Ringing in the Ears Diagnosis

  • Diagnosis

    Ringing in the ears, or tinnitus, is a condition in which people hear constant or periodic sound not caused by an outside source. The sound can also be described as a ringing, buzzing, or clicking noise that occurs inside the head. Ringing in the ears can be heard in one or both ears, and in the head, and its pitch may be low or high.

    Almost everyone has had a form of ringing in the ears where ringing is heard for several minutes, such as after a firecracker explodes. While this ringing usually goes away in a few minutes or a few hours, it may come back as persistent ringing in the ears years later. Of the 30 to 36 million Americans who have ringing in the ears, seven million cases are so severe that those affected have difficulty performing the activities of daily life. However, most cases of tinnitus are mild.

    Tinnitus is usually a symptom of another physical or psychological problem. It can be a symptom of ear conditions, such as infections or foreign objects or wax in the ear, heart disease, chronic stress, or persistent allergies. Additionally, it may represent a side effect from certain medicines (such as aspirin) or be a manifestation of excessive caffeine, nicotine, or alcohol intake.

    Tinnitus is also linked to hearing loss, although not everyone who has tinnitus experiences a loss of hearing.

    The mechanism that causes tinnitus is not known. Younger people tend to have tinnitus as a result of exposure to loud noise. Older people who experience tinnitus often have a certain amount of hearing impairment related to the natural aging process.

    Currently, there is no cure for tinnitus. Tinnitus is usually treated by addressing the underlying cause. Because it cannot be cured, treatments are offered to help the patient tolerate the noise.

    Exposure to a loud noise may predispose people to tinnitus Table 01. Long exposure to loud noise may cause people to hear sounds that do not exist in the external environment. Loud noises that contribute to tinnitus may be from a rock concert, a firecracker, a gunshot, a lawnmower, or an explosion. The sound may be either a single exposure (such as an explosion) or a continuous one (such as working in a woodworking shop or at a construction site) that damages the hair cells and nerves in the ear.

    Existing physical conditions, such as ear infections or allergies, may cause tinnitus. Ear conditions such as wax build-up, infection, or a hole in the eardrum, as well as heart conditions, allergies, tumors, and injury to the head or neck can cause tinnitus, although researchers still do not understand why. Because tinnitus may be the first sign of a serious illness (for example, a tumor or aneurysm), it is important to discover the underlying physical condition that may be causing it.

    Tinnitus may be a side effect of certain medications or alcohol. Tinnitus may be a side effect of drugs, including alcohol, aspirin, sedatives, antibiotics, antidepressants, stimulants, or anti-inflammatories. When tinnitus occurs as a drug side effect, it may cease when you stop taking the medication; however, it sometimes persists.

    Table 1.  Causes of Tinnitus

    Environmental noise Physical conditions Drugs
    Construction machinery Allergies Alcohol
    Power tools Anxiety/stress Antidepressants
    Lawn mowers Diabetes Anti-inflammatories
    Woodworking tools Ear conditions (ear wax, hole in eardrums) Aspirin
    Explosions Heart disease Sedatives
    Firecrackers Injury to head or neck Stimulants (e.g., coffee, tea, cola, tobacco)
    Gunshots Thyroid condition ?
    Rock concerts/ loud musical events Tumor ?

    People with tinnitus suffer from hearing noise inside their head. The noise sounds like a ringing, buzzing, clicking, blowing, hissing, whistling, roaring, or pulsating sound. The sound may be constant or may come and go, and can affect one or both ears.

    Sometimes, hearing loss accompanies tinnitus. Tinnitus is a symptom of some people who have hearing loss; however, not everyone with tinnitus has hearing loss or will develop a loss of hearing.

    If you are exposed to either prolonged or intermittent loud noise, you may be predisposed to tinnitus. Although no one really knows what causes tinnitus, people who have been exposed to loud noises often develop symptoms of tinnitus. According to some experts, 90% of those with tinnitus have some degree of noise-induced hearing loss. While expert opinion differs on the exact noise level at which hearing loss occurs, it’s safe to say that prolonged exposure to noises louder than 85 decibels will cause hearing loss. For reference, normal conversation is around 60 decibels, city traffic noise is 80 decibels, and a hair dryer gives off 90 decibels.

    If you have a medical condition such as heart disease, ear or sinus infection, thyroid disorders, head or neck trauma, or head tumors, you may be predisposed to tinnitus. Tinnitus can be caused by a variety of medical conditions that vary in severity from wax buildup in the ear to tumors and heart disease. Certain medications, such as some antibiotics (neomycin, streptomycin, and viomycin), indomethacin (an anti-inflammatory taken for rheumatoid arthritis), and quinine (taken to prevent malaria), may also activate tinnitus symptoms.

