Tinnitus is when you experience ringing or other noises in one or both of your ears. The noise you hear when you have tinnitus isn’t caused by an external sound, in the sense that people around you can’t hear it. Tinnitus is a common problem. It affects about 15% to 20% of people and is especially common in older adults.

Tinnitus is usually caused by an underlying condition, such as age-related hearing loss, an ear injury, or a problem with the circulatory system. For many people, tinnitus improves with treatment of the underlying cause or with other treatments that reduce or mask the noise, making tinnitus less noticeable.

Symptoms

Tinnitus is most often described as a ringing in the ears, even though no external sound is present. However, tinnitus can also cause other types of phantom noises in your ears, including:

• Buzzing
• Roaring
• Clicking
• Hissing
• Humming

Most people who have tinnitus have subjective tinnitus or tinnitus that only they can hear. The noises of tinnitus may vary in pitch from a low roar to a high squeal, and you may hear it in one or both ears. In some cases, the sound can be so loud it interferes with your ability to concentrate or hear external sound. Tinnitus may be present all the time, or it may come and go.

In rare cases, tinnitus can occur as a rhythmic pulsing or whooshing sound, often in time with your heartbeat. This is called pulsatile tinnitus. If you have pulsatile tinnitus, your doctor may be able to hear your tinnitus when he or she does an examination (objective tinnitus).

When to see a doctor

Some people aren’t very bothered by tinnitus. For other people, tinnitus disrupts their daily lives. If you have tinnitus that bothers you, see your doctor.

Make an appointment to see your doctor if:

• You develop tinnitus after an upper respiratory infection, such as a cold, and your tinnitus doesn’t improve within a week.

See your doctor as soon as possible if:

• You have hearing loss or dizziness with tinnitus.
• You are experiencing anxiety or depression as a result of your tinnitus.

Causes

A number of health conditions can cause or worsen tinnitus. In many cases, an exact cause is never found.

Common causes of tinnitus:

In many people, tinnitus is caused by one or more of the following:

• Hearing loss – There are tiny, delicate hair cells in your inner ear (cochlea) that move when your ear receives sound waves. This movement triggers electrical signals along the nerve from your ear to your brain (auditory nerve). Your brain interprets these signals as sounds.

If the hairs inside your inner ear are bent or broken—this happens as you age or when you are regularly exposed to loud sounds—they can “leak” random electrical impulses to your brain, causing tinnitus.

• Ear infection or ear canal blockage – Your ear canals can become blocked with a build-up of fluid (ear infection), ear wax, dirt, or other foreign materials. A blockage can change the pressure in your ear, causing tinnitus.

• Head or neck injuries – Head or neck trauma can affect the inner ear, hearing nerves or brain function linked to hearing. Such injuries usually cause tinnitus in only one ear.

• Medications – A number of medications may cause or worsen tinnitus. Generally, the higher the dose of these medications, the worse tinnitus becomes. Often, the unwanted noise disappears when you stop using these drugs.

Medications are known to cause tinnitus include nonsteroidal anti-inflammatory drugs (NSAIDs) and certain antibiotics, cancer drugs, water pills (diuretics), antimalarial drugs, and antidepressants.

Other causes of tinnitus

Less common causes of tinnitus include other ear problems, chronic health conditions, and injuries or conditions that affect the nerves in your ear or the hearing centre in your brain.

• Meniere’s disease – Tinnitus can be an early indicator of Meniere’s disease, an inner ear disorder that may be caused by abnormal inner ear fluid pressure.
• Eustachian tube dysfunction – In this condition, the tube in your ear connecting the middle ear to your upper throat remains expanded all the time, which can make your ear feel full.
• Ear bone changes – Stiffening of the bones in your middle ear (otosclerosis) may affect your hearing and cause tinnitus. This condition, caused by abnormal bone growth, tends to run in families.
• Muscle spasms in the inner ear – Muscles in the inner ear can tense up (spasm), which can result in tinnitus, hearing loss, and a feeling of fullness in the ear. This sometimes happens for no explainable reason, but can also be caused by neurologic diseases, including multiple sclerosis.
• Temporomandibular joint (TMJ) disorders – Problems with the TMJ, the joint on each side of your head in front of your ears, where your lower jawbone meets your skull, can cause tinnitus.
• Acoustic neuroma or other head and neck tumours – An acoustic neuroma is a noncancerous (benign) tumour that develops on the cranial nerve that runs from your brain to your inner ear and controls balance and hearing. Other head, neck, or brain tumours can also cause tinnitus.
• Blood vessel disorders – Conditions that affect your blood vessels — such as atherosclerosis, high blood pressure, or kinked or malformed blood vessels — can cause blood to move through your veins and arteries with more force. These blood flow changes can cause tinnitus or make tinnitus more noticeable.
• Other chronic conditions – Conditions including diabetes, thyroid problems, migraines, anaemia, and autoimmune disorders such as rheumatoid arthritis and lupus have all been associated with tinnitus.

