Ringing In The Ears
Ringing in the ears (also called tinnitus) refers to a sound that usually only the affected person can hear. The sound is not coming from the environment. Instead it seems to be coming from the person's body or from the ear itself. Other noises, such as buzzing or roaring, may also be heard.
What is going on in the body?
Ringing in the ears is a common problem, especially in elderly individuals. The ringing or other sound may be constant, or it may come and go. Usually, the ringing is not caused by serious problems and does not interfere with activities. In rare cases, ringing in the ears can be a sign of a serious condition, or a side effect of a medication, indicating that the medicine needs to be stopped or changed.
What are the causes and risks of the symptom?
Ringing or other noises heard in the ears can have many causes, including:
abnormal blood flow around the ear, due to a cerebral aneurysm or malformed blood vessel in the brain
age-related hearing loss, with up to 25% of people over the age of 60 experiencing occasional high-pitched ringing in their ears
anxiety or depression
damage to the ear from chronic noise exposure, such as damage from working near loud machines daily, which leads to occupational hearing loss
damage to the ear from noise that occurs suddenly, for example, an explosion
damage to the hearing area of the brain, caused by a stroke, multiple sclerosis, or other conditions
damage to the hearing nerves, as a result of trauma, a brain tumor, or other conditions
ear wax build-up
excess caffeine intake
infections in the ear, such as chronic otitis media or labyrinthitis
medications, such as aspirin, the heart medicine known as quinidine (i.e., Cardioquin, Quinaglute Dura-Tabs), carbamazepine (i.e., Epitol, Tegretol), a medication used to treat seizures, and antibiotics known as aminoglycosides
Meniere's disease, a condition that also causes severe vertigo, or a spinning sensation
otosclerosis, a condition in which the tiny hearing bones in the inner ear cannot move properly
There are other possible causes of ringing in the ears. Sometimes the cause cannot be found.
What can be done to prevent the symptom?
Prevention of ringing in the ears is related to the cause. Avoiding loud noises and high doses of aspirin can prevent some cases. A person on aminoglycoside antibiotics may need to have the blood level of the medication checked to avoid overdose, which can be a cause of tinnitus. Most cases cannot be prevented.
How is the symptom diagnosed?
The healthcare professionals can try to help the person figure out the cause of the ringing. In some cases, the diagnosis is obvious to the professional from the medical history and physical exam. In other cases, further testing is needed. Various tests are ordered, depending on the suspected cause. For example, a cranial CT scan may be done if a stroke or brain tumor is suspected. Hearing tests, such as an audiogram, may be done if age-related hearing loss or noise damage are suspected.
Long Term Effects
What are the long-term effects of the symptom?
Long-term effects of ringing in the ears depend on the cause. Ringing in the ears caused by age-related hearing loss has no long-term effects besides hearing loss. The hearing loss is usually mild and is rarely bothersome. If the cause is a brain tumor, death may occur. Strokes may paralysis and speech impairments.
What are the risks to others?
Ringing in the ears is not contagious and by itself poses no risks to others. If the cause is an ear infection, especially otitis media, the infection may be contagious.
What are the treatments for the symptom?
Treatment is directed at the cause. Age-related hearing loss may be treated with a hearing aid. This often covers up the ringing by amplifying normal sounds. Someone with a brain tumor may need surgery or radiation therapy. People with Meniere's disease may need medications to reduce symptoms. People with ear infections such as chronic otitis media often need antibiotics. If a medication is causing ringing in the ears, the medication may be stopped.
Recent research has shown that cognitive behavioral therapy is highly effective in reducing the distress caused by ringing in the ears. This type of therapy helps an individual with ringing in the ears see that negative thoughts about the ear problem can affect his or her mood. The therapist helps the individual changes his or her thoughts to a more positive outlook.
What are the side effects of the treatments?
Antibiotics and other medications used to treat ringing in the ears can cause allergic reactions or stomach upset. Surgery can be complicated by bleeding, infection, or reactions to anesthesia.
What happens after treatment for the symptom?
Some cases of ringing in the ears may be cured. Ringing caused by otitis media usually goes away after the infection clears up. Other cases last a long time, with or without treatment, such as ringing caused by a brain tumor or stroke.
How is the symptom monitored?
People can monitor their ringing and tell their healthcare professionals about any changes or response to treatment. Other monitoring depends on the cause. For example, people with depression may need regular counseling and monitoring of their moods. Any new or worsening symptoms should be reported to the healthcare professional.
Cecil Textbook of Medicine, 1996, Bennett et al. Harrison's Principles of Internal Medicine, 1998, Fauci et al.