Ringing in the Ears

Ringing in the ears, also called tinnitus, is when you hear a noise that is not caused by an external sound. It is a sound that no one else can hear.

It is common to have short-term ringing in the ears after exposure to a loud sound, such as fireworks or using power tools without ear protection. Ringing in the ears becomes a problem when it doesn't improve over time.

Ringing in the ears often occurs as a result of another health condition. Common causes include hearing loss, earwax buildup, medications, diabetes, head injuries, and certain ear conditions.

Treatment for ringing in the ears depends on the cause. Addressing the underlying health problem is often the first step. When the sound persists, the goal is to reduce it and lessen its impact on your quality of life.

This article discusses the symptoms and common causes of ringing in the ears. It also covers risk factors and when to seek treatment.

Symptoms of Ringing in Ears

Ringing in ears affects people differently. The sound that accompanies the ringing may be temporary or constant. It may be faint or loud. The pitch of the sound can also vary. It can be erratic or keep pace with your heartbeat.

Types of Sound

The sound of the disturbance varies by person. It may occur in one or both ears. The sound may be near-continuous, pulsing, or musical. It may be described as one of the following:

• Ringing
• Blowing
• Buzzing
• Clicking
• Hissing
• Humming
• Roaring
• Whistling
• Swooshing

Other Effects

In addition to physical symptoms, some people may experience psychological effects from ringing in the ears. These can cause distress and significantly impact quality of life:

• Anxiety
• Depression
• Disrupted sleep
• Memory problems
• Concentration problems

Causes of Ringing in the Ears

Ringing in the ears is caused by a disorder in the auditory system. This can involve the ear, the cochlear nerve that connects the brain and the inner ear, and the areas of the brain that process sound.

The causes can range from simple to complex. For some people, there isn't an obvious reason for sound they hear.

Common causes of ringing in the ears include:

Hearing Loss

Ringing in the ears is often linked to sensorineural (inner ear) hearing loss. This type of damage results from harm to the inner ear or the nerve pathways that connect the inner ear to the brain.

This problem often occurs as the result of noise-induced hearing loss, either from one incident or over time. It usually affects just one ear.

Ringing in the ears can also result from age-related hearing loss. This normal deterioration of hearing usually starts around age 60 and affects both ears. It often begins with the loss of high-frequency sounds, such as a whistle or squeal.

Outer Ear Canal Obstruction

Outer ear canal obstruction is often caused by an earwax blockage. When earwax builds up, it can block the ear canal and cause ringing in the ear.

Sources of middle ear obstruction can include:

• Sinus congestion
• Middle ear infection
• Dirt or foreign objects
• Loose hair in the ear canal
• Abnormal bone growth in the ear (otosclerosis)

Health Conditions

Ringing in the ears is often linked to certain health conditions. These can include:

• Ear and sinus infections
• Meniere’s disease
• Diseases of the blood vessels or heart
• Brain tumors
• Hormonal changes in women
• Thyroid disorders
• Temporomandibular joint (TMJ) disorders
  

Can Medications Cause Ringing in the Ears?

Ringing in the ears can occur as a side effect of more than 200 medications. These medications are referred to as ototoxic. In many cases, the problem disappears when the medication is stopped. These medications include:

• Salicylate pain relievers (aspirin)
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil and Motrin (ibuprofen) or Aleve (naproxen)
• Aminoglycoside antibiotics, such as gentamicin, tobramycin, or amikacin
• Certain cancer medications, such as Platinol (cisplatin) and Paraplatin (carboplatin)
• Diuretics (water pills)
• Quinine-based medications (to treat malaria)

How to Treat Ringing in the Ears

Treating ringing in the ears depends on the source of the problem and how it affects you. Temporary ringing can resolve without treatment. If your tinnitus is linked to a health problem, that issue is treated first.

If the ringing remains, the treatment goal is to reduce it and help you live with it. Depending on your age, medical history, current condition and medications, you may benefit from one or more of these treatments:

• Hearing aids to correct hearing loss and allow your brain to hear the external sounds above the ringing
• Cognitive behavioral therapy (CBT) to help you manage symptoms and learn how to lessen the impact ringing in ears may have on your quality of life
• Wearable or tabletop sound generators to mask the tinnitus with a soft, pleasant sound, such as white noise or waves crashing
• Acoustic neural stimulation, a technique that uses a device to stimulate change in the neural circuits in the brain to desensitize you from the sound
• Cochlear implants to bring in outside sounds to mask the ringing
• Antidepressants and antianxiety medications to help improve your mood and sleep patterns

Some people don't achieve the results they desire with traditional treatments and may want to try an alternative approach, such as acupuncture and biofeedback. These treatments may lack evidence of success or they may provide relief for some people. Check with your healthcare provider before trying common natural remedies for ringing in ears.

Complications and Risk Factors Associated With Ringing in the Ears

Ringing in the ears often occurs as the result of an underlying condition. The symptom doesn't cause harm on its own. Living with ringing in ears can impact your quality of life and emotional well-being.

Ringing in the ears increases your risk of the following mental health problems:

• Moderate to severe depression
• Isolation
• Feeling self-conscious in social settings
• Schizophrenia
• Cognitive decline and dementia in older adults

The following factors can increase your risk of developing ringing in the ears:

• High noise exposure without ear protection
• Age
• High sound level tolerance
• Recurring ear infections
• Hearing loss
• Smoking

Are There Tests to Diagnose Ringing in Ears?

If you have ringing in your ears, your healthcare provider, such as an audiologist (hearing specialist), will likely start with a general physical exam and hearing (audiological) exam to diagnose your condition.

Depending on the results of these preliminary exams, your provider may advise the following tests:

• Audiography
• Speech discrimination testing
• Tympanometry
• Audiogram
• Pitch masking
• Minimum masking level
• Residual inhibition
  
• Magnetic resonance imaging (MRI)
• Computed tomography (CT)

When to See a Healthcare Provider

Contact your healthcare provider if you have ringing in your ears that continues longer than a week. Seek evaluation for any type of sound that interferes with your sleep and/or concentration.

Living with ringing in your ears increases your risk of mental health problems. Report feelings of depression or anxiety to your healthcare provider as soon as you recognize them.

Summary

Ringing in the ears is a common problem that occurs as a result of hearing loss or damage to the areas that control hearing. It can also be linked to a health condition or medication side effect.

While the nuisance can occur for short periods, it becomes a problem when it persists longer than a week. If you have ringing in the ears, don't delay seeking help from your healthcare provider. Ringing in the ears is often linked to mental health issues such as depression and anxiety.

Treatment involves finding if the problem is linked to an underlying health condition. However, the issue may persist after that is treated.

Chronic tinnitus may improve with hearing aids and other hearing devices. Treatments that include counseling can help you deal with the challenges of living with the problem.