being their volume
- Musical tinnitus - patients experience musical hallucinations, such as singing or melodies without a physical source
- Objective tinnitus - it can also be heard by the doctor during the examination (for example in the case of objective pulsatile tinnitus, when the doctor can hear noises consistent with the patientās heart rhythm)
The causes of ringing in the ears
Up to now a cause of the appearance of tinnitus has not been determined exactly, it being often associated with the loss of hearing that comes with age, injuries to the ear, problems of the circulatory system and so on.
In the inner ear there are very fine hairs called cilia, which move with the sound waves. Through this movement they trigger electrical signals that are interpreted in the brain as sounds. With age or with exposure to loud noise, these cilia break or lose their elasticity, which generates a flow of random electrical signals, felt as ringing in the ears.
There are numerous pathologies in which tinnitus is a symptom of another condition:
- Hearing loss caused by noise pollution or by sudden deafness
- Ear infections and the blocking of the ear canal - the accumulation of fluid, earwax or foreign bodies can change the pressure on the eardrum
- Injuries to the skull and the neck can affect the inner ear, the auditory nerve and the brain function related to hearing
- Poor posture, cervical muscle contractures and abnormalities of the temporomandibular joint
- Meniereās disease - it shows itself through hearing loss, tinnitus and vertigo
- Dysfunction of the Eustachian tube, the canal that connects the middle ear with the throat
- Otosclerosis (changes in the bones of the inner ear, mainly their stiffening)
- Muscle spasms in the inner ear, of neurological origin (multiple sclerosis, stroke)
- Blood vessel abnormalities - capillary or arteriovenous malformations can cause increased pressure of the blood flow in the vessels inside the ear, which can cause pulsatile tinnitus
- Vestibular neuritis (inflammation of the vestibular nerve)
- Genetic predisposition - increased sensitivity of the auditory nerve
- Acoustic neuroma
- Diabetes
- Systemic lupus erythematosus
- Syphilis
- Thyroid conditions
- Rheumatoid arthritis
- Anaemic syndromes
- Migraines
- High blood pressure
Risk factors for tinnitus
Ringing in the ears is a problem that most people face at some point in their life. There are a number of factors that increase the chances of tinnitus appearing, among them:
- Age - the number of functioning cilia in the inner ear decreases with age, which can lead to weaker hearing and to the appearance of ringing in the ears
- Exposure to loud noise - it can cause damage to the sensory cilia and to the auditory nerve
- Reduced hearing
- Dental conditions
- Noise pollution in the work environment (for example musicians, construction workers, sound technicians and so on)
- Sex - men are twice as likely to have tinnitus compared with women
- Coronary or vascular diseases
- Smoking and excessive alcohol consumption
- The use of headphones and other in-ear devices
- Stress
- Insomnia
- Mental health conditions (depression, anxiety and so on)
- Chronic conditions (rheumatoid arthritis, glaucoma and so on)
Diagnosing tinnitus
Diagnosing tinnitus involves a series of investigations whose main purpose is determining the causes behind it.
After the medical history, the ENT specialist will check the ear canal in order to see whether there is a blockage caused by an excessive build-up of earwax. Besides the clinical examination of the head, the neck and the nose, a series of imaging investigations or tests may also be needed (Doppler ultrasound, CT or MRI, an audiological examination, tympanometry and so on)
If you are dealing with the discomfort caused by tinnitus, a BrainMap investigation carried out by a specialist of the institute can help you determine the best course of action for the ringing in your ears.
The treatment of tinnitus
In this situation, treatment means identifying the source that causes the ringing sensation and treating it. Being a set of symptoms without an exact cause or mechanism, the treatments available are diverse and their effectiveness depends on the source of the tinnitus:
- Clearing the ear canal in the case of a blockage with earwax
- Electrical stimulation in the inner ear - it generally has high effectiveness, but the effect is temporary
- The use of hearing aids or of cochlear implants (which directly stimulate the auditory nerve and thus change the neural circuits) in order to treat hearing loss
- Biofeedback therapy - therapies such as neurofeedback have been used successfully for over 25 years in the treatment of the symptoms associated with stress and other chronic conditions, pathologies that often cause tinnitus, among other manifestations.
- TMS - repetitive transcranial magnetic stimulation
- Sound therapy - for the acoustic desensitisation of the patient
- The use of devices that produce white noise in order to lessen the impact of tinnitus on the person affected
- Psychological counselling - needed in order to answer all the patientās questions and to reduce the level of stress they feel (generally caused by the fear of a serious pathology such as brain tumours and so on)
- Medication - if it is caused by conditions such as depression, treatment with antidepressants or benzodiazepines can make the tinnitus disappear
- Food supplements aimed at improving blood circulation in the middle ear and at reducing the impact of stress: zinc, melatonin, B group vitamins, ginkgo biloba
- Surgical treatment - used in the case of glomus tumours, sigmoid sinus diverticulum, arteriovenous malformations or conductive hearing loss.
Complications associated with tinnitus
The impact of these symptoms differs from one individual to another. Among the most frequently encountered complications are:
- States of insomnia and tiredness
- Stress
- Difficulty concentrating
- A negative impact on the ability to remember
- States of nervousness, depression or anxiety
- Headaches
- A negative impact felt in personal and/or professional life, or at school in the case of children and teenagers
Preventing noise and ringing in the ears
Although tinnitus cannot usually be prevented, there are a number of measures you can take in order to minimise the chances of it appearing or reappearing:
- Avoiding exposure to potential triggers: alcohol, drinks with a high caffeine content, tobacco, drugs
- Minimising exposure to loud noise and/or reducing its level (for example by using earplugs or special headphones when you go to concerts or if you are frequently exposed to noise pollution at work)
- Protecting the cardiovascular system (often responsible for pulsatile tinnitus) by adopting a healthy lifestyle: a balanced diet, regular physical activity, enough quality rest
- Reducing the level of stress and managing mental health problems
Bibliography
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