An Overview of Tinnitus

Tinnitus is when people think they hear something in their ears, but there is actually no sound. The sound people with tinnitus "hear" ranges in quality from a whistle or ringing noise to a crackling or roaring noise.

Diagnosis of tinnitus requires a careful medical history and physical examination. Sometimes, depending on the doctor's findings or associated symptoms, special tests like magnetic resonance imaging (MRI), are needed.

The treatment of tinnitus requires an integrative approach—correcting any underlying hearing loss or other associated problem, undergoing cognitive-behavioral therapy and/or a sound-based therapy, engaging in lifestyle modifications, and sometimes, taking a medication.

types of tinnitus
Verywell / Gary Ferster

Causes

There are two main types of tinnitus—subjective tinnitus (more common) and objective tinnitus (less common).

Subjective Tinnitus

Subjective tinnitus is believed to occur as a result of abnormal nerve activity in the part of your brain that processes sound/hearing information (called the auditory cortex).

Basically, experts suspect that some sort of disruption within the auditory pathway causes a person's central nervous system to abnormally perceive sound when it is not there—similar to phantom limb syndrome.

The most common conditions associated with subjective tinnitus are age-related sensorineural hearing loss (called presbycusis), occupational noise exposure, and exposure to an ototoxic drug.

Conditions that cause conductive hearing loss, such as cerumen (wax) impaction, middle ear effusion (fluid build-up), and eustachian tube dysfunction, are also associated with tinnitus.

Interesting Tidbit

Many causes of tinnitus are related to hearing loss—however, tinnitus does not directly cause hearing loss. Rather, in many cases, tinnitus is a consequence of the hearing loss.

Additional causes of subjective tinnitus include:

Objective Tinnitus

With objective tinnitus, a person hears an internal sound (a noise coming from an actual physiologic process occurring near the middle ear). Interestingly, the noise of objective tinnitus can sometimes be heard by the healthcare provider examining the patient's ear.

With objective tinnitus, the noise (often described as a pulsing sound) comes from problematic blood vessels, such as atherosclerosis (fatty build-up) within the carotid artery or a vascular malformation. Sometimes, the noise occurs as a result of a muscle spasm within the middle ear.

Diagnosis

A careful medical history and physical examination are the primary tools used to diagnose tinnitus.

Medical History

In order to narrow down a diagnosis, your doctor will ask you several questions related to your tinnitus.

Examples of questions may include:

  • Can you describe the specifics of the sound you are hearing (e.g., pitch, quality, loudness)?
  • Are you experiencing any associated symptoms (e.g., hearing loss, vertigo, headache, or temporomandibular joint pain)
  • Have you experienced any recent head or neck trauma?
  • What medications are you taking?
  • How is your tinnitus affecting your daily functioning—does it affect your sleep, or work and leisure activities?

Physical Examination

During your physical exam, your doctor will focus on evaluating your head, neck, eyes, ear, and neurological system.

For instance, during the ear exam, your doctor will check for and remove any impacted cerumen to determine if that is the culprit behind your tinnitus. He may also listen to the blood vessels in your neck, chest, and around your ears with his stethoscope.

Special Tests

Depending on your doctor's findings, as well as the features of your tinnitus—if it's persistent or associated with certain symptoms—one or more specialized tests may be recommended.

Some of these tests include:

Treatment

Tinnitus may be managed through a variety of techniques. The first step is to treat the underlying problem—stopping the offending medication or correcting the hearing loss—followed by interventions that help alleviate the tinnitus and minimize the impact this symptom has on a person's quality of life.

Correcting Hearing Loss

Fixing someone's hearing loss with hearing aids may ease or correct their tinnitus. For those with both severe hearing loss and tinnitus, cochlear implants can help by electrically stimulating the inner ear.

Tinnitus Masking

Another technique used to treat tinnitus is called tinnitus masking. This is a form of sound therapy, which uses sound to mask or "cancel out" the tinnitus.

Lifestyle Modifications

Since stress, sleep problems, and the use of stimulants, like caffeine, can irritate underlying tinnitus, strategies to address these exacerbating factors may be incorporated into your treatment plan.

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy, either face-to-face with a trained therapist or Internet-based, can help people with tinnitus develop distraction and relaxation skills, as well as strategies to help them think and react differently to their tinnitus.

Medications

There are no FDA-approved drugs for treating tinnitus. However, various antidepressants are sometimes used to help relieve a person's tinnitus; although, the scientific evidence backing up their benefit remains inconclusive.

Complementary Therapies

While there are many anecdotal reports of using various complementary therapies to treat tinnitus, such as acupuncture or gingko biloba, the scientific evidence backing up their benefit is scant.

That said, it's sensible to consider incorporating a complementary therapy into your treatment plan. If anything, various therapies like practicing mindfulness meditation, biofeedback, or other relaxation techniques may improve your overall health and help you cope with the stress of living with tinnitus.

A Word From Verywell

Living with tinnitus can be frustrating and anxiety-provoking, and it can negatively affect your ability to socialize, work, and navigate family relationships.

If you or a loved one has tinnitus, please seek out care from your primary care doctor or an ear, nose, and throat (ENT) doctor. This way you can obtain a proper diagnosis and develop a treatment plan that is scientifically-based and unique for your needs.

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