Tinnitus: Ringing in the Ears or "What are those Noises in My Head?"

     Do you hear noises that no one else hears?   “Are they in my head or coming from my ears?” you may ask.  Whether characterized as a ringing, hissing, or a static quality, the medical definition for this phenomenon is tinnitus.  When this occurs, some people feel the sound is external, and after failing to find the source or discovering no one else hears it, they may conclude the worse: that they might have a mental disorder, a brain tumor, or a horrible demon invading their head, vying for their souls.  The truth is tinnitus is a condition that plagues millions of people, so you’re not alone.
     Allow me to present my personal take on this.  Yes, as an ENT doctor, I too suffer from tinnitus; my ears have been constantly ringing loud and clear, 24/7, for the last 40+ yrs. 
     This dates to a Chinese New Year way back in the early 1970s, as I recollect.  My aunt and uncle owned a produce packaging company in Los Angeles’ Chinatown.  Each year they hosted a huge Chinese New Year’s celebration with colorful dragons dancing to loud drums and martial arts guys doing their kung fu shtick—in other words, it was an all-out shebang.  All of this took place in the middle of a large loading dock in a big warehouse-style building.  Around the dock on three sides was an elevated platform where boxes upon boxes of produce was stored, the offices were located, and during this time of the year, well over a hundred mostly Chinese people gathered around the dock watching the festivities below.  The last part of the celebration was, to me and most of the other kids there, the very best part.  As the kung fu guys and lastly the dragons departed, about half of the crowd had packs of firecrackers in one hand and a “punk”—so was the term given to the smoking incense stick—in the other.  As those dragons danced away, all these crazy people would then light the fuses on the pack of firecrackers with their punks—and I mean a whole pack of around 20 firecrackers, not just one firecracker at a time—and toss them into the middle of the dock below to “chase the dragon away.”  The dock was suddenly filled with bright red paper flittering amongst multiple fire-flashes as the packs upon packs of exploding firecrackers created a steady but extremely loud roar.  The noise was so loud you couldn’t hear someone shouting at arm’s distance, which for us kids was crazy-cool.  This lasted for what seemed like an eternity though more accurately 4-5 minutes.  After the roar ceased, I recall my ears would feel numb and ring for the entire day, often lasting 2-3 days.  But after one of those Chinese New Year’s events, the ringing never stopped.  I was about 11 years old at the time.
     Being a kid, I naturally shrugged this off and felt it was nothing to worry about.  That is until I mentioned it to some of friends.
     “Hey, dude (yes we used that term back in those days) you ever close your eyes at night and when it’s really quiet you hear that ringing in the ears?  Man, it can be really loud!”
     “What are you talking about?” one of them said.  “I don’t hear any ringing.”
     Re-explaining by other means, what I figured at that age as layman’s terms, I continued, “You know, just lie down when it’s quiet, close your eyes, and you hear that noise.  You know what I’m talking about!  Don’t you?”
     “Naw, Fong you’re crazy,” another friend said.   Then he changed the subject, “Let’s throw rocks at your pesty sisters.”
     “C’mon guys!  I’m serious.  Besides, I’ll get in trouble if my sisters start balling.  I always get into trouble for stuff like that man.”
     “Freakin’ Fong!” the third friend joined in.  “I don’t hear that ringing stuff either.  Are you sure your whole house isn’t ringing?”
     “No, no!  You know what I mean!”  I was getting a bit concerned.   It seemed none of these three guys had a clue to what I was describing.  But I tried to keep my cool, since to decompensate in front of a bunch of eleven-year old kids would open up a world of teasing and mockery that I didn’t need at that stage in life.  So I pressed on.
     “Do any of you hear that noise?  I can hear it right now—a constant high pitched noise, like an eeeeeeeeeee… sound.  C-mon you guys, you hear that!  Don’t you?”
     All three shook their heads, shrugged their shoulders.  Then one of the more sympathetic fellows said, “Hey man, I know what you got!”
     “What, what?” I implored.
     “You’re possessed man!” 
     “What?  What are you talking about?  What’s possessed?  Is it bad?”
     “Yeah man,” another chimed in, “I think that’s it!  You know that movie that just came out—The Exorcist?”
     “Uh, I heard of it,” I said, trying to sound worldly but unconvincingly.  “I think I have.  Oh, I don’t know!  What’s an exor…exa…exercist?  Is that what we do in P.E.?”
     “Naw, it’s called The Ex-Or-Cist.  It’s a word I’ve never seen before.”  He turned to another friend, “You know what that means?”
     “No, I don’t know but it’s super scary!”
     “Yeah, it’s suppose to be the scariest movie ever made in history, dude!” the third guy added.
     At this point I was really, really concerned.  “Uh, have any of you guys seen that movie?”
     They all shook their heads.
     “I don’t think they would let us in unless we’re with an adult.”
     “That’s right!  Even adults got really scared with that movie!” the third guy added.  “I know a friend of a friend who’s Uncle Ernie saw that movie and he said he peed in his pants ‘cause it was THAT freakin’ scary!”
     “Whoa, that’s bitchin’ man!” The first guy joined in.
     But it was the second guy’s next comment that nearly sent me through the roof, “Yeah, I heard stories some people DIED right in the theater--of heart attacks, man!  They DIED in the theater dudes!”
     “Holy crap!” the other two enjoined.
     Holy crap indeed.
     That following week my parents, in their infinite wisdom, decided to take all of us to watch The Exorcist at the local drive-in theater.  As per their usual custom, all four of us kids—me and my younger brother and two younger sisters—hid on the floor in the back covered with a blanket.  This way the folks only had to pay for two adults and not for the entire cadre of four extra kids.
