Tinnitus is the perception of sound when no external source of sound is present. It is often described as a 'ringing in the ears' and the word originates in Latin and simply means ringing. It is a symptom rather than a disease and has many causes. It's effects can range from unnoticed to devastating. The commonest cause of tinnitus is noise-induced hearing loss. This can be prevented by avoiding loud and prolonged noises through avoidance and wearing a pair of fitted earplugs from http://zenplugs.com/molded-earplugs/.
Noise-induced hearing loss is most likely to occur after prolonged exposure to excessively loud noise. It can happen after even brief episodes. It can be temporary or permanent. Most people have noticed a ringing in their ears and slight deafness after being to close to speakers in a bar, a gun going off or a balloon or bag bursting. People who are regularly exposed to loud noises for prolonged periods should wear earplugs on a regular basis. This includes construction workers, musicians and people who use guns for sport.
Prolonged and repeated earplug use can result in otitis externa, infection of the ear canal. This can lead to otitis media, infection of the middle ear; a cause of tinnitus in itself. Antibacterial earplugs may help reduce the chance of earplug-associated otitis externa. ZenPlugs earplugs contain a silver-based antibacterial compound. This is non-toxic and lasts longer than the plastic itself.
Other causes of tinnitus include allergic rhinitis (hay fever) and coryza (blocked/runny nose). Other causes include the common cold, foreign body (e.g. bead in ear) and aging. It can also happen as a side effect of wax in the ear and ear syringing; a treatment used to remove the wax. This has led to ear syringing being carried out less commonly. It is far safer to put a few drops of warm olive oil in the affected ear, or to buy ear wax removal drops from the chemist.
Tinnitus is common, affecting around 20% of people aged between 55 and 65, (1). The nature of the sound perceived varies as widely as the nature of sound itself. Ringing, whooshing, hissing, constant tones, white noise and human sounds have all been described. It can be intermittent or continuous and is often more noticeable in the absence of ambient noise. It is often associated with hearing loss, as in Meniere's Disease.
Perception of sounds similar to the nature of the tinnitus may be particularly affected. This has led to the idea that the problem may be the effect of the brain trying to make up for hearing loss by exaggerating sound in the affected range (2). Tinnitus is a recognized side effect of some drugs, including aspirin. Rarely tinnitus may be caused by a neurological condition such as the Chiari malformation, MS or after a head-injury.
The effects of tinnitus include; irritability, fatigue, depression and insomnia (3). It is likely that the effect of tinnitus, like any irritation in one's life, is made worse by your psychological state. If you are already depressed, tense or anxious, you will notice your tinnitus more. You are likely to respond in a more negative way that if you are happy, relaxed and well rested. Joining a tinnitus forum can help
Occasionally a medical professional may find objective evidence of tinnitus. This is when the sound can be heard by someone other than the affected person. This may be due to altered blood flow from atherosclerosis in the arteries of the neck. It causes turbulence ('bruit', French for noise). Muscle spasm or jaw joint (temporo-mandibular joint) problems can cause clicks and creaks. Alternatively the sound amplification structures in the inner ear may be vibrating and creating a sound. This is known as an oto-acoustic emission.
Tinnitus is usually subjective, with no sound heard whilst standing next to the affected individual. A possible cause of this is the death of hair cells, sensory structures in the inner ear, by listening to loud music. This affects the negative-feedback loop which controls the adjustment of the volume of the sound you perceive. There is evidence that tinnitus can be caused by over-activity of neurons in the brainstem. This is the more primitive part of your brain at the bottom which joins the spinal cord (4).
The diagnosis is made by playing sounds which are matched to the nature of the tinnitus. When a sound is masked by the tinnitus, it matches it's nature. The intensity can be found by increasing the volume of the matched sound until it becomes perceptible. At this point it is louder than the tinnitus itself.
In summary, tinnitus is a term used to describe a wide range of symptoms. It is most simply described as the perception of sound when no external sound source is present. The effects may range from barely noticeable to devastating. The causes are poorly understood but those recognised are broad in type. They include aging, infection, neurological problems and foreign bodies in the ear, although often no cause is found.
This article is not intended for use as medical advice. Please consult your doctor if any of these issues affect you.
Dr Toby Bateson
1) B-ENT. 2007;3 Suppl 7:37-49, 'Prevalence of Tinnitus and Audiometric Shape', Demeester K et al.
2) Schaette R, Kempter R. (2006). "Development of tinnitus-related neuronal hyperactivity through homeostatic plasticity after hearing loss: a computational model".
3) Berrios, G E; Rose, G S (1992). "Psychiatry of subjective tinnitus: conceptual, historical and clinical aspects". Neurology, Psychiatry and Brain Research 1: 76-82.
4) Nicolas-Puel C, Faulconbridge RL, Guitton M, Puel JL, Mondain M, Uziel A (2002). "Characteristics of tinnitus and etiology of associated hearing loss: a study of 123 patients". The international tinnitus journal 8 (1): 37-44.