Hear That Ringing? It Could Be Tinnitus

By Jennifer Kimberly, AuD

Most of us have experienced a ringing sound in our ears at least once, maybe after leaving a loud concert or in the aftermath of a sinus infection. In this case, the ringing is temporary and typically goes away after a few hours or days. But some people deal with a ringing or other sound, such as buzzing, clicking, or whistling, in one or both ears on a daily basis. While all incidences of hearing a “phantom” sound are considered tinnitus, people don’t typically say they have tinnitus unless it’s a chronic issue. The CDC estimates that more than 20 million Americans experience chronic tinnitus.

What Is Tinnitus?

Tinnitus isn’t a disease or a disorder, but rather a symptom of another issue that’s affecting the body’s auditory system, which includes the ear, the auditory nerve, and parts of the brain that process sound. Most cases of tinnitus stem from damage to the inner ear.

While experts have yet to agree on what happens in the brain to create the sound illusions generated by tinnitus, they do tend to agree that it has something to do with damage to the delicate inner-ear nerve cells. It’s possible that when these cells, which send electrical signals to the brain for interpretation, are damaged, they send random, false electrical signals that cause the brain to believe sounds are occurring when they actually aren’t. It could also be that the neural circuits in the brain are adapting to the loss of the cells by making the ears more sensitive to sound.

What Causes Inner Ear Damage?

Damage to the inner ear can occur for any number of reasons. The most common cause is extreme or prolonged exposure to loud noises. People who work in noisy environments, such as factory workers, construction workers, and musicians, as well as military service members who are exposed to loud bangs and explosions, are most susceptible to noise-induced tinnitus and hearing loss.

Other possible causes are:

• An ear or sinus infection, if left untreated, can spread to the inner ear and lead to tinnitus and hearing loss.
• Ototoxic medications, including prescription and over-the-counter medications, can damage the inner ear and cause tinnitus, hearing loss, and balance problems.
• Ménière’s disease, an inner ear disorder, frequently causes a ringing or roaring form of tinnitus, as well as vertigo and hearing loss.
• Hormonal changes in women may cause or worsen tinnitus, particularly when women in menopause are on hormone replacement therapy (HRT).
• Thyroid abnormalities, including hypothyroidism and hyperthyroidism, can increase blood pressure, which may affect the inner ear because it’s sensitive to blood pressure changes. Thyroid disorders also throw off hormone levels.

Is Tinnitus Ever a Sign of Something Serious?

In some cases, tinnitus and pulsatile tinnitus can be a sign of something more serious. For instance, tinnitus may signal abnormal blood flow to and from the head or neck, as well as brain tumors or brain structure abnormalities.

Can Tinnitus Be Treated?

Treatment for tinnitus depends on what’s causing it. If the underlying cause can be treated and there’s no permanent damage to the inner ear, there’s a good chance your physician can reduce or eliminate the tinnitus. For instance, if it’s caused by an earwax blockage, your doctor can easily decrease your tinnitus by removing the earwax. Or you may be able to stop experiencing tinnitus if you switch to a medication that’s not known as ototoxic.

If there is inner ear damage, however, treatment is more complex and it’s probable that the tinnitus can’t be eliminated. The good news is that there are treatments that can make tinnitus less noticeable.

• Hearing aids – In the case where hearing loss is present, many people find that wearing hearing aids provides relief from tinnitus. Many hearing aids have tinnitus maskers available in addition to providing hearing assistance.
• White noise generators – Most people with chronic tinnitus typically find that constant noise around them helps alleviate the ringing in their ears. White noise generators play pleasant, constant sounds that can aid in relaxation and sleep.
• Wearable masking devices – Similar to white noise generators, wearable masking devices are worn much like hearing aids and transmit a constant white noise sound or certain tones to help cover up tinnitus sounds.
• Tinnitus retraining therapy (TRT) – Administered by an audiologist or other physician, TRT combines sound masking (usually wearable) and counseling to help you better tolerate tinnitus.
• Cognitive behavioral therapy (CBT) – Mental health professionals can help you learn coping techniques to better endure and manage your tinnitus.

Although chronic tinnitus isn’t yet curable, researchers are working on potential future treatments involving magnetic or electrical stimulation of the brain.

If you experience a frequent or constant ringing or other “phantom” sound in your ears that is imperceptible to others, you likely have chronic tinnitus. Your doctor or an Audiology specialist may be able to determine the underlying cause of the tinnitus and treat it or provide ways to make your tinnitus more bearable.