Introduction
Tinnitus, also known as “ringing in the ears” is the sensation of hearing sounds produced in the ears. These may be buzzing, humming, chirping, whistling or other sounds. Tinnitus is not a disease but rather a symptom of various medical conditions.
Woman with closed eyes is plugging her ears with fingers when suffering from tinnitus. Red bells as symbol of unbearable ringing in ears.
Key Facts & Statistics
Key facts and statistics that surround tinnitus
- Tinnitus affects 10%-15% of the global population.
- In the United States of America, more than 50 million individuals are affected.
- It mostly affects people aged between 40 and 80 years.
- It is estimated that up to 90% of persons suffering from tinnitus have some level of noise-induced hearing loss.
- Tinnitus is a common complaint among the geriatric population.
Causes & Risk Factors
What are the causes of tinnitus?
The exact cause(s) of tinnitus is yet to be established.
It is not known exactly why some individuals experience ringing in their ears while others do not.
However, tinnitus is a common symptom of some health conditions.
The following are common causes of tinnitus:
- Age-related hearing loss. Almost 1 out of 3 adults aged above 65 years experience ringing in their ears.
- Noise-induced hearing loss. Loss of hearing and tinnitus can occur when an individual is exposed to loud sounds and noises. For example, in an explosion. Up to 9 out of 10 people with tinnitus have some level of noise-induced hearing loss.
- Medications. Some drugs cause tinnitus. There are more than 150 drugs that can cause tinnitus, especially when one starts or stops taking them.These drugs fall under the following categories:
- Antimicrobial agents such as aminoglycosides, fluoroquinolones (ciprofloxacin, norfloxacin), doxycycline, co-trimoxazole and sulfasalazine.
- Antidepressant medications like amitriptyline, nortriptyline and imipramine.
- Triptans such as frovatriptan and eletriptan.
- Anti-cancer agents (chemotherapy drugs).
- Quinine medications.
- Chlorpheniramine.
- Anti-hypertensive drugs such as timolol, enelapril, valssartan and irbesartan.
- Atorvastatin.
- Diuretic agents such as amiloride and hydrochrolothiazide.
- Non-steroidal anti-inflammatory drugs (NSAIDs).
- Ear infections. These can cause temporary loss of hearing and lead to experiencing ear ringing.
- Injuries and trauma to the ears. Nerves and areas of the brain responsible for hearing can get affected by trauma.
What are the risk factors for tinnitus?
Stated below are less common risk factors for tinnitus:
- Autoimmune illnesses such as lupus.
- Otosclerosis.
- Vestibular schwannoma.
- Eustachian tube dysfunction.
- Meniere’s disease.
- Blood vessels disorders (pulsatile tinnitus).
Signs & Symptoms
What are the signs and symptoms of tinnitus?
Tinnitus is sometimes referred to as ‘ringing in the ears’. However, it is not just ringing. One might hear:
- Hissing.
- Whistling.
- Clicking.
- Roaring.
- Humming.
- Buzzing.
- Sounds that correspond to time of pulse (pulsatile tinnitus).
Types
What are the most common types of tinnitus?
Two types of tinnitus are subjective and objective tinnitus.
Subjective tinnitus
- This is the most common form.
- The patient perceives a sound without the presence of an acoustic stimulus (only the patient hears the sound).
- It is caused by an abnormality along the auditory pathway.
- Causes include aging, loud noise, migraines and Meniere’s disease.
Objective stimulus
- It is an uncommon form.
- It occurs when structures in the ear generate noise.
- The clinical examiner may sometimes hear the tinnitus.
Diagnostic Procedures & Tests
How is tinnitus diagnosed?
Evaluation of tinnitus includes:
- Review of patient history. This includes history of presenting illness (HPI), systemic review (functional enquiry) and past medical history (to identify any risk factors).
- Physical examination. The ear and the nervous system are examined. Inspect the tympanic membrane for signs of acute infection such as redness.
A patient can be referred to a specialist, in this case an otolaryngologist who can then determine if there are any medical conditions that are affecting the ears. Addressing the underlying issue is one good way of treating tinnitus.
For accurate diagnosis, several tests can be conducted. These are:
- Blood tests. These are performed to check for other medical conditions that may cause tinnitus.
- Hearing tests. These may include: pure audiometry and tympanometry.
- Imaging tests. For example, computed tomography scans.
Female Doctor Looking At Patient Undergoing CT Scan.
Treatment and Management
How is tinnitus treated?
- Treating the underlying disorder lessens tinnitus.
- Factors that exacerbate tinnitus such as depression must be dealt with accurately.
- Eliminate substances that worsen tinnitus such as caffeine.
- Background sounds. These can mask tinnitus and enable patients to fall asleep.
- Tinnitus masker. This is a device which patients wear like a hearing aid. It is used to provide low-level sound that covers up the tinnitus.
- Electrical stimulation of the inner ear for patients who are profoundly deaf.
- Tinnitus retraining therapy.
Complications
What are the complications of tinnitus?
Untreated tinnitus may lead to:
- Anxiety.
- Depression.
- Difficulty concentrating.
- Decline in cognitive ability.
Prevention
How do we prevent tinnitus?
- Being a symptom of other conditions, tinnitus is not always preventable.
- However, taking several steps to protect your ears (and hearing) can lower risks. For example, keeping the volume low when listening to music through headphones or earbuds.