Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at June 29, 2016

Ear pain or hearing loss are common ailments which can stem from exposure to loud music, infection, or genetics. Those suffering from tinnitus, a common ear complaint, hear ringing, hissing or buzzing sounds in their ears. For a lot of people, it can lead to severe depression and other health related issues. Tinnitus can be temporary (temporary threshold shift) though the damage that normally causes tinnitus tends to be permanent.


Definition & Facts

Tinnitus is the experience a person has of hearing ringing or noise in their ears. Tinnitus affects a large majority of people. One of every five people may have tinnitus. Tinnitus stems from underlying conditions. Tinnitus can worsen with age, but treatment can lessen the noise in people’s ears. According to the American Hearing Research Foundation, about 7 million Americans have tinnitus that seriously disrupts their quality of lives.

Any damage to the ear could cause extra ringing noise inside of the ear, and there are a number of conditions that cause that kind of damage. They include otitis externa (an infection of the outer ear) as well as metabolic disorders, among other causes. Doctors can pinpoint these and devise a course of treatment.

There are several different kinds of tinnitus. Subjective tinnitus can only be heard by the individual whereas objective tinnitus can be heard by the doctor doing the examination. Objective tinnitus is the rarer of the two, and problems with the blood vessels, inner ear, or muscles are all underlying causes of objective tinnitus. In addition, tinnitus can be classified as vibratory and nonvibratory.

Symptoms & Complaints

Symptoms of tinnitus include hearing noises such as ringing, clicking, or hissing. These noises can have a low pitch or high pitch. Usually, noises are low enough to be ignored. However, there are cases where it becomes a distraction for the person. People with tinnitus may hear the noise all the time, or it may come and go.


There are many possible causes of tinnitus, and they usually are related to the same underlying mechanisms of hearing loss. Hearing loss and tinnitus can be caused by the inability of sound to transmit into the inner ear (conductive hearing loss) or they can be caused by damage to the inner ear or cranial nerve III (sensorineural hearing loss).

Sound may not be able to enter into the inner ear due to a ruptured eardrum (perforated eardrum), cerumen impaction (earwax buildup that causes a blockage), or bone abnormalities such as otosclerosis. Inner ear damage or disease may result from exposure to loud noises (noise-induced hearing loss) or the processes of aging that cause some people to lose their hearing (presbycusis).

Neurological disorders and traumatic brain injuries can cause tinnitus. Temporomandibular joint disorder, multiple sclerosis, and skull fracture are all potential causes as well.

Common medications can also cause tinnitus, and they are said to be ototoxic or toxic to the ears. Some of the common ones include cancer medications (chemotherapy drugs) such as methotrexate and cisplatin. Antibiotics like erythromycin and tetracycline may be ototoxic and cause tinnitus. Aspirin and nonsteroidal anti-inflammatory drugs can cause tinnitus.

Diagnosis & Tests

Diagnosis begins with a physical examination in which the doctor inspects the ears. They will use an otoscope to look inside the ears and check for any evidence of a ruptured eardrum or impacted earwax among other possible signs. The Weber test is commonly used in combination with the Rinne test and both involve the use of tuning forks. The Weber test tests for conductive hearing loss or the inability of sound waves to travel into the inner ear and the Rinne test tests for sensorineural hearing loss. A tympanometry may be performed which changes the ear pressure in the person's ear and tests its effects on the movements of the eardrum.

Audiological exams or hearing tests will also be performed. Tests will examine whether or not the patient has any issues interpreting speech in order to assess underlying disease of the central nervous system. Exams will try to understand the character of the tinnitus: to what extent it involves the interpretation of pitch, loudness, tone, and location of sound.

For those with objective tinnitus, underlying diseases are usually the culprit, and so imaging tests, such as CT scans and MRIs can help determine the root causes. These scans may also be necessary if it is suspected that the tinnitus is caused by head trauma.

Treatment & Therapy

The first step to treating tinnitus is treating any underlying causes. Methods to treat underlying causes include removal of earwax and changing medications. Removal of impacted earwax involves using solutions that remove cerumen (cerumenolytic solutions), visiting a health care provider to remove the cerumen through a suction or other medical tool, or rinsing out the ear canal with water or saline with the use of a syringe.

Auditory masking is a common treatment method. This involves the use of certain sounds to distract from or mask other sounds. Some people may opt for a masking device or tinnitus maker. The masking device sits in the ears but lets out a low level of white noise. This noise helps those affected to block out the noise. Hearing aids may also be recommended though their efficacy varies.

In addition, medications may be prescribed for people with tinnitus. These include Benzodiazepines such as lorazepam or clonazepam; vitamin B12 supplements; and calcium channel blockers like verapamil or nimodipine.

Prevention & Prophylaxis

There are multiple ways to avoid tinnitus. One of the most important ways to protect oneself from tinnitus is to wear ear protection. Ear protection is necessary for anybody who works around loud noises on a regular basis. Ear protection includes the use of earmuffs and earplugs.

Groups that need to be especially vigilant about ear protection include musicians, audio engineers, others who work in theater and the arts, construction workers, and laborers in certain industrial settings with loud noises. The Department of Labor in the United States requires hearing conservation programs for workplace settings in which the amount and decibel of noise that workers are exposed to on any given day exceeds a certain threshold.

Improving one's overall health may help prevent tinnitus that is caused by vascular disorders. Avoiding exposure to caffeine and cigarettes; reducing alcohol intake; engaging in regular exercise; and practicing relaxation techniques and stress reduction are important preventative approaches.

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