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Causes of Tinnitus

Tinnitus (literally “ringing” in Latin) is characterized by ringing, buzzing, or noises that originate in the ear or the head, and can cause discomfort and stress.

Though this condition is usually not dangerous, it can be a symptom of another health problem or underlying condition. Tinnitus can cause so many stressful side effects, including fatigue, sleep problems, concentration difficulty, memory problems, depression, anxiety, and irritability. Though it's not necessarily serious, it can be quite debilitating.

The quality of the tinnitus refers to the description by the patient of the tinnitus. It may be a ringing, buzzing, cricket, ocean, or other type of sound. Also, the quality may be multiple sounds or a singular sound. Tinnitus is a very common disorder, and may be:

  • Intermittent, constant, or fluctuating
  • Mild or severe
  • Varied in nature, from a low roaring sensation to a high-pitched type of sound
  • Associated with a hearing loss

What Causes Tinnitus?

Tinnitus may have several underlying causes. Your doctor may begin investigating the condition by first finding out what kind of tinnitus you suffer from. There are two general types of tinnitus: subjective and objective tinnitus.Subjective tinnitus means that only you can hear the noise or ringing in your ears. Objective tinnitus means that it may be possible for your physician to also hear the noise or ringing while performing an exam - this type of tinnitus is rare.

Tinnitus may be produced in one or more locations, called the site of lesion. The cause of tinnitus may be one or many.

  • Peripheral site lesion - One located on the auditory nerve or cochlea, and includes dysfunction established within the auditory system that extends up to, but not involving, the brainstem.
  • Central site of lesion - This refers to involvement of the central auditory pathways, beginning at the brainstem and involving other portions of the central nervous system.

Tinnitus may originate from various lesions and from different sites. The auditory system involves highly complicated inner ear structures, many nerve pathways, and a great amount of nuclei that form a complex neural network. Pinpointing the cause of tinnitus to a certain structure becomes questionable.

This is demonstrated by patients who have had unyielding tinnitus after having surgery on their ear or incurring severe diseases of the ear. In an attempt to relieve the tinnitus, cutting the auditory nerve is often done. When the tinnitus is persistent, this indicates that the site of lesion causing the tinnitus likely shifted into the central nervous system.

There are many other causes related to the ear which would result in tinnitus. These include:

  • Abnormal neural activity - Tinnitus could be explained by abnormal neural activity in the auditory nerve fibers, which may occur if there is a partial breakdown of the myelin covering of individual fibers. A defect in the hair cell would trigger the discharge of connected nerve fibers.
  • Chronic cochlear disorders - There may be increased spontaneous activity in the hair cells and neurons, resulting in tinnitus. There are two different kinds of afferent fibers in the auditory nerve: inner hair cell fibers with large diameters and outer hair cells fibers with small diameters. Thus, loss of signals from the cochlea might trigger tinnitus as a manifestation of a functional imbalance between the two sets of fibers. In addition, other abnormal changes of the cochlear fluids may result in tinnitus.
  • Medications - There are some drugs which will cause tinnitus, such as excessive aspirin intake. If you have tinnitus and are on medication, you should discuss the symptom of tinnitus with your physician. In many instances, once the drug is discontinued, the tinnitus will no longer be present.
  • Ear wax - Cerumen, known as simple ear wax, in the ear canal.
  • Otosclerosis - This is a fixation of the stapes bone in the middle ear.
  • Meniere’s disease - A complex syndrome involving hearing loss and vertigo.
  • Sudden trauma - A direct blow to the ear or head.
  • Injury - This causes damage to the inner ear such as exposure to excessively loud sounds.
  • Tumors - On the hearing nerve or other problems in the brainstem or central nervous system.
  • Other vascular abnormalities – These can occur in the skull or base of the skull.

In some cases, the exact cause of the tinnitus may not be found but serious underlying conditions can be ruled out.

How is Tinnitus Treated?

Generally, most patients will not need any medical treatment for their tinnitus. For patients who are greatly bothered by tinnitus, they may use masking techniques and other treatments, such as:

  • Listening to a fan or radio - This generally is more advantageous if one is attempting to go to sleep.
  • Amplification - tinnitus is most often a side effect of hearing loss. Consistent use of hearing aids provides relief of tinnitus -when you hear other sounds, your own internal sounds are masked.
  • A tinnitus masker - This device is a small electronic instrument built into a hearing aid case. It generates a noise which prevents the wearer from hearing his own head noise. The masker is based on the principle that most individuals with tinnitus can better tolerate outside noise than they can their own inner head noise.
  • Biofeedback training - This is effective in reducing tinnitus in some patients. It consists of exercises the patient learns in order to control various parts of the body and relax the muscles. When a patient is able to accomplish this type of relaxation, tinnitus generally subsides. Most patients have expressed that the biofeedback offers them better coping skills.
  • Avoidance - This includes making every attempt to avoid anxiety, as anxiety increases tinnitus. A person with tinnitus should avoid losing sleep and becoming fatigued, because, generally, patients who are tired seem to notice their tinnitus more. Also, the use of nerve stimulants is to be avoided, as excessive amounts of coffee and smoking contribute to the head noise.
  • Medications - There are some medications utilized to suppress tinnitus. Some patients benefit with these drugs, and others do not. Each patient has an individual response to medication, and what works for one patient will not always work for others. Some of these medications have been proven, however, to decrease the intensity of the tinnitus and make it much less noticeable to the patient. There is, however, no drug anywhere which will eliminate tinnitus completely and forever.

    Speak with your hearing specialist about the best tinnitus treatment option for you.