What is tinnitus?

Tinnitus¹ causes the perception of noise or ringing in the ears in the absence of an external source of sound. The sound experienced can vary from a low roar to a high squeal and can affect either one or both ears. Sometimes, the noise can be so loud or bothersome that it can impact your ability to concentrate or to hear external sounds.

Tinnitus Symptoms

Tinnitus² is not an independent condition. Rather, it is a symptom of one or more underlying conditions, including ear injury, hearing loss, or a circulatory system disorder.

While it can get worse with age, tinnitus’ symptoms can often be improved with treatment. This treatment can address either the symptoms of tinnitus or the underlying cause of the tinnitus itself.

Different types of tinnitus

There are two kinds of tinnitus³.

The first type, subjective tinnitus, is the most common, with 99% of reported tinnitus cases falling into this category. Subjective tinnitus is tinnitus that only you can hear. It can be caused by ear problems in the outer, middle, or inner ear, but is usually traceable to auditory (hearing) problems and neurological reactions to hearing loss.

The second type, objective tinnitus, can be heard by other people or a healthcare provider when he or she conducts an examination. This type of tinnitus is rare. Objective tinnitus is caused by internal conditions such as problems with circulation (blood flow) or the body’s somatic (musculo-skeletal movement) systems. It can also be caused in some cases by a middle ear bone condition or muscle contractions.

One specific form of objective tinnitus is pulsatile tinnitus. This presents as an audible rhythmic pulsing in the ear that is generally in time with your heartbeat. Pulsatile tinnitus is most frequently caused by circulation problems in the head or neck (but can also result from brain tumors or abnormalities in brain structure).

How common is tinnitus?

Tinnitus is one of the most common health conditions in the United States, affecting about 15–20% of people⁴.

According to the U.S. Centers for Disease Control, over 50 million Americans⁵ experience some form of tinnitus, with roughly 20 million people struggling with burdensome chronic tinnitus and 2 million people struggling with extreme and debilitating cases of tinnitus.

In its 2011-2012 National Health and Nutritional Examinations Survey⁶, a longitudinal study of the American population’s health, the U.S. Centers for Disease Control included several questions on tinnitus that were used to determine the national scope and severity of the condition.

According to the American Tinnitus Association⁷, the survey found that:

• 15% of respondents experienced some form of tinnitus
• 67% of people who reported experiencing tinnitus had presented regular symptoms for over a year
• 26% of those reporting tinnitus experienced constant or constant symptoms
• 30% of those reporting tinnitus classified their condition as a “moderate” to “very big” problem in their lives

Disparity in tinnitus

Some populations are more likely to get tinnitus⁸ than others. Men, for example, are more likely to get tinnitus than females. This may be attributable to males being more heavily represented in professions with a high risk for causing tinnitus (such as manufacturing, construction, and military service) and being more likely to participate in high hearing-risk behaviors like hunting or motorsports.

Tinnitus is also more common in the elderly than in younger populations. The prevalence of tinnitus increases as people age, peaking between ages 60–696. The correlation between age and the incidence of tinnitus is likely attributable to age-related hearing loss as well as noise-induced hearing loss.

Finally, while it is uncertain exactly why this is the case, non-Hispanic Caucasians report a higher prevalence of tinnitus than other racial and ethnic groups.

Tinnitus symptoms

Tinnitus involves experiencing “phantom noises,” or the sensation of hearing sound when no external sound is actually present.

Those with tinnitus may experience any of the following noises:

• Ringing
• Buzzing
• Roaring
• Clicking
• Hissing
• Humming

It’s important that you consult with your healthcare provider or a specialist if you experience any of these symptoms. You should see your provider as soon as possible if the following occur:

• You develop tinnitus following an upper respiratory infection (such as a cold) and your tinnitus symptoms don’t improve within a week
• You have tinnitus that occurs suddenly or without an apparent cause
• You have tinnitus accompanied by dizziness or hearing loss

Risk factors for tinnitus

While anyone can experience the symptoms of tinnitus, these factors may increase your risk of developing symptoms:

• Prolonged loud noise exposure: Continued exposure to loud noises can damage the tiny sensory hair cells in your ears that transmit sound to your brain. This hearing damage can cause symptoms of tinnitus. People who work in loud environments (such as construction workers, musicians, and soldiers) have a heightened risk of developing hearing damage.
• Age: The likelihood of developing tinnitus increases with age, peaking between ages 60–69. As we get older, the number of functioning nerve fibers in the ear decreases, possibly contributing to hearing problems often associated with tinnitus.
• Biological sex: Men are more likely to experience tinnitus than women.
• Smoking: People who smoke are more likely to develop tinnitus than those who do not.
• Cardiovascular problems: Conditions that affect your circulation, such as high blood pressure or narrowed arteries (atherosclerosis), can increase the risk of developing tinnitus.

Further tinnitus symptoms

Tinnitus can present with a number of different concurrent symptoms. While it affects people differently, tinnitus can significantly affect your quality of life and can lead to:

• Fatigue
• Stress
• Insomnia or trouble sleeping
• Difficulty concentrating
• Memory problems
• Depression
• Anxiety
• Irritability

While tinnitus itself cannot be treated directly, treating these related conditions can help you deal with your symptoms more successfully.

As always, your healthcare provider is the best person to see if you believe you may have tinnitus or if you are unsure about your symptoms.

Tinnitus causes

Scientists remain unsure about what exactly happens in the brain to cause the phantom sounds characteristic of tinnitus. It is known, however, that the condition originates in the brain’s neural circuits. Tinnitus could be caused by these neural circuits attempting to compensate for damaged sensory hair cells in the ears by increasing sensitivity to sound.

