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Tinnitus, ringing in the ear, the annoying constant noise in the head. Scientists define it as ‘a perception of sound without corresponding acoustic or mechanical correlates in the cochlea’. In other words, tinnitus is a perception of sound in the absence of an actual external sound. Thankfully, it’s not a serious health disorder but it can be one of the most distressing ear problems, causing various physical and psychological disorders that interfere with the quality of life.

It is difficult to describe the sound of tinnitus through language. The sound varies; some people may hear it as a hissing sound, others like a tea kettle whistling, or a sort of electricity noise, or even as humming.

Sound waves travel from outside through the outer ear to the ear canal, and from there to the middle and inner ear. There are tiny delicate hairs in your inner ear which move according to the pressure of sound waves and help transform sound waves into electrical signals. These signals then travel to the brain’s auditory cortex via the auditory nerve. When hair cells are damaged, that is, bent or broken, they can leak electrical impulses to the brain. So, the brain doesn’t receive the signals it is expecting. This stimulates abnormal activity in the neurons, which results in the illusion of sound, or tinnitus.

Causes

Tinnitus may have different causes but mainly it results from hearing disorders and the most probable cause is noise induced hearing loss. But before we look into the causes of tinnitus, let’s understand how sound travels through the ear and how the typical tinnitus sound is produced.

 

Tinnitus can actually be caused any number of reasons ranging from noise induced hearing loss to nerve disorders to side effects of certain medications. Here we describe the most common causes of tinnitus.

1. Exposure to loud noise

One of the most common reasons you may hear ringing in your ears or head is when you are exposed to loud noise over extended periods of time. For example, it more commonly hits people who work in noisy environments, or listen to constant loud music, or maybe are frequent clubbers.

2. Presbycusis

Age related hearing loss is called presbycusis. This is an irreversible condition since the damage is caused by degeneration of sensory cells which occurs with age.

3. Otosclerosis

Otosclerosis is a condition in which there is an abnormal bone growth in the middle ear that causes hearing loss.

4. Otitis

Otitis is the infection or inflammation of the inner or outer parts of the ear. It can occur suddenly and for a short time which is then called acute otitis or it can occur repeatedly over long periods of time which is called chronic otitis. Otitis media is a middle ear infection and usually occurs in children along with cold and flu.

5. Meniere’s disease

Meniere’s disease is a chronic disorder of the inner ear. It usually affects just one ear and is the common cause of hearing loss.

6. Whiplash

Whiplash is a neck injury caused by acceleration – deceleration forces as in automobile collisions in which the neck and the head suddenly moves backward and then forward. This causes the neck muscles and ligaments to push beyond their normal range of motion.

7. Multiple sclerosis

Multiple sclerosis is an autoimmune disease that affects the nervous system, that is, the brain and the spinal cord. The body’s immune cells damage the myelin sheath that surrounds and protects the nerve cells thus blocking the messages between the brain and the body.

8. Acoustic neuroma

Acoustic neuroma, also called vestibular schawannoma, is a benign tumour that develops on the nerve which connects the ear to the brain. It grows slowly pressing against the hearing and the balance nerves. The tumour becomes life threatening when it starts pressing against the brain. If two tumours develop on both hearing nerves because of genetic disorder, it is termed neurofibromatosis.

9. Cervical vertigo

Vertigo caused by neck disorders is called cervical vertigo.

10. Meningitis

Meningitis is the inflammation of thin tissue (meninges) surrounding and covering the brain and the spinal cord. Meningitis can be bacterial, viral, fungal or parasitic. Over 30 percent of bacterial meningitis results in some form of hearing loss. Apart from hearing loss, balance problems and tinnitus, too, may result because of meningitis.

11. Neurosyphilis

Neurosyphilis is an infection of the brain or spinal cord caused by the syphilis bacteria Treponema pallidum. It usually occurs in people who have had untreated syphilis for many years.

12. Medication that cause or worsen tinnitus

• NSAIDs and salicylates such as aspirin, ibuprofen and naproxen.


• Aminoglycoside antibiotics such as erythromycin, tetracycline, doxycycline, ciprofloxacin, and gentamicin.


