Why do my ears ring?
What is tinnitus?
Tinnitus is when you experience a sound in your ears or head with no external source. You hear it, but other people can’t. It is often described as a ringing, buzzing, humming, roaring, clicking, whistling, or hissing sound. The noise can have different volume and pitches. It can come and go, or may be constant. Tinnitus can affect one or both ears, or can be perceived as a sound inside your head.
Most people experience tinnitus from time to time. If it is chronic, frequent, or constant, tinnitus can be very frustrating and impact your quality of life. Tinnitus can cause concentration difficulties, sleep disturbance, anxiety, stress, mood changes, fatigue, and sound intolerance. Tinnitus and its associated symptoms can be quite disabling.
What causes tinnitus?
Tinnitus is often associated with dysfunction in your auditory system - the ear and brain pathways responsible for hearing.
Tinnitus is often caused by hearing loss. This hearing loss may be age related - this comes on gradually as we get older and causes loss in the higher frequencies. Hearing loss can also be noise induced - when exposure to loud noise damages the hair cells in your inner ear. Most tinnitus is related to sensorineural hearing loss.
Tinnitus can also be a result of inner ear disorders that affect hearing like Meniere’s Disease, labyrinthitis, or vestibular schwannoma.
When it is due to hearing loss, tinnitus is “phantom sound”. Hearing loss is often caused by damage or deterioration in the hair cells in our cochlea. If the hair cells are damaged and no longer able to send signals to the brain, this causes our brain to “turn up the volume” on the hearing pathways in an effort to detect these signals. Your brain attempts to compensate for the missing input. This causes electrical noise in the pathways, often perceived as high pitched tinnitus if the hearing loss is in the high frequencies, and low pitched tinnitus if the loss affects the lower frequencies of hearing.
Other causes of tinnitus
Tinnitus can also be caused by something blocking your ear canal like excess cerumen (too much ear wax), or by sinus congestion affecting your eustachian tube.
Neck muscle tension or temporomandibular (jaw) joint dysfunction can also cause “somatic tinnitus”. It is thought that problems in the jaw joints or neck may cause altered somatosensory information to be sent to the brain, which may alter perception of tinnitus. Some people may find that jaw clenching or certain neck movements/positions will alter the pitch or intensity of their tinnitus.
Tinnitus is a common symptom after concussion. This could be due to effects on hearing related pathways in the brain, or related to associated neck problems.
In rare circumstances, tinnitus can be a side effect of medications like benzodiazepines and tricyclic antidepressants, or can be a side effect of taking Aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) at high doses or for long periods of time. There are some medications that are ototoxic and can cause hearing loss, tinnitus, and vertigo such as aminoglycosides antibiotics (e.g. gentamicin, tobramycin) and loop diuretics (e.g. furosemide).
Pulsatile tinnitus is when you experience a rhythmic sound, often a whooshing or thumping, which may be in time with your heartbeat. Pulsatile tinnitus can be caused by many conditions including atherosclerosis, hypertension, glomus tumours, idiopathic intracranial hypertension, and superior semicircular canal dehiscence.
How is tinnitus evaluated?
Tinnitus is usually evaluated by an audiologist or an ENT physician. They will do a physical assessment, and will look in your ears with an otoscope. You will typically be sent for a hearing test and tympanometry (a test of middle ear and ear drum function). Depending on the results of your hearing test, you might be sent for additional evaluations or MRI imaging. If you also have vestibular symptoms like vertigo, dizziness, or imbalance, you may also be sent for vestibular function tests.
Tinnitus treatment
Treatment of tinnitus is usually with an audiologist and can include:
Hearing aids & tinnitus masking devices
Recommendations for competing background noise or sound generators
Relaxation and mindfulness-based techniques
Distraction techniques
Tinnitus retraining therapy, progressive tinnitus management, or sound therapy
Understanding your tinnitus and what helps you manage it better
Your doctor may also prescribe SSRI or SNRI medications. If tinnitus interferes with sleep, your doctor may prescribe medications or supplements to help with sleep.
Counseling, cognitive behavioural therapy (CBT), and/or acceptance and commitment therapy (ACT) may also help.
Physiotherapy may help if your jaw joints or neck contribute to tinnitus. Vestibular rehabilitation physiotherapy can help if you have vestibular symptoms like dizziness or balance problems associated with your tinnitus.
How can I prevent tinnitus?
The most common cause of tinnitus is hearing loss. Protecting your hearing may help prevent you from developing noise induced hearing loss and tinnitus. Wearing appropriate ear plugs or ear muffs in loud environments can reduce your noise exposure and decrease your risk.
