Slideshow Pictures: Tinnitus -- Why Are My Ears Ringing?

What Is Tinnitus?

Tinnitus is a ringing, swishing, or other type of noise that seems to originate in the ear or head. In many cases, it is not a serious problem but rather a nuisance that eventually resolves. Rarely, however, tinnitus can represent a serious medical health condition.

It is not a single disease but a symptom of an underlying condition. Nearly 36 million Americans suffer from this disorder. In almost all cases, only the affected person can hear the noise.

Some Head Noise Is Normal

If a person goes into a soundproof booth and normal outside noise is diminished, he or she becomes aware of these normal sounds. We usually are not aware of these normal body sounds, because outside noise masks them. Anything, such as ear wax or a foreign body in the external ear, that blocks these background sounds will cause us to be more aware of the sounds in our heads.

What Causes Tinnitus?

Tinnitus can originate from any of the following areas: the outer ear, middle ear, inner ear; or it can be due to abnormalities in the brain. Common causes of tinnitus include the following:

• Fluid, infection, or disease of the middle ear bones or ear drum (tympanic membrane)
• Damage to the microscopic endings of the hearing nerve in the inner ear (advanced aging is generally accompanied by a certain amount of hearing nerve impairment)
• Loud noise exposure, such as loud noises from firearms, and highly intense music
• Medications (for example, aspirin)
• Meniere's syndrome
• In rare situations, tinnitus can be a symptom of serious problems such as a brain aneurysm or acoustic nerve tumor.

How Is Tinnitus Evaluated?

A medical history, physical examination, and a series of special tests can help determine precisely where the tinnitus is originating. It is helpful for the doctor to know if the tinnitus is constant, intermittent, or pulsating (synchronous with the heartbeat, referred to as pulsatile tinnitus), or if it is associated with hearing loss or loss of balance (vertigo or vestibular balance disorders). All individuals with persisting unexplained tinnitus need a hearing test (audiogram). Patterns of hearing loss may lead the doctor to the diagnosis.

Other tests, such as the auditory brain stem response (ABR), a computerized test of the hearing nerves and brain pathways, computer tomography scan (CT scan), or magnetic resonance imaging (MRI scan) may be needed to rule out a tumor occurring on the hearing or balance nerve. These tumors are rare, but they can cause tinnitus.

What Is the Treatment of Tinnitus?

After a careful evaluation, your doctor may find an identifiable cause and be able to treat or make recommendations to treat the tinnitus. Once you have had a thorough evaluation, an essential part of treatment is your own understanding of tinnitus (what has caused it, your specific symptoms, and options for treatment).

Tinnitus Medications

In many cases, there is no specific treatment for tinnitus. It may simply resolve on its own, or it may be a permanent disability that the person will have to "live with." Some otolaryngologists (ear specialists) have recommended niacin to treat tinnitus. However, there is no scientific evidence to suggest that niacin helps reduce tinnitus, and it may cause problems with skin flushing. The drug gabapentin (Neurontin, Gabarone) was studied in high doses and was found to reduce the annoyance level of the tinnitus in some patients, but it did not decrease the volume of the noise and was not found to be better than placebo.

In patients who suffer from related depression, nortriptyline (Pamelor, Aventyl) is the most helpful treatment. Selective serotonin reuptake inhibitor (SSRI) antidepressants appear to have a better safety record compared to tricyclic antidepressants. Sertraline (Zoloft) at fixed doses and paroxetine (Paxil) at low doses have been shown to be helpful. In a 2009 study by Jalai, alprazolam (Xanax) improved VAS (visual analog scale) scores in patients with tinnitus who did hot have anxiety or depression disorders.

Relief Remedies for Tinnitus

Some common and easy remedies, such as the following, may be of benefit to some individuals:

• Reduce or avoid caffeine and salt intake, and quit smoking.
• Some individual's with tinnitus have been found to have lower zinc levels and may benefit from zinc supplementation.
• Melatonin may help those who suffer with tinnitus, particularly those with disturbed sleep due to tinnitus.
• Ginkgo biloba has been touted as a natural tinnitus remedy, but to date, controlled studies have not shown to be effective.
• Some behavioral and cognitive therapies that have been successful include retraining therapy, masking, and behavioral therapy.

Can Tinnitus Be Prevented?

The only real prevention for tinnitus is to avoid damaging your hearing. Most causes other than hearing loss do not have prevention strategies. However, there are several things you can do to protect yourself from noise-related tinnitus. These tips will be described in the following slides.

Tinnitus Prevention Tip #1

Do not use cotton swabs (Q-tips) to clean your ears. This can cause a wax impaction against your eardrum, which can cause tinnitus.

Tinnitus Prevention Tip #2

Protect your hearing at work. Your workplace should follow Occupational Safety & Health Administration (OSHA) regulations. Wear earplugs or earmuffs and follow hearing conservation guidelines set by your employer.

Tinnitus Prevention Tip #3

When around any noise that bothers your ears (a concert, sporting event, hunting) wear hearing protection to reduce noise levels. Wear protective earplugs or earmuffs if you cannot avoid loud noises. Do not use wadded-up tissue or cotton balls since they may become lodged in the ear canal and do not protect adequately against the more dangerous high frequencies and loud noises.

Tinnitus Prevention Tip #4

Be careful when using music headphones. If the music is so loud that others can hear it clearly or you can't hear other sounds around you, the volume is too high.

Tinnitus Prevention Tip #5

Even everyday noises, such as blow-drying your hair or operating a lawn mower, can require hearing protection. Keep earplugs or earmuffs handy for these activities.

Tinnitus Prevention Tip #6

Cut back on or stop drinking alcohol and beverages that contain caffeine. Don't smoke or use smokeless tobacco products (secondhand smoke also affects those around you and may contribute to SIDS, ear infections, and asthma in children). Nicotine use may cause tinnitus by reducing blood flow to the structures of the ear.

Tinnitus Prevention Tip #7

Tinnitus occurs more frequently in obese adults. Exercising regularly and maintaining a healthy weight improves blood flow to the structures of the ear and may prevent tinnitus.

Is There Anything to Lessen the Intensity of Tinnitus?

• Avoid exposure to loud sounds and noises.
• Control your blood pressure.
• Decrease your salt intake.
• Avoid nerve stimulants such as coffee and colas (caffeine) and tobacco (nicotine).
• Reduce your anxiety.
• Stop worrying about the tinnitus. The more you worry and concentrate on the noise, the louder it will become.
• Get adequate rest and avoid fatigue.
• Exercise regularly.
• Utilize a masking noise (for example, a competing sound such as a ticking clock, a radio, a fan, or white noise machine).
• Biofeedback may help or diminish tinnitus in some individuals.
• Avoid aspirin or aspirin products in large quantities.

More Reading on Ear-related Conditions

• Tinnitus
• Hearing Loss
• Ménière Disease
• Ear Infections
• Foreign Body, Ear
• Anatomy of an Ear Infection