     Anyway, to make a long story short, the movie really was THAT FREAKIN’ SCARY.  After watching it, I couldn’t sleep for a week.  Every time I closed my eyes, I saw flashes of that scary devil-girl with putrefied, rotting flesh, spinning her head around 360 degrees while projectile-vomiting a stream of nasty lime-green bile.  It got worse when they splashed her with a bottle of holy water, making the devil within her scream, “It burns! It burns!”  Watching that movie between my fingers was one of the most traumatic events of my young life.  It was worse than Mom forcing me to eat liver and onions.  It was THAT bad.
     So of course the following Monday I go to school and tell all my friends that I, Fong, saw the freakin’ scariest movie in the entire world.  They were all quite impressed.
     “Man, I’m glad you’re still alive!” one guy announced.  “Did your dad have chest pains?”
     “Naw, but he was pretty scared.”
     “Your dad, SCARED?” another declared.  Yes, even ex-paratrooper Dad, Dad the sharpshooter was scared out of his boots.
     “So what about your ear ringing?”  Another asked.
     “What about it?”
     “Don’t you remember?  The ringing in your ears?  It’s actually in your head, dude!”
     “Hey, yeah,” another kid joined in, recalling last week’s conversation.  “Didn’t I tell you?  Fong you’re possessed!  That’s really cool!”
     I honestly hadn’t thought about the darn ear ringing.  I had trouble going to sleep and purging my mind of images of Linda Blair spinning her head to be worried about my tinnitus. 
     “Yeah man, you better get some help with that!  You might die, or something,” the most sympathetic friend declared.
     So there I was, an eleven year-old kid convinced he was possessed by Satan himself and on the verge of death or worse—having my soul swept away to some ungodly place while Lucifer took over my body.  So right after school, I ran as fast as I could in a cold sweat, my heart beating rapidly not from the actual running but from the mortal fear that pervaded my entire skinny frame.
     “Mom! Mom!” I screamed as I rushed through the front door!  “I’m possessed!  I’m possessed!  We gotta go to a priest right NOW!  I need some holy water or something, but we gotta go to a church or somewhere and see a priest NOW!”
     Mom, a small woman barely five feet tall, just looked at me while preparing dinner. 
And when I rapidly unveiled my tale of woe, my constant ear ringing, and that my three best friends in the world told me I was possessed and was going to die and the Devil himself will keep me in hell forever and ever…well she sort of stood there and looked at me until I exhausted myself out.
     “What are you talking about?” she finally asked after I plopped into a chair.  “My ears ring too”, she said matter-of-factly.  “They have been for years.  A lot of people have that.  It doesn’t mean you’re possessed.”
     “Really?”  After she convinced me I was going to be O.K., I calmed down considerably and really gave no more fret to the ear ringing, though once in a while during that half-asleep twilight, the visions of The Exorcist do now and then pop into my head.
     So that’s my personal story. I’m a fellow tinnitus sufferer.  Yet I’ve long ago adapted to it and typically am not aware of it unless I make an effort to listen for it.  And it is there, loud as it ever was, especially when I’m lying in bed with the lack of ambient noise to mask it out.  But I learned to live with it and so can you.  It occurs when those tiny receptor cell in your inner ear (the cochlea) decline in function or there is a problem with nerve that connects the cochlea to the brain.  These cells normally convert sound into electrical energy that is transmitted along the cochlear nerve to your brain; this is how we hear.  However, as the cells decline or die off from loud noise or just a natural aging process, they sometimes continue sending electrical signals to the brain.  This is tinnitus.  And when both ears are involved equally, it often feels the noise is generated right there inside your head.
     As I’ve said before, the most common causes are noise exposure, whether sudden noise or chronic exposure, or part of the aging process known as presbycusis.  Drugs sometimes can cause this, notably aspirin.  Other causes are Meniere’s disease which usually is associated with tinnitus in one ear along with sporadic episodes of spinning-type dizziness and hearing loss.  Acoustic neuromas—benign tumors of the nerve of hearing—are uncommon, and occur typically in patients with hearing loss with/without tinnitus but only in one ear.  These are only a few potential causes but as I’ve mentioned before the majority of cases are benign often without an exact cause.
     To evaluate this, an ENT doc needs to examine you and then do an audiogram (specialized hearing test).  Further testing might be needed based on the initial evaluation, such as an MRI or blood tests, but often these are not needed.  For most people when the cause is noise or age-related or when there is no known cause, there really are no curative measures for tinnitus, medically or surgically.  Treatment focuses on adapting to this, using measures to make it less noticeable.  Take to heart though that if the workup shows no underlying serious problem, the vast majority tend to “tune it out,” and go about their daily lives. 
     Granted, this is quite a short synopsis on the issue of tinnitus and a complete medical treatise on this subject would go well beyond the confines of this blog and, as with many medical topics, may lead to a to a deluge of too much detail and ultimately boredom.  So I’ll stop here.  And as my eleven year-old self can attest, you really don’t need an excorcist for the noises in your head.

©Randall S. Fong, M.D. 
Randall S. Fong, MD  (www.randallfong.com)


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