Less common causes of tinnitus include other ear problems, chronic health conditions, and injuries or conditions that affect the nerves in your ear or the hearing centre in your brain.

• Meniere’s disease – Tinnitus can be an early indicator of Meniere’s disease, an inner ear disorder that may be caused by abnormal inner ear fluid pressure.
• Eustachian tube dysfunction – In this condition, the tube in your ear connecting the middle ear to your upper throat remains expanded all the time, which can make your ear feel full.
• Ear bone changes – Stiffening of the bones in your middle ear (otosclerosis) may affect your hearing and cause tinnitus. This condition, caused by abnormal bone growth, tends to run in families.
• Muscle spasms in the inner ear – Muscles in the inner ear can tense up (spasm), which can result in tinnitus, hearing loss and a feeling of fullness in the ear. This sometimes happens for no explainable reason, but can also be caused by neurologic diseases, including multiple sclerosis.
• Temporomandibular joint (TMJ) disorders – Problems with the TMJ, the joint on each side of your head in front of your ears, where your lower jawbone meets your skull, can cause tinnitus.
• Acoustic neuroma or other head and neck tumours – Acoustic neuroma is a noncancerous (benign) tumour that develops on the cranial nerve that runs from your brain to your inner ear and controls balance and hearing. Other head, neck, or brain tumours can also cause tinnitus.
• Blood vessel disorders – Conditions that affect your blood vessels—such as atherosclerosis, high blood pressure, or kinked or malformed blood vessels—can cause blood to move through your veins and arteries with more force. These blood flow changes can cause tinnitus or make tinnitus more noticeable.
• Other chronic conditions – Conditions including diabetes, thyroid problems, migraines, anaemia, and autoimmune disorders such as rheumatoid arthritis and lupus have all been associated with tinnitus.

Risk factors

Anyone can experience tinnitus, but these factors may increase your risk:

• Loud noise exposure – Loud noises, such as those from heavy equipment, chain saws, and firearms, are common sources of noise-related hearing loss. Portable music devices, such as MP3 players, can also cause noise-related hearing loss if played loudly for long periods. People who work in noisy environments—such as factory and construction workers, musicians, and soldiers—are particularly at risk.

• Age – As you age, the number of functioning nerve fibres in your ears declines, possibly causing hearing problems often associated with tinnitus.

• Sex – Men are more likely to experience tinnitus.

• Tobacco and alcohol use – Smokers have a higher risk of developing tinnitus. Drinking alcohol also increases the risk of tinnitus.

• Certain health problems – Obesity, cardiovascular problems, high blood pressure, and a history of arthritis or head injury all increase your risk of tinnitus.

Complications

Tinnitus affects people differently. For some people, tinnitus can significantly affect their quality of life. If you have tinnitus, you may also experience:

• Fatigue
• Stress
• Sleep problems
• Trouble concentrating
• Memory problems
• Depression
• Anxiety and irritability
• Headaches
• Problems with work and family life

Treating these linked conditions may not affect tinnitus directly, but it can help you feel better.

Prevention

In many cases, tinnitus is the result of something that can’t be prevented. However, some precautions can help prevent certain kinds of tinnitus.

• Use hearing protection – Over time, exposure to loud sounds can damage the nerves in the ears, causing hearing loss and tinnitus. Try to limit your exposure to loud sounds. And if you can not avoid loud sounds, use ear protection to help protect your hearing. If you use chain saws, are a musician, work in an industry that uses loud machinery or use firearms (especially pistols or shotguns), always wear over-the-ear hearing protection.

• Turn down the volume – Long-term exposure to amplified music with no ear protection or listening to music at very high volume through headphones can cause hearing loss and tinnitus.

• Take care of your cardiovascular health – Regular exercise, eating right, and taking other steps to keep your blood vessels healthy can help prevent tinnitus linked to obesity and blood vessel disorders.

• Limit alcohol, caffeine and nicotine – These substances, especially when used in excess, can affect blood flow and contribute to tinnitus.

For further information, see 

https://www.mayoclinic.org/diseases-conditions/tinnitus/symptoms-causes/syc-20350156