What is Tinnitus or Ringing in Ear?

Tinnitus is the perception of sound in the ears or head not caused by an external sound source. Ringing and buzzing sounds may be heard in one or both ears or appear to be generally in the head region but can be variable and difficult to decide exactly where it seems to be.

Almost always, it is a totally subjective noise which only the person who has it can hear. On rare occasions, it can be heard by others as well; this is called objective tinnitus but is not associated with the effects of noise exposure. In fact, objective noises in the ears can have various causes, for example vascular diseases, vascular constrictions, cancer, muscle spasms or high blood pressure.

It’s not an illness or a disease in itself, but it is often a symptom of a problem with the ear or the hearing pathways to the brain. Usually, it occurs when the inner ear is damaged or impaired in some way. Some of the causes of are:

These are just a few of the most common causes, but it can also be a side-effect of medication or a result of other health concerns, such as high blood pressure. It is also commonly associated with age-related hearing loss, although it can affect anyone at any age.

Tinnitus symptoms

It is often described as a "ringing in the ears," but what people with this condition hear is extremely variable. Some people hear hissing, whooshing, roaring, vibrating, whistling or clicking. It can be intermittent or constant, single or multiple tones or more noise-like. Probably the most common description for noise-induced tinnitus is a high pitched tone or noise.

The volume or loudness is very individual and can range from very quiet to disturbingly loud. Although some people say that it comes and goes or as a tone that changes pitch through the day. For most it is a steady, unchanging noise every waking minute.

Key signs to recognise tinnitus Discover more

Tinnitus causes

The causes of tinnitus can be very diverse. Typical causes are excessive noise, excessive exposure and stress, high blood pressure, sudden hearing loss, ear diseases or impairment of the cervical spine. The most common causes of tinnitus are:

  • Permanently strong noise nuisance (concert, disco / night club, construction site, industry, hunting, shooting sports, etc.) 
  • Emotional conflicts and stress that can lead to tinnitus
  • Extreme situations such as excessive sport, great stress, pronounced fatigue or extreme cold
  • Hearing loss
  • Sudden hearing loss
  • High blood pressure, circulatory disorders
  • Diseases of the middle or inner ear, for example otitis media or Menière's disease
  • Tumors in the middle ear
  • Severe cold with runny nose and headache
  • Perforated eardrum 
  • Tension in the neck and in the cervical spine area
  • Malfunctions in the jaw area, for example teeth grinding and bruxism.

Does tinnitus cause hearing loss?

Tinnitus is not a disease itself or a cause of hearing loss. It is a symptom that something is wrong somewhere in the auditory system, which can include the cochlea of the inner ear, the auditory nerve and the areas of the brain that process sound. In about 90% of cases, it accompanies hearing loss and an individual can have both hearing loss and tinnitus from noise damage. However the two do not always occur together. It is possible to have no measurable hearing loss but suffer from the condition.

How many people have tinnitus?

About 90 percent of cases occur with an underlying hearing loss. The World Health Organisation (WHO) now lists tinnitus as a distinct disorder and states that noise exposure is a major cause of permanent hearing loss around the world.

Recent research confirms that it is the second most common form of hearing loss after age-related hearing loss.

The persistency of the condition is experienced by approximately 10% of the adult UK population. Prevalence increases with age but experiences of it are very common in all age groups, especially following exposure to loud noise. About half of those who live with the condition find it moderately or severely distressing with about 0.5% of adults in the UK (242,000 people) having a severe effect on the ability to lead a normal life.

About 8% of the population actively seek medical advice with approximately 750,000 primary care consultations in England each year. You may suffer debilitating symptoms such as anxiety, depression or sleep disturbances but only 2.5% attended hospital for this purpose.

It can be confusing and even frightening when it occurs for the first time, but it is rarely a symptom of a serious disorder. If it lasts for longer than a week, or if it is affecting your concentration, sleep or anxiety levels, book an appointment with your GP or with your local Amplifon Audiologist.

