WHAT IS TINNITUS?

Usually tinnitus is described as a ringing or a buzzing sound in the ear, and sometimes as a pulsating sound. Tinnitus symptoms include any of the following sounds being heard when no external sound is actually present:

  • Ringing
  • Buzzing
  • Roaring
  • Clicking
  • Hissing

Again, tinnitus is described as a phantom auditory sound which means that it is a perceived sound that occurs in the absence of any external sound or noise. This phantom noise may vary in pitch – it could be perceived as a low roar or a high squeal, and it may be heard in one or both ears. The sound heard can be so loud that it interferes with one’s ability to concentrate or to hear actual sounds. Additionally, tinnitus may be present all the time or it may come and go.

Often people who suffer from tinnitus also experience tension in their head, neck and jaw as well as experience symptoms of tiredness, irritability, poor concentration, anxiety and depression (that can be severe).

Tinnitus is defined by two different kinds of tinnitus:

  • Subjective tinnitus: As the name suggests, this is tinnitus that only the person with tinnitus can hear. This is the most common type of tinnitus. It can be caused by problems in the outer, middle or inner ear.  It may also be caused by problems with the hearing (auditory) nerves or the part of the brain that interprets nerve signals as sounds (auditory pathways).
  • Objective tinnitus:  With this type of tinnitus, a doctor performing an examination can also hear the tinnitus. This is rarer type of tinnitus which may be caused by a blood vessel issue, certain middle ear bone conditions or muscle contractions.

How Many People Are Affected By Tinnitus?
Tinnitus is a problem that affects somewhere between 10 to 15% of the population, which is a very significant and perhaps somewhat surprising percentage! Approximately 5% of the population reports severely intrusive tinnitus that affects day-to-day activities.

What Causes Tinnitus?

Unfortunately, in many cases the exact cause of tinnitus is never found. There are a number of health conditions that can cause or make tinnitus symptoms more severe. A common cause is inner ear cell damage. Inside the inner ear there are tiny, delicate hairs that move in relation to the pressure of sound waves. This in turn triggers ear cells to release an electrical signal through a nerve from the ear (auditory nerve) to the brain. The brain then interprets these signals as sound. If these hairs get bent or broken they can cause random electrical impulses to the brain, resulting in tinnitus.

Common Causes of Tinnitus

Below are the more common causes of tinnitus:

  • Age-related hearing loss – Tinnitus often worsens with age, usually starting around age 60. Hearing loss can result in tinnitus. The medical term for this is presbyscusis.
  • Exposure to loud noises – Loud noises, such as those from heavy equipment, aircraft, sirens, saws and firearms, can cause noise-related hearing loss.  The use of portable music devices can also cause noise-related hearing loss if played at high volumes for long periods (and may be worse with the use of in-the-ear headphones). If you have attended a very loud music concert, you may have experienced short term tinnitus (ringing in your ears), but fortunately this usually goes away. However, long-term over-exposure to loud sound can cause permanent damage that results in on-going tinnitus.
  • Earwax – Earwax serves a useful function in that it protects the ear canal by trapping dirt and slowing the growth of harmful bacteria. However, when too much wax accumulates, it becomes difficult to wash away naturally leading to hearing loss or irritation of the eardrum, which in turn can lead to tinnitus.
  • Changes to the ear bone – Stiffening of the bones in the middle ear, called otosclerosis, can affect hearing and in turn cause tinnitus. This condition which is caused by abnormal bone growth tends to be genetic in nature.
  • Head and neck injuries – head and/or neck injuries can affect the inner ear, hearing nerves and/or brain functions linked to hearing Usually this type of tinnitus occurs in one ear only.
  • TMJ disorders – TMJ, which stands for temporomandibular joint, is the joint found on either side of the head in front of the ears where the lower jawbone meets the skull and is known to cause tinnitus.
  • Meniere’s disease – This involves a dysfunction of the inner ear, the exact cause of which is not known and there is no cure for Meniere’s to date. Symptoms include vertigo, dizziness, nausea and a progressive loss of hearing. While there is no cure, certain drugs can ease the symptoms of Meniere’s.
  • Acoustic Neuroma – Acoustic neuroma is a benign (meaning non-cancerous) tumor that develops on the cranial nerve that runs from the brain to the inner ear where balance and hearing are controlled. This is also known as vestibular schwannoma. Generally this type of tinnitus will only be experienced in one ear.

Tinnitus From Blood Vessel Disorders

While also rare, tinnitus can be cause by certain blood vessel disorders. This type of tinnitus is referred to as pulsatile tinnitus. Causes of this include:

  • High Blood Pressure – Hypertension and factors that increase blood pressure including stress, alcohol and caffeine, can all make tinnitus more noticeable.
  • Artherosclerosis – Due to aging and the build-up of cholesterol and other deposits, major blood vessels close to the middle and inner ear lose some of their elasticity (the ability to flex or expand and contract slightly with each heartbeat). This causes blood flow to become more forceful which in turn makes it easier for the ear to detect these heartbeats. Usually this type of tinnitus is heard in both ears.
  • Head and neck tumors -Tumors that press on blood vessels in the head or the neck, known as vascular neoplasm, can cause tinnitus (and a number of other symptoms).
  • Turbulent Blood Flow – Narrowing or other restrictions in a neck artery i.e. the carotid artery or in the vein in the neck i.e. the jugular vein can cause turbulent and irregular blood flow which in turn can lead to tinnitus.
  • Malforming of Capillaries -A condition know as arteriovenous malformation (AVM), can result in tinnitus. This is where abnormal connections occur between the arteries and the veins. Generally this type of tinnitus occurs in one ear only.

Tinnitus and Medications

Many medications can cause or worsen tinnitus and generally the higher the does of these medications, the worse the tinnitus becomes. Fortunately, the unwanted tinnitus often disappears when you stop using these particular medications. Medications that are known to cause or worsen tinnitus include:

  • Antibiotics including erythromycin, polymyxin, neomycin and vancomysin
  • Cancer medications such as mechlorethamine and vincristine
  • Diuretics (water pills) such as bumetanide, ethacrynic acid and furosemide
  • Quinine medications which are used for malaria and some other health conditions
  • Antidepressants – some of these can make tinnitus worse
  • Aspirin – if taken in uncommonly high dosages (usually 12 or more a day) can make tinnitus worse

Risk Factors for Tinnitus

After having read through the common causes of tinnitus you can probably guess what some of the risk factors are for tinnitus. They include:

  • Exposure to loud noises – Construction workers, factory workser, musicians, soldiers and other people exposed to prolonged loud noises are particularly at risk of developing tinnitus. As mentioned before, exposure to loud noises can damage the tiny sensory hairs in the ear that transmit sound to the brain.
  • Age – As one ages a number of aging factors come into play, many of which were defined above. As well the number of healthy, functioning nerve fibers in the ear declines which may cause hearing problems and tinnitus.
  • Gender – Men are more likely to experience tinnitus than women.
  • Smokers have a higher risk of developing tinnitus than non-smokers.
  • Cardiovascular problems – conditions that affect blood flow including high blood pressure and atherosclerosis (narrowing of the arteries) can increase the risk of tinnitus.

Impact of Tinnitus to Quality of Life

Tinnitus can have a very significant impact on the quality of one’s life. Those with tinnitus can have a wide variety of experiences including:

  • Problems sleeping
  • Trouble concentrating
  • Excess stress
  • Excessive fatigue
  • Memory problems
  • Depression including severe depression
  • Anxiety and irritability