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Tinnitus: Causes, Risk Factors & Treatment

What Causes Ringing in the Ears?

Tinnitus is a pervasive problem in the United States. According to both the Mayo Clinic and the American Tinnitus Association, about 15 to 20% of Americans suffer from daily tinnitus. This number represents approximately 50 million people. There are various causes of tinnitus, and fortunately, several treatments are available for this condition.

We’ll take a look at the different possible causes of tinnitus below. We will also explore risk factors, prevention, and treatment options for tinnitus. Remember, although this article provides valuable information about tinnitus, your ear, nose, and throat (ENT) specialist is always your best source of tinnitus advice and guidance. 

What is Tinnitus?

Tinnitus is a ringing or buzzing in the ears. These sounds can be heard only by the patient and are not generated by an external source. While almost everyone has experienced at least one episode of tinnitus during their life, people with chronic tinnitus may suffer from daily bouts.

The nature of tinnitus varies from person to person. While most patients report their tinnitus as ringing or buzzing, tinnitus may also take the form of a hissing, clicking, or whooshing sound. Some people experience tinnitus only in quiet conditions, such as at night when preparing for bed. For others, tinnitus is near-constant and also occurs in a noisy environment.

Pulsatile tinnitus is a common variant of the condition. In pulsatile tinnitus, the patient feels a pulsing sensation that occurs along with the noise of tinnitus. The condition may feel like blood rushing in the ears and often produces a whooshing sound.

Tinnitus may occur in one or both ears. The severity of tinnitus cases also varies. Tinnitus may be mild and only an occasional annoyance. However, tinnitus can also manifest as a severe condition that interferes with sleep, focus, and the ability to hold a conversation.

Causes of Tinnitus

Tinnitus has many possible causes, and some of these causes respond better to treatment than others. To understand the origins of tinnitus, it is necessary to give an overview of how hearing works. In summary, sound waves stimulate cells in the inner ear called hair cells. In turn, these cells generate electrical impulses that travel along the auditory nerve to the brain, where the impulses are interpreted as sound. Any damage or blockage of this process can result in tinnitus.

Here are some specific causes of tinnitus:

Loud noise exposure – Exposure to loud noise is one of the most common tinnitus causes. High-decibel sounds can result in hearing damage, which leads to tinnitus. Both brief and extended exposure to loud noises can be triggers for tinnitus. Tinnitus that results from a brief or single exposure to loud sound will usually resolve spontaneously. However, tinnitus arising from repeated exposures may be chronic or long-lasting.

Examples of sound sources that can cause tinnitus include jet engines, heavy equipment, loud music, gunshots, and more. It is important to always wear ear protection when exposed to high-volume sounds to avoid problems with both hearing loss and tinnitus.

Age-related tinnitus – As people age, their propensity for tinnitus increases. Those older than 60 have the highest incidence of tinnitus. The high rate of tinnitus among seniors is due to a lifetime of noise exposure as well as age-related degeneration in the structures of the inner ear. Additionally, build-up of plaque in the arteries can lead to higher-than-normal pressure in the blood flow of the inner ear. This phenomenon can cause tinnitus or pulsatile tinnitus.

Earwax accumulation – Earwax, also called cerumen, protects the skin of the ear canal and helps to guard against harmful microorganisms. However, earwax can accumulate to the point that it blocks the ear canal and reduces hearing acuity. When this happens, tinnitus can result.

Acoustic neuroma – This is a benign tumor that grows on the nerves in the inner ear responsible for hearing and balance. Also called a vestibular schwannoma, the tumor may lead to balance issues and tinnitus in one ear only.

Ménière’s disease – Ménière’s is a disease characterized by abnormal inner ear pressure. In some cases, patients experience tinnitus as an early symptom of Ménière’s.

Eustachian tube dysfunction – The Eustachian tube connects the middle ear to the back of the throat. Eustachian tube dysfunction occurs when this tube stays open even when it should close. This condition can cause a sensation of fullness in the ear and is often mistaken for an earwax blockage by patients. Tinnitus is another common symptom of Eustachian tube dysfunction.

Head and neck trauma – Injuries to the head, face, and neck may result in problems with tinnitus. These injuries do not have to be sound-related but can result from automobile crashes, sports accidents, and workplace incidents.

Low zinc levels – Zinc, a common mineral, is normally present in the human bloodstream. Research suggests that some tinnitus patients have low zinc levels, a condition called hypozincemia. Studies have been contradictory as to whether taking zinc supplements can help lessen tinnitus symptoms, and the findings remain controversial.

Certain medications – Taking certain classes of medications may increase the chances of developing tinnitus, at least in the short term.

Risk Factors

The following are major risk factors for tinnitus:

Loud noise exposure – Prolonged exposure to loud noises often leads to tinnitus. Individuals who work in heavy industry, construction, and music are particularly at-risk.

Age – Those older than 60 have a greater risk of tinnitus than the general population.

Male sex – Men are more likely to experience tinnitus than women, although the reasons for this fact are still unknown.

Other medical conditions – Conditions such as cardiovascular disease, Ménière’s disease, and previous head trauma can increase the likelihood of tinnitus.

Smoking status – Smokers suffer from a huge variety of medical conditions at a higher rate than non-smokers, including tinnitus.

Preventing Tinnitus

The most effective way to prevent tinnitus is to protect against loud noise exposure. Hearing protection should always be worn in noisy environments, and music should be enjoyed at a reasonable volume. It is also important to have hearing checked on a regular basis so that any hearing loss or other problems can be identified early.

Other than sound protection, patients should also safeguard their ears in other ways. For example, earwax removal should never be attempted on one’s own. Instead, a visit to the ENT can safely remove excess earwax while checking for any problems. Also, protected the ear from water can prevent irritation and infections, which could lead to tinnitus. Consulting an ENT about earplugs or other ways of avoiding swimmer’s ear is an excellent idea.

Another effective method of tinnitus prevention is keeping in good general health. Good diet and exercise are crucial for overall health, but these measures can also cut the risk of cardiovascular disease that can contribute to tinnitus. Also, quitting smoking is paramount for both tinnitus prevention and longevity.

Tinnitus Treatment

Treatment of tinnitus largely depends on the underlying cause of the problem. For instance, if the tinnitus is due to an earwax obstruction, the treatment may be as simple as an ear cleaning by an ENT. Likewise, a doctor may decide zinc supplementation is the best course of action if a patient’s zinc levels are low.

Surgery is usually necessary to resolve tinnitus caused by an acoustic neuroma. If the tinnitus is due to medication, a physician may decide to discontinue that medication or switch to an alternate drug. This point illustrates the importance of keeping the entire healthcare team up-to-date on a patient’s entire medication list, both prescription and over-the-count.

In cases of age-related tinnitus or tinnitus resulting from noise exposure, the latest hearing aids can be quite helpful. Some degree of hearing loss usually accompanies these types of tinnitus, and patients often have trouble understanding conversational speech or audio from devices like phones and televisions. The latest hearing aids are “smart” devices that do more than merely amplify sound.

These smart hearing aids contain microprocessors that also filter out noise, such as background sounds and the buzz of tinnitus. This feature can be invaluable for patients dealing with severe tinnitus, enhancing their quality of life and allowing them to take part in social interactions. Many smart hearing aids also have Bluetooth connectivity so that they can interface with smartphones, smart TVs, etc.

First Steps

Consulting an ENT specialist should be the first action for anyone experiencing lasting tinnitus or suspected hearing loss. A proper diagnosis is necessary for meaningful treatment, and ENTs are experts in all forms of hearing issues. Tinnitus can be frustrating and even debilitating, but help is available.