Many people experience an occasional ringing (or roaring, hissing, buzzing, or tinkling) in their ears. The sound usually lasts only a few minutes. If it becomes persistent, you may have tinnitus. Tinnitus is most common in people over age 40. It affects men more often than women.
There are two main types of tinnitus:
- Vibratory tinnitus is often caused by mechanical sounds created by muscle contractions near the ear, changes in the ear canal, or blood flow (vascular) problems involving the face or neck. You may hear sounds such as your own pulse or the contractions of your muscles.
- Nonvibratory tinnitus is caused by problems in the central or peripheral nerves involved with hearing. You may hear sounds in one or both ears. Sometimes this type of tinnitus is described as coming from inside the head.
Tinnitus is usually caused by prolonged exposure to loud noise (acoustic trauma), which damages the nerves in the inner ear. However, tinnitus can occur with all types of hearing loss and may be a symptom of almost any ear disorder. Other possible causes of tinnitus include:
- Medications, especially antibiotics or large amounts of aspirin.
- Drinking an excessive amount of alcohol or caffeinated beverages.
- Dental or other problems affecting the mouth, such as temporomandibular (TM) problems.
- Injuries, such as whiplash or a direct blow to the ear or head.
- Injury to the inner ear following surgery or radiation therapy to the head or neck.
- A rapid change in environmental pressure (barotrauma).
- Severe weight loss from malnutrition or excessive dieting.
- Repeated exercise with the neck in a hyper-extended position, such as bicycle riding.
- Nerve problems (neurologic disorders), such as multiple sclerosis or migraine headache.
Most tinnitus that comes and goes (intermittent) does not require medical treatment. However, if tinnitus is accompanied by other symptoms, becomes persistent, or starts to localize to one ear, a visit to a health professional usually is needed. Often there is no cure for tinnitus, but your health professional can help you learn how to live with the problem.
As there are so many diverse causes for tinnitus, treatment must be aimed at the underlying health problem. Once a negative work-up is completed, strategies for comfort and relief become important to the patient’s quality of life. Many of these treatment modalities are anecdotal and lack rigorous study but have been found to be beneficial.
Lifestyle changes may lessen the severity of tinnitus. All of the following modalities can easily be implemented in a primary care setting:
- Regular exercise to increase circulation to head and neck structures
- Avoidance of alcohol, smoking, caffeine, and cheese, as these substances may aggravate tinnitus intensity
- Decrease in salt intake
- Adequate rest to avoid fatigue
- Avoidance of exposure to loud noises
- Blood pressure control
- Relaxation exercises
- Playing soothing music or using a “white noise” machine (fan) to help cover tinnitus, especially at bedtime.
There are also various treatment protocols that may help to manage persistent tinnitus and should be started only after specialty evaluation.
- Medications — anticonvulsant agents such as carbamazepine (Tegretol) and diphenylhydantoin (Dilantin) may diminish tinnitus by suppressing hyperreactivity within the auditory system.Antianxiety agents such as diazepam (Valium) help the patient manage stress related to the health problem.
A referral to an audiologist is helpful in choosing the following treatment modalities:
- Masking — involves the use of small devices, much like hearing aids, to introduce an external, pleasant, low-volume sound that reduces perception of the tinnitus. These devices can be purchased and tuned by a hearing aid manufacturer to mask irritating sounds.
- Tinnitus-retraining therapy (TRT) — combines masking with education and counseling to reduce patient awareness of tinnitus.
- Hearing aids to correct any underlying loss that may increase existing tinnitus.
As most patients with subjective tinnitus will have a negative work-up, good advice for patients is to become educated about the symptom and current research surrounding various treatments. The American Tinnitus Association has taken a lead in providing educational materials for both patients and healthcare providers. There are also many support groups throughout the United States.
Many healthcare providers tend to dismiss patients with tinnitus after evaluation and diagnosis of idiopathic disease, often telling them that nothing more can be medically done. However, a focus on interdisciplinary care with a specialist, an audiologist, and complementary providers will result in a more informed primary care provider, as well as a patient whose needs are met and whose symptoms of unwanted noise are effectively reduced.
sources: WebMD and Medscape
Dr. Gnap is a family practice physician and behavioral medicine specialist in suburban Chicago. Dr. Gnap developed the Inner Control™ Program in 1970 and has worked with thousands of people to improve and correct medical, emotional, behavioral and learning problems including performance. He started the Inner Control program because so many patients asked, “what more can be done along with traditional treatment methods?”