Tinnitus

Causes

It is not known exactly what causes a person to "hear" sounds with no outside source of the noise. However, tinnitus can be a symptom of almost any ear problem, including:

• Ear infections
• Foreign objects or wax in the ear
• Hearing loss from loud noises
• Meniere disease -- an inner ear disorder that involves hearing loss and dizziness

Antibiotics, aspirin, or other drugs may also cause ear noises. Alcohol, caffeine, or smoking may worsen tinnitus if the person already has it.

Tinnitus may occur with hearing loss. Sometimes, it is a sign of high blood pressure, an allergy, or anemia. In rare cases, tinnitus is a sign of a serious problem such as a tumor or aneurysm.

Tinnitus is common in older adults from 65 to 74 years old.

Home Care

Tinnitus is often more noticeable when you go to bed at night because your surroundings are quieter. To mask tinnitus and make it less irritating, background noise using the following may help:

• White noise machine
• Running a humidifier or dishwasher

Home care of tinnitus mainly includes:

• Learning ways to relax. It is not known if stress causes tinnitus, but feeling stressed or anxious can worsen it.
• Avoiding things that may make tinnitus worse, such as caffeine, alcohol, and smoking.
• Getting enough rest. Try sleeping with your head propped up in an elevated position. This lessens head congestion and may make noises less noticeable.
• Protecting your ears and hearing from further damage. Avoid loud places and sounds. Wear ear protection, such as earplugs, if you need them.

When to Contact a Medical Professional

Call your health care provider if:

• Ear noises start after a head injury.
• The noises occur with other unexplained symptoms, like dizziness, feeling off balance, nausea, or vomiting.
• You have unexplained ear noises that bother you even after you try self-help measures.
• The noise is only in one ear and it continues for several weeks or longer.

What to Expect at Your Office Visit

The following tests may be done:

• Audiology/audiometry to test hearing loss
• Head CT scan
• Head MRI scan
• Blood vessel studies (angiography)

TREATMENT

Fixing the problem, if it can be found, may make your symptoms go away. (For example, your provider may remove ear wax.)

Talk to your provider about all your current medicines to see if a drug may be causing the problem. This may include over-the-counter drugs, vitamins, and supplements. Do not stop taking any medicine without talking to your provider.

Many medicines have been used to relieve symptoms of tinnitus, but no drug works for everyone.

A tinnitus masker worn like a hearing aid helps some people. It delivers low-level sound directly into the ear to cover the ear noise.

A hearing aid may help reduce ear noise and make outside sounds louder.

Counseling may help you learn to live with tinnitus. Your provider may suggest biofeedback training to help with stress.

Some people have tried alternative therapies to treat tinnitus. These methods have not been proven, so talk to your provider before trying them.

The American Tinnitus Association offers a good resource center and support group.

References

Bauer CA. Tinnitus and hyperacusis. In: Flint PW, Haughey BH, Lund V, et al, eds. Cummings Otolaryngology. 6th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 151.

Tunkel DE, Bauer CA, Sun GH, et al. Clinical practice guideline: tinnitus. Otolaryngol Head Neck Surg. 2014;151(2 Suppl):S1-S40. PMID: 25273878. www.ncbi.nlm.nih.gov/pubmed/25273878.