When to Worry About Ringing in Your Ears

“Dear House Call Doctor,

Would you do a podcast about ringing in the ears in the future?”

–  W.S.

What a great suggestion, W.S. Thank you. Ringing in the ears, referred to as “tinnitus” in doctor-lingo, is quite common. In fact, approximately 50 million people in the U.S. suffer from this annoying medical condition. Let’s learn what tinnitus really is, what can cause it, and how you can treat it.

What Is Tinnitis?

If you’ve ever experienced it, you know what it feels like. Tinnitis refers to a misperceived sound that is not externally audible. Patients describe it as a “buzzing” or “ringing,” “clicking,” or “pulsating,” and even akin to a “factory working in my brain.” It can be loud or only faintly audible. It can involve only one ear or both. For most, it is intermittent but can become chronic in 1 in 4 sufferers.

It is often worse in the mornings upon awakening, at bed time, or when it is most quiet. This is because our brains are good at tuning out unnecessary stimuli. So when there are other noises in the room, the nuisance is not as well-perceived.

Most people that experience it tell me that it’s not bothersome. But on occasion, a patient will report that it is severe enough to interfere with daily activities.

Causes of Tinnitis

Most cases of tinnitus are benign and nothing serious. Most causes are due to tiny damage to the hair cells that line the inner ear. Just like arthritis and joint changes with age, this can be due to normal wear and tear through age, but other factors can also contribute.

Here are some factors that have been reported in studies to increase risk of tinnitus:

·         Age: Risk for tinnitus development increases as we get older.

·         Non-Hispanic Whites

·         Noise exposure:  Work-related noise that is chronic is a consideration. So are concerts, listening to loud music, and exposure to firearm noise.

·         Hypertension

·         Prior cigarette smoking

·         Anxiety disorder and/or depression

·         Temporomandibular Joint Disorder (TMJ)

·         Hearing loss

·         Meniere’s disease: These patients report a triad of symptoms, to include tinnitus, hearing loss, and dizziness

·         Medications:  Aspirin and other non-steroidal anti-inflammatories (NSAID), some blood pressure medications, benzodiazepines, drugs used to treat prostate enlargement, certain antibiotics, and proton pump inhibitors (PPIs)  used to treat stomach acid disorders

·         Trauma to the head and neck (secondary to trauma to the blood vessels and/or nerves in the vicinity)

·         Tumor of the vestibular nerve, or other nearby structures

·         Blood vessel disorders

·         Neurologic disorders

Tinnitis that is described as a “clicking” often (but not always) reflects muscle spasms of the muscles surrounding the ear and ear canal. And a “pulsating” description can sometimes be due to blood vessel anomalies that really warrant further investigation. Therefore, it’s important to thoroughly describe the sound when discussing it with your doctor in order to help delineate the cause.


Evaluation of Tinnitis

Most cases of tinnitus can be observed. A thorough head and neck exam by your doctor may be all that is necessary. However, brain imaging such as MRI’s and CT scans can be used to rule out less common causes if there is concern. A hearing test is a more useful and easily accessible test to rule out one of the most common causes.

A thorough head and neck exam by your doctor may be all that is necessary. 

Treatment of Tinnitis

Unfortunately, there is no cure for tinnitus. However, it’s often manageable by learning to trick your brain into tuning it out. I would suggest white noise, a fan, clock, light music, and there are now even apps for white noise that simulate all of these sounds and more.

Treating any hearing loss can also diminish tinnitus. It does so by tricking your brain into tuning out the tinnitus since other noises are enhanced in the environment.

In a nutshell, tinnitus is most often a benign symptom that reflects any minute changes in the auditory system, including hearing loss which is the most common cause, and not a serious condition in most. However, those very infrequent causes are enough to truly warrant a thorough discussion and exam by your doctor.

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Please note that all content here is strictly for informational purposes only.  This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider.  Please always seek a licensed physician in your area regarding all health related questions and issues.

Image courtesy of Shutterstock.

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