Hearing Loss and Tinnitus Symptoms, Causes and Treatments
04 April 2019
What is Tinnitus and Can it Cause Deafness?
Tinnitus, often described as ringing in the ears, is very common among my patients. It may manifest as an intermittent or continuous sound in one or both ears. Its pitch can go from a low roar to a high squeal or whine. Prior to any treatment, it is important to undergo a thorough examination and evaluation by your ear specialist and audiologist. An essential part of the treatment will be your understanding of tinnitus and its causes.
What are the Common Causes of Tinnitus?
Tinnitus is commonly defined as the subjective perception of sound, like a persistent ringing in ears or buzzing in the ear, even in the absence of external sounds. It is not a disease but a symptom that can be caused by various issues within the hearing system. At times, it is easy to associate the symptom of tinnitus with specific problems affecting the hearing system, while at other times, the connection may be less clear.
Tinnitus may be caused by different parts of the hearing system. At times, for instance, it may be caused by excessive earwax, especially if the wax touches the eardrum, causing pressure and changing how the ear drum vibrates. Other times, loose hair from the ear canal may come in contact with the ear drum and cause tinnitus.
Middle ear problems can also cause tinnitus, such as a middle ear infection or the build up of new bony tissue around one of the middle ear bones which stiffens the middle ear transmission system (otosclerosis). Another cause of tinnitus from the middle ear may be muscle spasms of one of the two tiny muscles attached to middle ear bones. In this case, the tinnitus can be intermittent and at times, the examiner can also hear the patient’s sounds.
Most commonly, tinnitus originates in the inner ear. Damage and loss of the tiny sensory hair cells in the inner ear (that can be caused by different factors) may be commonly associated with the presence of tinnitus. This may be cause by viral infection and present as a common cold and followed by a sudden onset of tinnitus. Diabetes and neuropathies may also contribute to hearing loss with tinnitus. It is interesting to note that the pitch of the tinnitus often coincides with the area of the maximal hearing loss.
One of the preventable causes of tinnitus, is excessive noise exposure. In some instances of noise exposure, tinnitus is the first symptom before any noticeable hearing loss developes, so it should be considered a warning sign and an indication of the need for hearing protection in noisy environments. As we age, the incidence of tinnitus increases, often related to presbycusis, or hearing loss associated with ageing.
Tinnitus may also originate from conditions affecting the hearing nerve, such as benign tumors like acoustic neuroma (vestibular schwannoma). These are typically unilateral tinnitus and may be accompanied by hearing loss. Lesions near the auditory cortex, including whiplash injuries or benign tumors like meningiomas, can also cause tinnitus.
Tinnitus may also originate from lesions on or in the vicinity of the hearing portion of the brain, called the auditory cortex. These can be traumatic injuries with or without skull fracture, as well as whiplash-type injuries common in automobile accidents. Benign tumours known as meningiomas that originate from the tissue that protects the brain may also be a cause for tinnitus that originates from the brain.
There are also non-auditory conditions that can contribute to tinnitus. High blood pressure (hypertension), thyroid issues, and chronic brain syndromes can cause tinnitus without affecting the auditory system. Stress, fatigue, poor diet, and lack of exercise can exacerbate existing tinnitus or contribute to its development.
How is Tinnitus Treated?
An ear specialist can identify the specific cause of your tinnitus, and treatment may vary depending on the diagnosis. Testing, including imaging studies, audiological tests, and balance function tests, may be required. However, in many cases, pinpointing a specific cause is difficult, and treatment focuses on managing the condition.
For sensorineural hearing loss, tinnitus is often seen in cases of unilateral tinnitus. Prompt and adequate treatment can improve hearing, and often, this resolves the tinnitus as well.
Treatment of Sudden Sensorineural Hearing Loss
If sudden hearing loss occurs, an initial audiometry assessment will quantify the degree of hearing loss. The more severe the loss, the less likely full recovery will occur. Early intervention within the first week of onset provides the best outcomes. Steroid treatment is the most consistent therapy, with high-dose steroids being given either orally or through intratympanic delivery (direct injection into the cochlear). This method has fewer side effects than oral steroids and is preferred for patients with diabetes.
Vitamin B12 may also be given alongside steroids to aid in recovery.
Can children be at risk for tinnitus?
While tinnitus in children is relatively rare, it’s possible that many cases go underreported, especially in younger children who may not be able to express their symptoms. Among pre-teens and teens, high-intensity sound exposure, particularly through personal MP3 players or earbud-equipped electronic games, poses a significant risk. Parents should educate children about safe listening levels and monitor their use of devices to prevent tinnitus and hearing damage.
How to Manage Tinnitus When Medications Fail
- Avoid exposure to loud sounds and noises.
- Get your blood pressure checked. If it is high, get your doctor’s help to control it.
- Decrease your intake of salt. Salt impairs blood circulation.
- Avoid stimulants such as coffee, tea, cola, and tobacco.
- Exercise daily to improve your circulation.
- Get adequate rest and avoid fatigue.
- Stop worrying about the noise. Recognize your head noise as an annoyance and learn to ignore it as much as possible. It is part of you.
How to Cope with Tinnitus?
Concentration and relaxation exercises can help to control muscle groups and circulation throughout the body. The increased relaxation and circulation achieved by these exercises can reduce the intensity of tinnitus in some patients.
Tinnitus, or the condition of ringing in the ears, is usually more bothersome in quiet surroundings.
Masking tinnitus with a competing sound at a constant low level, such as a ticking clock or radio static (white noise), may make it less noticeable.
Hearing aids may reduce head noise while you are wearing them and sometimes cause the noise to go away temporarily. If you have a hearing loss, it is important not to set the hearing aid at excessively loud levels, as this can worsen the tinnitus in some cases. However, a thorough trial before purchase of a hearing aid is advisable if your primary purpose is the relief of tinnitus.
Tinnitus maskers can be combined within hearing aids. They emit a competitive but pleasant sound that can distract you from head noise. Some people find that a tinnitus masker may even suppress the head noise for several hours after it is used, but this is not true for all users.
This article was adopted from the America Academy of Otolaryngologist.