    If you hear sounds such as ringing in your ears, you may have tinnitus. Your doctor will do tests to see if the noise you hear is related to an underlying medical condition. He or she may also refer you to a specialist for a more detailed examination of your ears. The sounds you hear may vary in pitch and sound like ringing, hissing, roaring, whistling, or buzzing. The sounds may be continuous or periodic. While a diagnosis of tinnitus is based on your own subjective experience, your doctor will do an exam and order tests to see if the sound is related to an underlying problem such as high blood pressure, kidney disorders, diet, or allergies.

    Doctors who specialize in the ears and hearing will further evaluate your hearing Figure 01. Your doctor may refer you to an ear, nose, and throat doctor (otolaryngologist), who can do a more detailed exam to find out what is causing your tinnitus. Either the otolaryngologist or another specialist — an audiologist — will do a comprehensive hearing assessment. If indicated, the doctor will try to determine whether your tinnitus is associated with your inner ear or the acoustic nerve. This is important because unilateral hearing loss damage may indicate the presence of a tumor.

    Click to enlarge: Anatomy of the ear

    Figure 01. Anatomy of the ear

    Hearing a pulsing, throbbing sound may be a sign of heart disease. If you hear a pulsing sound, you may have pulsatile tinnitus, in which case your doctor may order an angiogram. An angiogram is a type of x-ray taken after a special dye is injected into your blood vessels. These x-rays allow the doctor to check for blockage in your arteries, aneurysms (a weak spot in a vein or artery that balloons out and may burst), or small tumors in your veins.

    Special imaging tests, such as an MRI or a CT scan, allow the doctor to see the structure of your head, brain, and ears.

    Avoid exposure to loud noises and wear earplugs when you cannot avoid loud noises. Cotton balls do not provide adequate protection and may become lodged in your ear canal. A variety of affordable and comfortable ear protection devices are available today. Over-the-counter earplugs can be purchased at most drugstores and certain sporting goods stores. They range from the conventional foam variety to rubber, silicone, and wax. Besides being easy to find, easy to wear, and disposable, they provide important help in reducing the dangers of exposure to excessive levels of noise.

    Exposure to loud noise on a continuous or one-time basis causes symptoms of tinnitus and/or hearing loss. Some loud noises are worse than others and are more important to avoid Table 02. Specialists think that exposure to noise louder than 110 decibels (the noise from a snowmobile is 120 decibels) for more than one minute will result in permanent hearing loss. Prolonged exposure to noise of 90 decibels (the sound of a lawn mower) will result in gradual hearing loss. Very loud noises, such as that of a firing range or an airport runway, require special ear protection. Speak to your doctor about having special ear plugs made if you're exposed to very loud noises on a regular basis.

    Table 2.  Decibel Comparison of Common Noises

    Noise Decibel (loudest possible: 196 dB)
    Normal conversation at three to five feet 60 to 70 dB
    City traffic inside car 85 dB
    Train whistle at 500 feet 90 dB
    Subway train at 200 feet 95 dB
    Power mower 107 dB
    Jet engine at 100 feet 140 dB
    Normal piano practice 60 to 70 dB
    Average walkman volume setting 95 dB
    Symphonic music peak 120 to 137 dB
    Rock music amplified at four to six feet 120 dB
    Rock music peak 150 dB

    Data from a study by Marshall Chasin , M.Sc., Aud(C), FAAA, Center for Human Performance & Health Promotion, Ontario, Canada.

  • Prevention and Screening

    Avoid exposure to loud noises and wear earplugs when you cannot avoid loud noises. Cotton balls do not provide adequate protection and may become lodged in your ear canal. A variety of affordable and comfortable ear protection devices are available today. Over-the-counter earplugs can be purchased at most drugstores and certain sporting goods stores. They range from the conventional foam variety to rubber, silicone, and wax. Besides being easy to find, easy to wear, and disposable, they provide important help in reducing the dangers of exposure to excessive levels of noise.

    Exposure to loud noise on a continuous or one-time basis causes symptoms of tinnitus and/or hearing loss. Some loud noises are worse than others and are more important to avoid Table 02. Specialists think that exposure to noise louder than 110 decibels (the noise from a snowmobile is 120 decibels) for more than one minute will result in permanent hearing loss. Prolonged exposure to noise of 90 decibels (the sound of a lawn mower) will result in gradual hearing loss. Very loud noises, such as that of a firing range or an airport runway, require special ear protection. Speak to your doctor about having special ear plugs made if you're exposed to very loud noises on a regular basis.

    Table 2.  Decibel Comparison of Common Noises

    Noise Decibel (loudest possible: 196 dB)
    Normal conversation at three to five feet 60 to 70 dB
    City traffic inside car 85 dB
    Train whistle at 500 feet 90 dB
    Subway train at 200 feet 95 dB
    Power mower 107 dB
    Jet engine at 100 feet 140 dB
    Normal piano practice 60 to 70 dB
    Average walkman volume setting 95 dB
    Symphonic music peak 120 to 137 dB
    Rock music amplified at four to six feet 120 dB
    Rock music peak 150 dB

    Data from a study by Marshall Chasin , M.Sc., Aud(C), FAAA, Center for Human Performance & Health Promotion, Ontario, Canada.

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