Tinnitus

Tinnitus is a ringing or similar sound in the ear.


Causes/associated factors
Tinnitus is a symptom, rather than a disease. The exact physiology behind ringing in the ear isn't yet understood, but hearing loss is often associated with tinnitus. It may also be related to a variety of other factors, including:
obstruction of the external ear canal (sometimes due to wax buildup or a foreign body) or the eustachian tube (the tubes connecting the middle ear to the back of the nose and throat)
tumors of the middle or inner ear
otosclerosis (a disorder caused by an abnormal growth of spongy bone at the entrance to the inner ear)
infectious conditions, such as:

otitis externa (inflammation of the outer ear canal)
otitis media (an infection of the middle ear)
myringitis (inflammation of the eardrum)
labyrinthitis (inflammation of the bony structures and membranes within the inner ear that contain the receptors for hearing and equilibrium)
petrositis (an infection of part of the temporal bone, a bone on both sides of the skull at its base)
syphilis (a sexually transmitted disease; if left untreated, syphilis can cause serious mental, visual or heart problems)
meningitis (inflammation of the membranes surrounding the brain or spinal cord)

vascular disease (any disease involving the blood vessels, veins or arteries)
cardiovascular disease, such as:

high blood pressure
arteriosclerosis (a disease in which arteries lose elasticity, harden and narrow, resulting in coronary heart disease)
aneurysm (a weakness in a blood vessel wall, usually an artery)

central nervous system or muscular disorders, such as multiple sclerosis or stroke
Ménière's disease (an inner ear complication that produces severe attacks of dizziness, nausea, vomiting, hearing loss and tinnitus)
physical conditions such as neck arthritis or temporomandibular disorders (TMD, a group of musculoskeletal conditions that limit jaw movement and cause pain in the jaw joint and surrounding muscles
acoustic trauma (exposure to a violent sound, such as a horn blast) or head trauma, such as an injury involving a blow to the head or ear
barotrauma (physical injury or damage to the ear as a result of an imbalance in pressure between the air outside and inside the middle ear)
hypothyroidism (underactive thyroid)
the use of certain medications, including aminoglycoside antibiotics, some diuretics and high doses of salicylates (products that contain aspirin)
exposure to carbon monoxide, heavy metals or alcohol
anemia (a condition marked by a decreased number of red blood cells or hemoglobin, a protein in red blood cells that contains iron)
stress, depression or anxiety

Signs/symptoms
The sound heard is a subjective experience. It's been described as a ringing, buzzing, roaring, whistling or hissing sound. It may be constant, intermittent or associated with a feeling of pulsation that may coincide with your heartbeat. Occasionally, tinnitus leads to sleep deprivation, anxiety and depression. (Ironically, tinnitus can both originate from and contribute to depression and anxiety.) In severe cases, the disturbance from tinnitus may even lead to thoughts of suicide.

Diagnosis
Your doctor may recommend testing to determine possible causes of tinnitus because it's a symptom and not a disease itself. Testing may involve:
audiological assessment, which may include lab work and specialized hearing tests with an audiologist
computed tomography (CT scan, a computer-generated, cross- sectional picture of internal body parts) of the area surrounding the temporal bone
magnetic resonance imaging (MRI, an imaging technique based on computer analysis of the body's response to a magnetic field) of the head
When a feeling of pulsation exists, a cerebral angiography (an imaging technique of the brain that allows the study of blood vessels through injection of contrast dye) may be done to rule out an obstruction in an artery, an aneurysm (a weakness in a blood vessel wall) and vascular neoplasm (new or abnormal tissue formation in the blood vessels, veins or arteries that serves no useful function).


Treatment
Ideally, treatment focuses on the cause of the ringing sensation. For example, if tinnitus is related to high doses of products containing aspirin, decreasing the dosage may be effective. When a cause isn't identified, it's often helpful to play background music to mask the ringing or sleep with a radio playing. Managing stress is also important. In some cases, hearing aids help tone down the tinnitus. For people who don't need hearing aids, a device called a tinnitus masker can be worn like a hearing aid to mask the tinnitus with a more pleasant sound.

Pregnancy-specific information
If you experience tinnitus during pregnancy, consult your doctor. Certain diagnostic tests wouldn't be recommended during pregnancy.

Senior-specific information
Tinnitus may accompany certain disorders that are more common in older adults, such as cardiovascular disease.

Prevention
Most causes of tinnitus don't have a clear explanation, which makes prevention difficult. If you choose to take aspirin, take the lowest dose possible. Avoid situations that may put you at risk for an ear injury. It may also help to avoid stimulants such as nicotine and caffeine.