It is also possible that tinnitus is the result of neural circuits being thrown off balance when inner ear damage changes signaling activity in the auditory cortex (the part of the brain that processes sound). Ultimately, what we do know is that objective tinnitus results from abnormal communication between the ears and the brain.

Most cases of tinnitus are “sensorineural,” meaning that they are due to hearing loss at the level of the cochlea⁹ (the structure in the ear that turns external stimuli into neural signals) or the cochlear nerve. However, there are a number of conditions and external causes that may lead to tinnitus.

Common causes of tinnitus

A variety of conditions or problems may cause tinnitus, including:

• Age-related hearing loss: Hearing commonly worsens with age, beginning around age 60. Age-related hearing loss, also called presbycusis, can cause tinnitus.
• Noise-related hearing loss: Exposure to loud noises as a result of your profession is not the only cause of hearing loss—portable music players like iPods can also cause hearing loss when played at too loud of a volume for long periods of time. While tinnitus caused by short-term exposure to loud noise (such as attending a concert) generally goes away, both short-term and long-term exposure to loud noise can cause permanent hearing damage.
• Inner ear hair cell damage: This is a common cause of tinnitus and occurs when the tiny, delicate hairs in your ear are bent or broken. These hairs normally move in response to the pressure of sound waves, triggering an electrical signal from the auditory nerve to the brain which is interpreted as sound. When these hairs are damaged, they can send random electrical impulses to the brain, causing the noises characteristic of tinnitus.
• Earwax blockage: The buildup of earwax in your ear canal can cause hearing loss or irritation of the eardrum, both of which can lead to tinnitus.
• Ear bone changes: Conditions like otosclerosis—stiffening of the bones in the middle ear caused by abnormal bone growth—may also cause hearing problems leading to tinnitus. This condition is often genetic and can run in families.

Other causes of tinnitus

Some less common causes of tinnitus can include:

• Meniere’s disease: The presence of tinnitus can be an early indication of Meniere’s disease¹⁰, an inner ear disease that can be caused by abnormal inner ear fluid pressure.
• TMJ disorders: Tinnitus can be caused by problems with the temporomandibular joint (or TMJ), the joint on either side of the head in front of the ears where the lower jawbone meets the skull.
• Head or neck injuries: Injuries to the head or neck can affect the inner ear, auditory (hearing) nerves, or brain function linked to hearing. These injuries usually cause tinnitus in just one ear.
• Acoustic neuroma: An acoustic neuroma is a benign (non-cancerous) tumor that grows on the cranial nerve (the nerve that runs from your brain to your inner ear and controls balance and hearing). As with head or neck injuries, this condition—also called vestibular schwannoma—usually causes tinnitus in just one ear.
• Eustachian tube dysfunction: Eustachian tubes are tubes in the ear that connect the middle ear to the upper throat and nose. When not functioning properly, these tubes can remain expanded all the time, causing the ear to feel full and, in some cases, leading to tinnitus. This condition can be caused by significant weight loss, pregnancy, and radiation therapy.
• Muscle spasms in the inner ear: Some people suffer from involuntary muscle tensing (spasms) in the inner ear. This can result in hearing loss, tinnitus, and a feeling of fullness in the ear. These muscle spasms can be caused by neurological disorders (including multiple sclerosis) but can sometimes happen for no apparent reason.
• Blood vessel disorders: Pulsatile tinnitus can be caused by blood vessel disorders like atherosclerosis (the loss of elasticity of major blood vessels close to the middle and inner ear), hypertension (high blood pressure), or turbulent (irregular) blood flow in a neck artery or vein.
• Malformation of capillaries: Arteriovenous malformation (AVM), the presence of abnormal connections between arteries and veins, can cause tinnitus (generally only in one ear).
• Hypothyroidism

Medications that can cause tinnitus

Some medications can cause or worsen symptoms of tinnitus. Usually, the severity of tinnitus corresponds with the dose of the medication, and symptoms will generally subside after use of the drugs is discontinued.

Some medications known to cause or worsen tinnitus symptoms include:

• Certain antibiotics, such as doxycycline (generic Vibramycin), erythromycin (generic Ery-Tab), tetracycline (generic Sumycin), and vancomycin (generic Vancocin)
• Aspirin and NSAIDs (nonsteroidal anti-inflammatory drugs): High doses of Aspirin (4–8 grams/day), as well as NSAIDs, may cause tinnitus.
• Tricyclic antidepressants, such as amitriptyline (generic Elavil), clomipramine (generic Anafranil), and imipramine (generic Tofranil) may worsen tinnitus
• Quinine medications used to treat malaria or other health conditions
• Water pills (diuretics) like bumetanide (generic Bumex), ethacrynic acid (generic Edecrin), or furosemide (generic Lasix)
• Cancer medication including methotrexate (generic Trexall), and cisplatin (generic Platinol)
• Macrolide, which includes azithromycin and clarithromycin (although reported incidence rate is just 1%)

Why are my ears ringing? Do I have tinnitus?

There are a variety of reasons that may cause you to hear ringing in your ears¹¹.

What causes ringing in the ears?

Almost everyone has experienced tinnitus, if only for a short period of time. Exposure to loud noises can cause short-lived tinnitus that goes away relatively quickly after exposure to the noise ends. Similarly, some medications may cause tinnitus that subsides after they are discontinued.

When tinnitus lasts longer than 6 months, it is called chronic tinnitus. This condition is most common in people of age 55 and older and is frequently associated with hearing loss. While many people worry that tinnitus is a sign of going deaf or a serious medical problem, this is not always the case.