Why is there a ringing in my ears?

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What is Tinnitus?

There are approximately more than 10 million people who suffer from tinnitus. Why is there a ringing in my ears? you may ask. Tinnitus causes a person to hear sounds that are not actually present externally. These external sounds cannot be heard by a doctor and therefore are extremely difficult to measure. On the contrary, objective tinnitus can be heard by a doctor and is usually a sign of an aneurysm or another underlying health condition.

Why is there a ringing in my ears?

People with tinnitus may hear faint or loud noises. It is reported that many hear sounds similar to crickets, wind, fluorescent lights, and the dripping noise of tap water. Tinnitus is not a disease but rather its cause is linked to an array of underlying health issues. Present data suggest that people hear sounds that are associated with a network of patterns reserved in their auditory memory, which are related to their emotions. Symptoms may include discomfort, insomnia, depression, and physical exhaustion.

The causes of Tinnitus

Ear conditions such as Meniere disease or injuries affecting the connected cranial nerves may cause tinnitus – a ringing in the ears. Some people with tinnitus report that there is a sensation of blockage in the middle ear, usually meaning that there may be a concern with the ossicular chain or ear pressure.

Cardiovascular disease, high blood pressure, and diabetes are correlated with early tinnitus. Head injuries and vestibular schwannoma are likely neurological correlations with tinnitus. Infections like, meningitis and dental disorders like temporomandibular joint disease can cause tinnitus.

Medication, such as aspirin at higher dosages, can cause tinnitus. This issue is reversible when the medication is stopped. Other medications include certain diuretics and antibiotics.

Hearing loss—age-related and exposure to loud noise over time, is a major cause of tinnitus. The brain may be filling in absent sound frequencies that were previously lost as a result of hearing loss. Who is most at risk? Reportedly those in the military with exposure to loud noises, movie production workers, and musicians have a higher chance of developing tinnitus. Currently, there is limited data on the biological pathway of hearing loss and tinnitus.

Managing Tinnitus

Most likely, a doctor will examine the ear canal and check for foreign materials and signs of infections or impurities. A hearing test may also be done, where a patient is asked to identify the sounds they hear and the amplitude of that sound or ringing in the ears, with the tones that the doctor presents.

An X-ray or MRI is usually not necessary for tinnitus. If tinnitus is linked to hearing loss, hearing aids are recommended. Presently, there are no drugs for the treatment of tinnitus though, drugs that help with the underlying causes of tinnitus are available. Anti-depressants and anti-anxiety drugs may be used. Seek medical advice if you are feeling symptoms of anxiety, depression, or any other mental health-related illness.

Cognitive therapy involves understanding tinnitus and changing the way one may think about it. In doing so, the symptoms of ringing in the ears can be greatly reduced. Stress management and sleep improvement can also help relieve symptoms of tinnitus.

Behavioural therapies help individuals with tinnitus control their behaviours. This is the most effective for extreme tinnitus. These techniques essentially help patients minimize their attention to tinnitus. Relaxing techniques, analyzing emotional triggers, determining reactions to tinnitus, and so forth. These treatments are not “overnight” remedies to tinnitus, rather they require constant and determined effort with the help of a healthcare team.

Sound therapy can also help a tinnitus patient. There are unique strategies to cope with external sounds. Masking is a technique that exposes the patient to the same internal noise, at a very high volume, to mask the intensity of their internal tinnitus. There are many kinds of masking techniques. One can introduce the same noise of their internal tinnitus, a different noise, use music in the absence of their internal noise, or use white noise.

Ambient sounds such as, white noise or nature sounds can reduce the intensity of a patient’s tinnitus.

A study looked at different modern apps that provide tinnitus management through sound therapy. The apps most listed for the management of tinnitus include white noise free, myNoise, Tinnitus Therapy Lite, Oticon Tinnitus Sound and Relax Melodies: Sleep Sounds. Sound therapy is not expensive. In fact, any device that can make a noise and stimulate positive emotions and reactions can be used in the management of tinnitus. For example, electric fans, provide excellent white noise, as do radios, and televisions. Other sound therapies include distraction, neuromodulation, and habituation.

A nutritious diet is just as, if not more important to improve symptoms of tinnitus. Issues like hypertension and diabetes can significantly improve with the help of a healthy diet.

Other types of tinnitus

The intensities of the sound in the ear may change if the body moves a certain way, such as turning of the eyes or clenching of the jaw. This is defined as somatic tinnitus. Data suggests that this type of tinnitus is most present when a person wakes up.

When blood flow speeds up in the blood vessels it can disturb the already smooth or laminar flow of blood. Blood vessels and arteries close to the ears which are disturbed by events such as this can cause pulsatile tinnitus. This type of tinnitus is identifiable by a doctor. Some causes include arteriovenous fistulae, vascularized tumors, arteriosclerosis, and intracranial hypertension. Treatment is likely dependent on an otology exam and a CT or MRI. Please consult your doctor for any information regarding the diagnosis and treatment of pulsatile tinnitus.

Underlying health conditions and environmental exposures may worsen tinnitus. Try to limit your exposure to loud noises as much as possible. It is important to practice healthy eating and regular exercise and general wellness as often as possible. If you are ever concerned speak to your doctor about getting help from anear, nose and throat specialist about medical advice regarding your hearing.

References:

Han, B. I., Lee, H. W., Kim, T. Y., Lim, J. S., & Shin, K. S. (2009). Tinnitus: characteristics, causes, mechanisms, and treatments. Journal of clinical neurology (Seoul, Korea)5(1), 11–19. https://doi.org/10.3988/jcn.2009.5.1.11

Grossan M, Peterson DC. Tinnitus. [Updated 2020 Aug 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430809/

Hofmann, E., Behr, R., Neumann-Haefelin, T., & Schwager, K. (2013). Pulsatile tinnitus: imaging and differential diagnosis. Deutsches Arzteblatt international110(26), 451–458. https://doi.org/10.3238/arztebl.2013.0451

Sereda, M., Smith, S., Newton, K., & Stockdale, D. (2019). Mobile Apps for Management of Tinnitus: Users’ Survey, Quality Assessment, and Content Analysis. JMIR mHealth and uHealth7(1), e10353. https://doi.org/10.2196/10353

Pegge, S., Steens, S., Kunst, H., & Meijer, F. (2017). Pulsatile Tinnitus: Differential Diagnosis and Radiological Work-Up. Current radiology reports5(1), 5. https://doi.org/10.1007/s40134-017-0199-7

American Tinnitus Association – Fact Sheet: https://www.ata.org/understanding-facts/causes#:~:text=Tinnitus%20is%20not%20a%20disease,the%20ear%20and%20auditory%20system. 

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