Ringing in the Ears (Tinnitus)

Ringing in the ears is a general term to describe a condition in which a person perceives sounds that have no acoustic origin. Although tinnitus, the medical name for the condition, comes from the Latin term "to ring," the noises can take many forms -- whistling, buzzing, humming, or roaring -- and range from a soft hum to a high-pitched squeak. Some people hear the sounds constantly in one or both ears, while others hear them only intermittently. Sometimes the sounds pulsate, synchronizing with the heartbeat.

At any given time, approximately 35 million people in the United States are affected by some degree of ringing in the ears, which may impair their hearing. For many, it is a minor nuisance that can be ignored or handled without medical intervention. For others, the condition can be eliminated or minimized when the underlying cause is discovered. For about 7 million people, however, the noises are distressing and distracting enough to interfere with normal activities.

Tinnitus has many causes. One of the most common is ear damage from exposure to very loud noise. Such damage may occur from a single event, such as an explosion, or develop over time from listening to superamplified rock music, operating noisy machinery, or living close to an airport. The problem often originates in the ear itself; possibilities include infection, a blocked eustachian tube, obstruction by earwax, a tumor, or -- especially in the elderly -- the progressive growth of spongy bone in the middle ear, a condition called otosclerosis.

Ringing in the ears is frequently a side effect of medications, especially aspirin and other drugs that contain salicylates, quinine, aminoglycoside antibiotics, and certain diuretics. Alcohol abuse, carbon monoxide poisoning, or toxicity from lead, mercury, and other metals can also produce the ringing. Less commonly, systemic diseases, such as high blood pressure, thyroid disease, arteriosclerosis, and anemia, can cause tinnitus, as can meningitis, syphilis, and head injuries.

Diagnostic Studies and Procedures

Diagnosis begins with asking numerous questions about medications, work and recreational exposure to noise, and other illnesses. A physician will then examine the inside of the ear with an otoscope, looking for obvious causes such as an infection, a foreign object, or accumulation of earwax.

If the patient complains of pulsating tinnitus, a doctor will look for circulatory problems, a process that may require angiograms, dye-enhanced X-rays of the blood vessels. In some cases, a physical examination that includes blood and urine studies may reveal the cause. But if no obvious explanation is forthcoming, the patient may be referred to an ear specialist (otologist) or an ear, nose, and throat doctor (otorhinolaryngologist), who may order CT scans or MRI and conduct various hearing tests. The purpose of these procedures is to determine whether the problem originates in the ear itself, in the acoustic nerve, or in the brain.

Medical Treatments

There are no treatments for tinnitus as such; efforts are directed to eliminating the underlying cause. An easy one to remedy is tinnitus caused by medication; stopping the drug or substituting another usually solves the problem.

Certain devices can be helpful. For some patients, a hearing aid works. For others, especially people who cannot tolerate the noise, a tinnitus masker brings relief. This is a device that resembles a hearing aid and provides a sound that is more pleasant than the troubling noise. Deaf patients may be helped by having a device that provides electrical stimulation implanted in the cochlea portion of the inner ear.

Alternative Therapies

Hypnosis. Self-hypnosis techniques can help patients to ignore the noises or perceive them as pleasant sounds. For example, a buzzing sound may be imagined as flowing water or waves.

Meditation. Deep breathing and other meditation methods, perhaps combined with visualization, may make the tinnitus less intrusive and bothersome.

Music Therapy. Playing background music to mask tinnitus is a time-honored remedy that many ear specialists recommend. If headphones are used, the volume should be loud enough to mask the noise in the ears, but not so loud that it causes further damage.

Self-Treatment

In addition to the alternative therapies discussed above, you might investigate a white sound machine, a device that plays a monotonous yet pleasant masking sound, such as falling rain or waves. People who suffer from chronic tinnitus find these machines especially useful for helping them to fall asleep.

To prevent tinnitus from getting worse, wear earplugs when you find yourself in an excessively noisy environment. If your job exposes you to loud noise, wear protective earmuffs. Avoid listening to loud rock music, especially through a headset.

Other Causes of Ringing in the Ears

Meniere's disease and vertigo are often accompanied by ringing in the ears. People who suffer from motion sickness may also experience tinnitus along with the more common queasiness. Some persons have temporary ringing in the ears when riding in a fast elevator or during descent on a plane trip. In such cases, the problem is due to changes in atmospheric pressure.