Tinnitus or “Ear Ringing”: Causes and Remedies



My ears have been ringing nonstop since I was 9 or 10 years old, a high pitched “eeeeeee” that screams in my ears 24/7.  It’s more noticeable when I’m lying awake in bed and is so loud I wonder how I ever get any sleep, though beside me I can still hear wife snoring loud and clear.   I believe my ear-ringing occurred after a joyous session of intense firecracker blasting (and being around Dad at a shooting range, collecting the spent brass casings, without hearing protection).  You might have this problem too, and it may be causing some degree of distress or anxiety.  Take heart though--we’re not alone with this phenomenon called tinnitus, estimated to affect 10-15% of the population; that’s over 30 to 45 million Americans!

I wasn’t too concerned about my tinnitus as a happy-go-lucky kid, that is until I was eleven years old when another smart-alec 11 year-old convinced me my ear ringing was a sign of possession, by no other than Satan himself, and that I needed an exorcism, muy pronto.  Check out the post Tinnitus: Ringing in the Ears or What are those Noises in My Head? for a delightful story of that agonizing period in my youth which lead to intolerable despair, sleepless nights, and one of the worst ordeals of my prepubescent life.  Needless to say, I wasn’t possessed and I survived.  Although I still have tinnitus, it does not affect my quality of life one iota.  I’ve learned to live with it.  And so can you.

Tinnitus is a sound generated by your inner ear.  The quality and intensity of the sound often varies amongst people with this problem.  They can describe a constant ringing or hissing like air leaking from a tire, or the sound of overhead power lines, or for those old enough to remember the cathode-ray television sets, the “sssssss” noise when the television station went off the air (yes, back in the old days there were many stations that broadcasted nothing on the screen other than a fixed logo, often with the profile of an American Indian for reasons I still don’t understand).  Others describe it as the ocean sound of a seashell held up to the ear or like “crickets” or “cicadia.”  The intensity or loudness also varies from very light and noticeable only under very quiet conditions to an almost screaming quality as happens with me, particularly if I concentrate on it.  For some the tinnitus comes and goes, can be brief; for others, it is constant, like mine.  Most tinnitus is a level, persistent noise, though at times can be louder or have a change in pitch for no rhyme or reason.  Less frequency, it pulses, much like a heartbeat.

What causes tinnitus?

Tinnitus 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 hair 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 cease to function properly, the neuron connected to that hair cell may continue sending electrical signals to the brain for reasons not completely understood.  This is perceived as tinnitus.  Also if the neuron itself is not properly functioning or is damage, it can still create a neural impulse and send it to the brain.   This also creates tinnitus.  And when both ears are involved equally, it often feels the noise is generated right there inside your head.

A common cause of a decline in cochlear function is the natural process of aging, called presbycusis.  Another common cause is a past insult to the ear such as noise exposure (either sudden loud noise or continuous, long-term exposure).   Other causes of cochlear decline or injury are: side effects of drugs (aspirin, NSAIDs, loop diuretics, chemotherapy, some antibiotics such as aminoglycosides, diet (sometimes caffeine worsens tinnitus), prior viral infections, head or skull, to name a few. 

However, tinnitus also can be experienced when something occurs around or near the cochlea.  Some examples are things blocking he ear canal (i.e., ear wax, foreign bodies, tumors), middle ear problems (otitis media, otosclerosis, tympanic membrane perforation, cholesteatoma.  The auditory nerve that connects to the cochlea to the brain can also be a source (i.e., acoustic neuroma—a benign tumor of the nerve, or other brain tumors that compress the auditory nerve).

Temporal Mandibular Joint (TMJ) disorder also can create tinnitus, due to inflammation of the joint capsule that sits in front of the ear.  Migraine and tension headaches also can cause tinnitus for reasons not clearly understood. 

Keep in mind the above is not an exhaustive list however.  And often times, even after a thorough workup we sometimes never discover the cause.

Evaluation

If you experience tinnitus, especially of recent onset, you should see your doctor.  If your doctor is unable to determine a cause, they might refer you to an Ear, Nose and Throat (ENT) specialist.  An exam of your ears and other associated structures is done, often including a microscope ear examination.   Also, an audiogram (a detailed hearing test) and tympanograms (that measure middle ear pressure and tympanic membrane movement) is often needed.  Less often additional testing with blood tests or imaging (such as an MRI) are required.

Treatments

Barring any unusual or serious findings, the source of tinnitus is often benign.  Most causes tend to be from a natural decline of cochlear function or prior noise exposure or a prior viral infection.  Unfortunately, there is not a cure per se for tinnitus, and some patients find this disappointing.  However, take heart there are some remedies and techniques that may help.  Again, these won’t resolve the tinnitus completely, but should help reduce its intensity and loudness and allow you to adapt to it, such that it becomes less of an annoyance.

Of course, if there is medical or physical problem such as middle ear fluid, ear wax, otosclerosis, etc, then medical or surgical treatment often resolves the tinnitus.  The variety of treatments for particular ear ailments is way beyond the scope of this post.  In such cases, tinnitus is a symptom of a potentially more serious problem.  This is the reason you ought to see your doctor for this before embarking on any therapies. 

