By Thuy-Anh Melvin, MD
Most people call it “ringing in the ear,” but tinnitus—which, according to the Centers for Disease Control and Prevention, afflicts some 25 million Americans, or 10 percent of the adult population—can present as any number of phantom sounds.
Sufferers might complain not only of ringing, but of buzzing, roaring, whistling, swooshing, clicking or hissing. In rare cases, people have even reported hearing music. You might hear it in one or both ears. You might hear a low roar or a high squeal. It can be temporary or chronic, intermittent or a constant presence.
And while many of my patients with tinnitus experience it as merely annoying, it can also be seriously debilitating. The good news is that tinnitus—which is not a disease, but a symptom, most commonly of age- or noise-related hearing loss—is very rarely a sign of a serious medical condition, but some of my patients find it interferes with their ability to sleep or concentrate or even hear other sounds. Those with severe tinnitus can suffer from exhaustion, memory problems, anxiety and depression, too.
Types of Tinnitus
More than 99 percent of cases are known as subjective tinnitus, in which only the patient can hear the noise. Much more rare, only 1 percent of all cases, is objective tinnitus, in which medical professionals can hear the ringing while examining the patient. Objective tinnitus can be caused by musculoskeletal or circulatory problems.
Causes of Tinnitus
1. Age-related hearing loss, which usually begins at around age 60
2. Exposure to loud noise from, for example, heavy machinery, chainsaws, firearms or loud music
3. Obstructions in the middle ear including excessive ear wax, head congestion, middle ear fluid, loose hair from the ear canal, dirt or foreign objects. Stiffening of the bones in the middle ear, a condition that can run in families, is another obstruction.
Less common causes include Meniere’s disease, an inner ear disorder; problems with the temporomandibular joint (TMJ), where your jawbone meets your skull; head and neck injuries; and acoustic neuroma, a benign tumor on the cranial nerve. Rarely, tinnitus can be caused by any number of blood vessel disorders, including atherosclerosis, high blood pressure or a tumor pressing on a blood vessel, as well as by autoimmune disorders like Lyme disease and fibromyalgia.
Some medications can cause or exacerbate tinnitus, including diuretics, high doses of aspirin, quinine-based medications and certain cancer drugs, antidepressants and antibiotics.
Managing Tinnitus
You can’t do much about two of the biggest risk factors for tinnitus, age and gender—men are more likely to experience tinnitus than women. But modifiable risk factors include exposure to noise, smoking and cardiovascular problems.
I recommend that my patients always wear ear protection around loud noise, stop smoking and adopt a heart-healthy diet and exercise program to prevent or mitigate tinnitus. I also suggest they avoid caffeine and alcohol, which dilate your blood vessels, thereby increasing the force of your blood flow, which can cause or exacerbate the condition.
You should see your doctor if:
1. You develop tinnitus after an upper respiratory infection and it persists for more than a week.
2. You develop tinnitus suddenly or without apparent cause.
3. Your tinnitus is accompanied by hearing loss or dizziness.
4. Tinnitus is interfering with your quality of life.
In some cases, hearing aids can help mitigate the severity and frequency of tinnitus, if tinnitus is secondary to hearing loss. Background noise can help you tolerate tinnitus, too. For example, using white noise machines, fans, humidifiers and air conditioners can help mask the unwanted sounds you are hearing.
If you are suffering depression or anxiety as a result of tinnitus, antidepressant or anti-anxiety treatment may be helpful. Relaxation therapy, biofeedback and exercise can also provide relief.
Behavioral therapy, including Tinnitus Retraining Therapy, can also lessen the burden of tinnitus. It combines the use of sound masking devices with counseling to help patients reclassify the sounds they hear as emotionally neutral.
Thuy-Anh Melvin, MD, is a board-certified otolaryngologist and head and neck surgeon with the Mid-Atlantic Permanente Medical Group. She sees patients at the Kaiser Permanente Tysons Corner Medical Center.