• Chemotherapy agents, for example, platins and vincristine.


• Loop diuretics bumetanide, furosemide, and torsemide.


• Antidepressants and benzodiazepines such as amitriptyline, clomipramine, Xanax (Alprazolam), Valium and Ativan.


• Anticonvulsants such as carbamazepine and valproic acid.

Sometimes, dental disorders can also cause tinnitus. It is therefore clear that tinnitus does not represent a disease itself but instead it is a symptom of a variety of underlying diseases. Many a time even underlying physical cause cannot be identified.

Read more about causes, symptoms, diagnosis and treatment of hearing loss.

Symptoms

Depending upon the causes of tinnitus, the symptoms vary.

Presbycusis

• Asking people to repeat what they are saying


• Tinnitus and inability to hear high pitched sound


• Raising the volume of television to higher than normal levels

Otosclerosis

• Gradual hearing loss


• Tinnitus


• Vertigo or dizziness

Otitis

• Headache


• Tinnitus or buzzing in the ears


• Trouble sleeping at night and irritability


• Pain and fever

Meniere’s disease

• Severe dizziness, so much so, some people lose their balance and fall


• Tinnitus (a roaring sound in your ears)


• Ear pain or feeling of ear pressure


• Hearing loss that comes and goes

Whiplash

• Neck pain and stiffness


• Dizziness, blurred vision and fatigue


• Tinnitus


• Difficulty concentrating

Multiple sclerosis

• Numbness or weakness in one or more limbs


• Tremor or lack of coordination in limbs


• Slurred speech, dizziness, fatigue


• Blurring of vision, tingling or pain in parts of the body


• In some people, tinnitus that resolves completely

 Acoustic neuroma 

• Loss of hearing on the side where the tumour is growing


• Tinnitus


• Dizziness and balance problems


• Sometimes, the face can become numb

 Cervical vertigo

• Dizziness related to neck movement


• Ear pain and tinnitus (swishing, ringing or other sounds in the ear and head)


• Nausea and vomiting, loss of balance while walking, sitting or standing


• Visual disturbance while shaking the head are the main symptoms of cervical vertigo

 

Meningitis

• High fever, headache


• Sensitivity to light


• Vomiting


• Stiff neck and rashes


• Confusion

 

Neurosyphilis

• Abnormal gait and inability to walk


• Dementia, depression, confusion and headache


• Numbness in toes, feet or legs


• Seizures, poor concentration, stiff neck


• Visual disturbance or blindness


• Tinnitus is the only symptom of neurosyphilis otitis

Treatment

The treatment options are determined based on the causes and symptoms observed by the patients.

Presbycusis:  Hearing aids and other communication devices.

Otosclerosis: Medications such as fluoride, calcium or vitamin D may help slow the hearing loss but these cannot cure the condition. Hearing aids can be used. Surgery to remove parts of the ear bones and replace it with prosthesis may help cure conductive hearing loss.

Otitis : Antibiotics, ear drops, and NSAIDs such as ibuprofen.

Meniere’s disease: There is no cure for Meniere’s disease. Medications are prescribed to control dizziness. If you are given diuretics to regulate the fluid volume and pressure in your inner ear, remember to take plenty of potassium-rich foods such as bananas, spinach, and sweet potatoes.

Whiplash: Pain killers, muscle relaxants, ice or heat therapy.

Multiple sclerosis: No cure for MS; treatment to slow the progress of the disease includes drugs, muscle relaxants, physical therapy and medication to reduce fatigue.

Acoustic neuroma: Just regular check-ups if the tumour is small. Enlarged tumour requires radiation therapy and surgery.

Cervical vertigo: Physical therapy that includes gentle mobilization, neck exercises, and proper posture training, medication such as muscle relaxants such as tizanidine, cyclobenzaprine and baclofen, and surgery.

Meningitis: Bacterial meningitis are treated with antibiotics; viral meningitis generally improve on their own in few weeks. Bed rest and plenty of fluids is generally recommended for viral meningitis. Fungal meningitis are treated with antifungal medication.

Neurosyphilis: Penicillin is usually the first and only line of treatment for this condition.