Q: Sometimes I hear a ringing in my ear. What causes it?
A: Tinnitus is defined as a perception of sound in proximity to the head in the absence of an external source. Though clearly heard by the affected individual, it does not have an outside source and is not heard by others.
The sound can be continuous or pulsatile in nature. The sound can wax and wane in intensity or for some persons, may never improve or go away. The sound is often described as buzzing, ringing, or hissing, although it can also sound like other noises such as roaring. It can be low or high pitched.
Tinnitus is a common problem, occurring in up to 1 in 5 persons in their lifetimes. According to the American Tinnitus Association, an estimated 50 million people in the United States have chronic tinnitus, persisting for greater than six months. More men have problem with tinnitus than women and is common in people over age 40.
There are many causes of tinnitus. A common cause of tinnitus is hearing loss due to damage to the fragile structures and nerves inside the inner ear that transmit sound to the brain. This is often due to from the aging process and chronic loud noise exposure. However, there are many causes of tinnitus, some serious, most not serious. These include:
- A build-up of ear wax.
- Medicines, like certain types of antibiotics, some classes of antidepressants, diuretics (“water pills”), chemotherapy drugs or large amounts of aspirin.
- Drinking an excessive amount of alcohol or caffeinated beverages.
- Ear infections or ear drum rupture.
- Dental or other problems affecting the mouth including temporal mandibular joint disease (TMJ)
- Injury to any ear or surrounding structures, either due to direct/indirect blow, following surgery or due to radiation cancer therapy of head or neck.
- A rapid change in environmental pressure.
- Severe weight loss from malnutrition or excessive dieting.
- Repeated exercise with the neck in a hyperextended position, such as when bicycle riding.
- Blood flow problems in or around the ear.
- Nerve problems such as multiple sclerosis or migraine headache.
Most tinnitus comes and goes and does not require medical attention. See your primary care provider if tinnitus becomes persistent, occurs with other symptoms such as fever, pain or drainage from the ear, is pulsatile in nature, occurs in only one ear, or is becoming overly disruptive or rapidly worsening.
Healthy lifestyle habits may prevent or reduce symptoms of tinnitus:
- Cutting back on or stop drinking alcohol and beverages containing caffeine.
- Stop smoking and stop using smokeless tobacco products. Nicotine use makes tinnitus worse by reducing blood flow to the structures of the ear.
- Limiting use of aspirin and products containing aspirin, and other non-steroidal anti-inflammatory drugs.
- Exercising regularly because it improves blood flow to the structures of the ear.
- Avoid loud noises and use protective devices in loud environments. Never put anything such as Q-tips in the ear canal.
Using “background noise” to mask tinnitus usually helps, such as running a fan or playing soft music with the volume on low setting. Relaxation techniques may help reduce stress, which will in turn reduce perception of tinnitus. Distraction with reading or engaging in fun activity is often helpful. If tinnitus occurs after starting a new medicine or supplement, alert your health care provider.
For some individuals a referral to an ear nose and throat specialist may be needed for further evaluation and/or treatment options and may be recommended by your primary care provider.
Today’s expert is Kathryn Hanson, APNP, ThedaCare Physicians-New London.