Avoid loud noise or use maximal hearing protection when potentially exposed to excessive noise.  My NRA (National Rifle Association) membership certificate hanging in a room where we discuss audio findings and hearing issues.  Where I live, the majority of people I meet own firearms for hunting or target shooting and give me the “thumbs-up” on being an NRA member.  However, this triggers the discussion of maximal hearing protection when shooting.  I advocate double hearing protection with ear plugs (preferably custom-fitted plugs) AND ear muffs that cover the ears completely.  For hunting, I recommend electronic ear muffs which allows the hunter to hear environmental sounds but activates immediately to attenuate sound when the gun is fired.  Also, caution with those earbuds used for music, especially in young kids. Long-term use can cause noise-induced hearing loss and subsequently tinnitus.

Avoid medications that can affect the cochlea, such as aspirin (i.e., dose higher than an 81mg baby-size or regular-sized 325mg once a day dose) and too much NSAID use (ibuprofen, naproxen).  If you’re using NSAIDS multiple times a day on a chronic basis, you should see your doctor to see what ails you as there might be other effective therapies to keep you off long-term NSAID use, which has potential adverse side-effects. 

Avoid too much caffeine.  We live in a highly-caffeinated society.  Kids are drinking energy drinks and sweet, super-sized coffee drinks loaded with caffeine.  Generally, one or two (8 ounce cups) is O.K.  Tinnitus might not resolve with caffeine cessation, but higher doses can make it worse (I’ve suffered the same when overloading on the coffee at work).

Masking techniques:  Masking is a technique where a competing noise is created to counteract the tinnitus.   Many people with tinnitus already experience this during the day: the ambient noise of their environment during their routine day at work or school is a natural masker for tinnitus.  Some people need masking at bedtime given the lack of ambient noise, which is the time tinnitus is most distracting.  For instance, you can play an FM radio between stations to create the constant “sssssss” sound.  Play it for about 15-20 minutes or go to sleep with it.  After you turn it off, you may notice a reduction in the level of your tinnitus.  This phenomenon is called residual inhibition.  Other techniques are to run a fan or play environment CDs or cellphone apps to pay sounds found in nature, such as ocean waves, falling rain or natural running water of a brook or stream.  The rhythmic sounds of chirping crickets through an open window also can be quite soothing.  The sounds of the natural world have an odd way not only of masking tinnitus, but in calming our minds and lowering levels of anxiety and depression.

You might’ve heard of lipoflavonoids which are over-the-counter supplements made to combat tinnitus, making it quieter and more bearable.   These can be found in pharmacies (i.e., Walmart, CVS, to name a few), some grocery stores and or via online sources, these non-prescription supplements are derived from flavonoids, naturally occurring phytochemicals found in almost all plant foods and are thought to have protective effects on the cardiovascular and neurologic systems.  Early studies using lipoflavonoids for Meniere’s disease (a condition with a triad of symptoms including vertigo, hearing loss and tinnitus) found that many people reported improvement in their Meniere’s symptoms.  Lipoflavonoids were then suggested for tinnitus in general, though there is not convincing research showing an obvious beneficial effect.  I have many patients who swear by these supplements, noting a marked improvement and in some cases complete resolution of their tinnitus.  Be mindful however that this is anecdotal and not scientific proof of its usefulness.  I typically tell patients wanting to try lipo-flavonoids that the results are “hit-or-miss”--they might or might not notice an improvement.

Other unproven remedies including herbal meds such as ginko biloba, high-dose vitamin and mineral supplements have also been suggested.  However, there are is no convincing evidence any of these cure or alleviate tinnitus.  Essentially to-date, there is no magic bullet, no medication or supplement that is scientifically proven to cure tinnitus.

Hearing aids can help but again will not resolve the problem completely.  For those with hearing loss who could benefit from aids, the amplification itself can mask the tinnitus, making it less noticeable.  A tinnitus masker also can be programmed into the hearing aid device if needed.  Sometimes those patients with tinnitus but normal hearing, a masking device in the form of a hearing aid can be created and often is very helpful.

Stress-relief often helps a great deal.  Relaxation techniques, meditation (though be careful not to perseverate on your tinnitus in those quiet moments).  Exercise seems to help.  In fact, when I’m out on a run I never seem to notice it and it never bothers me.   I’m fully engaged with the environment and everything around me, or involved in happy thoughts to be distracted by my tinnitus.  Leading a productive life and engaging with family and friends is one of the best therapies, keeping your mind off your tinnitus and onto more important matters.  In some cases, patients may need an antidepressant or anti-anxiety medication may help, but again, we’re treating not the tinnitus, but the emotional or psychological problems that might occur with it.

WARNING:  Before embarking on any of these treatments however, see your doctor or an ENT physician first to rule out more serious or ominous problems needing additional diagnostic tests or different means of treatment.    Like everything else in life, be proactive in your health, which includes seeking medical attention.

If everything checks out hunky-dory, take solace you’re not insane or possessed by the 666er himself, and you can still lead a happy and fulfilling life.  Just look at me—I ironically became an Ear, Nose and Throat doctor despite the constant ringing in my ears for nearly half a century! (yes, that’s old as dirt).

©Randall S. Fong, M.D.



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