In some cases, the problem can be managed with relaxation exercises. There are also specialist hearing solutions available that can provide soothing tones to distract you from the noise of it.

Does tinnitus cause hearing loss?

Due to the fact that there is no cure, the goal of tinnitus treatments is to manage your perception of the sound. There are many treatments available that can help reduce the perceived intensity of tinnitus, as well as its omnipresence. Here are some remedies that may not be able to stop the perceived sound, but they can improve the overall quality of life: 

  • Hearing aids represent a good option for people suffering from both tinnitus and hearing loss at the same time.
  • Tinnitus maskers play with white, pink or natural noise providing a pleasant option to drown out the ringing (partially or completely).
  • Exercise can positively impact the overall well-being and therefore reducing all those factors that aggravate tinnitus, such as stress, depression and anxiety. 
  • Antidepressant and antianxiety drugs can be prescribed as medication for tinnitus. On one hand, they represent an effective treatment for insomnia. On the other hand, many studies confirm that they provide some relief for tinnitus suffers. 

For more information, visit The British Tinnitus Association who can support and authoritative information, much of it written by medical and audiology professionals or clinical researchers. Its support network can also put you in touch with other people who share similar experiences.

Tinnitus diagnosis: Is there a way to test tinnitus?

How to measure tinnitus?

Tinnitus is an ear disorder that manifests itself in the form of phantom noise that does not correspond to a real external sound source: patients hear sounds at different pitches and volumes, sometimes like a whistle or a buzz.

The causes of this disorder can directly affect the ear or depend on other external factors; some of the best-known causes are:

  • ear disorders (ear wax, ear infections, foreign bodies, hearing loss);
  • ménière's syndrome;
  • exposure to too loud sounds;
  • stress;
  • muscle contractures;
  • cardiovascular problems;
  • neurological damage

Tinnitus is not harmful from a clinical point of view. However, the constant sensation of disturbed noise over time affects the psyche of patients, hindering with the concentration throughout the day and makes sleeping difficult.

What is a tinnitus test?

If you are suffering from tinnitus, it is recommended that you contact your ENT and hearing care professional immediately. Depending on the type and severity of the disorder an individual treatment plan is prepared according to each patient.

A tinnitus test is performed to identify the type and severity of the disorder, the purpose of this examination is to establish the tonal range of tinnitus and its subjective intensity.

The test lasts just a few minutes, during which a couple of sounds in their accurate tones are played and the patient must compare them to his tinnitus until the frequency closest to the sound is identified correctly. Subsequently, the intensity of the tinnitus is measured. Furthermore, tinnitus can also determine and carry out:

  • the measurement of the timbre and if there is a difference between the right and the left ear;
  • loudness coupling, which consists in adapting the sound used during the test at a high frequency;
  • Minimum Masking Levels (MML) is used to determine the lowest level at which noise can mask tinnitus;
  • the residual inhibition test which takes place by adding 10 dB to the established frequency and sending a sound stimulation lasting one minute to the patient. After the stimulation is completed, the patient is asked what effect it had on the sounds he perceived due to the tinnitus.

Tinnitus Handicap Inventory Questionnaire

When it comes to tinnitus, it is essential to consider the impact that the disorder is having on the patient's psyche. The Tinnitus Handicap Inventory (THI) is used to understand this: it is a 24-question test that identifies the severity of tinnitus and the impact it is having on the daily life of those who suffer from it which helps in better understanding of how to treat tinnitus.

Online tinnitus test

You can take the tinnitus test online to check the ability to distinguish different words in a noisy environment. Although it is a practical and quick method of obtaining answers but it is always recommended to take all types of hearing tests with the help of a hearing care professional who will be able to effectively identify disorders and suggest correct therapies accordingly.

What is pulsatile tinnitus?

The occasional perception of one's heartbeat in the ear, better defined as pulsatile tinnitus, falls into the category of objective tinnitus, as it is actually produced by a sound source.

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