• Ringing in the Ears



    Tinnitus is the perception of abnormal ear or head noises without any external sound. Noises may be high pitched, ringing, clicking, or buzzing. Pulsatile tinnitus is caused by the flow of blood that accompanies each heartbeat.
    Anatomy of the Ear
    Copyright © Nucleus Medical Media, Inc.


    Tinnitus may be caused by:
    • Cochlear damage from exposure to loud sounds
    • Hearing loss
    • Damage to the auditory system, including the ear drum and nerves
    Occasional episodes of tinnitus lasting at most a few minutes are quite common in most people, especially after exposure to loud noises.

    Risk Factors

    Factors that may increase your chance of tinnitus include:
    • Occupations or activities that expose you to loud noises
    • Wax or a foreign body in the ear canal
    • Stress
    • Fatigue
    • Certain medications, such as aspirin, antibiotics, or diuretics
    • Toxins, such as heavy metals, carbon monoxide, or alcohol
    • Certain health conditions, such as:
    • Blood vessel disorders, such as an aneurysm, fistula, or hardening of the arteries are associated with pulsatile tinnitus
    • Fluid in the ear
    • Ruptured membrane in the ear
    • Injury to the head or neck


    The sensations of tinnitus may have the following characteristics:
    • Ringing, roaring, buzzing, whistling, or hissing sounds
    • Intermittent, continuous, or pulsatile quality
    • Same or varying intensity
    • Single or multiple tones
    • More annoying symptoms at night or when there are fewer distractions
    • Sensation of normal internal events, such as blood pulsing or muscles contracting
    Sometimes tinnitus is accompanied by hearing loss and vertigo, a sensation of spinning while standing still.

    When Should I Call My Doctor?

    Call your doctor if you have tinnitus, especially if it:
    • Is associated with hearing loss, vertigo, change in personality, speech, or weakness in any body area
    • Starts after head or neck injury
    • Is associated with new medication
    • Is pulsatile
    • Is associated with pain in the ear, fever, nausea, or vomiting
    • Is interfering with your activities


    The doctor will ask about your symptoms and medical history. A physical exam will be done. Special attention will be paid to your head, neck, and ears.
    You will be asked questions about:
    • The sensations that you have
    • The factors that may increase or decrease the sensation
    • The medications that you take
    • History of trauma
    The doctor will look at your ear canal and eardrum using an instrument with a light that is held at the external opening of the ear. A tuning fork can help evaluate hearing. You should receive a complete hearing test. Imaging tests, such as a CT or MRI scan, may be ordered to rule out serious conditions.
    In addition to hearing the test may include:
    • Tympanogram
    • Auditory brain response
    • Electrocochleoraphy—to test for Meniere's disease


    Tinnitus treatment depends on what is causing the symptoms. This may mean:
    • Wearing a specially made splint to help manage temporomandibular joint disorder
    • Taking antibiotics for a sinus or ear infection
    • Having the wax removed from your ear canal
    • Stopping or changing medications to see if tinnitus goes away
    Therapy aims to eliminate or reduce bothersome sensations. Treatment may include:


    No medication has been shown to be very effective in treating tinnitus. Your doctor may still try to use some medications to ease your symptoms. These may include antidepressants and sedatives.
    If you have Meniere's disease, your doctor may prescribe medication to treat that condition.

    Mechanical Devices

    Devices include:
    • Hearing aid—sometimes relieves tinnitus and improves hearing in some people with hearing loss
    • Tinnitus masker—a device that emits a low level of white noise to help cover up the internal sensations and block out external noises

    Lifestyle and Self-care Measures

    Measures to discuss with your doctor if no cure or specific treatment is available include:


    Surgery may help relieve certain causes of tinnitus. These include:
    • Tinnitus caused by a tumor frequently subsides after the growth is removed
    • Abnormalities in blood vessels that lead to tinnitus can sometimes be corrected with surgery
    • Surgery may also be an option for people with Meniere's disease, but it is usually done only for disabling vertigo


    To help reduce your chance of tinnitus:
    • Avoid exposure to excessively loud noise.
    • Wear earplugs in noisy situations.
    • Wear earmuffs when mowing the grass or using any other loud machinery.
    • Learn and practice stress management and relaxation techniques.
    • Limit use of medications that damage hearing.


    American Academy of Otolaryngology—Head and Neck Surgery http://www.entnet.org

    American Tinnitus Association http://www.ata.org


    The Canadian Hearing Society http://www.chs.ca

    Canadian Society of Otolaryngology—Head and Neck Surgery http://www.entcanada.org


    Acute otitis media (AOM). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 2, 2014. Accessed September 26, 2014.

    Conn HF, Rakel. Conn’s Current Therapy. 54th ed. Philadelphia, PA: WB Saunders Company; 2002.

    Goroll A, Mulley A. Primary Care Medicine. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2000.

    Tinnitus. American Academy of Otolaryngology—Head and Neck Surgery website. Available at: http://www.entnet.org/?q=node/1324. Updated December 2010. Accessed September 26, 2014.

    Tinnitus. American Speech-Language-Hearing Association website. Available at: http://www.asha.org/public/hearing/Tinnitus. Accessed September 26, 2014.

    Tinnitus. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116486/Tinnitus. Updated June 16, 2015. Accessed September 6, 2016.

    Understanding the facts. American Tinnitus Association website. Available at: http://www.ata.org/understanding-facts. Accessed September 26, 2014.

    10/16/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Baldo P, Doree C, Lazzarini R, Molin P, McFerran D. Antidepressants for patients with tinnitus. Cochrane Database Syst Rev. 2009;(4):CD003853.

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