Ringing in the ears (tinnitus)

Anyone who has been to a loud concert or exposed to very loud machine noise has sometimes experienced whistling, humming or a high-pitched buzzing sound in their ears afterwards. It usually goes away on its own. These kinds of sounds in the ear are also called tinnitus aurium or tinnitus, for short. They can have many different causes and are only very rarely a sign of a serious medical condition. Sometimes people develop tinnitus quite suddenly and for no known reason such as noise – but then it usually doesn’t last for more than a minute.

In some people, the sounds in the ear continue over a longer period of time. If tinnitus lasts longer than three months, it is considered to be chronic.

Most people with tinnitus only have mild symptoms. Although the ringing in the ears is annoying, people can learn to live with it. Yet sometimes it’s so bad that their everyday lives and quality of life are severely affected. Severe tinnitus can lead many people to feel constant stress and it makes it hard to concentrate and sleep properly.

The word tinnitus comes from Latin and means “ringing”. People with tinnitus can indeed hear a ringing in their ears. But they also hear sounds like whistling, buzzing, humming, hissing, clicking or knocking. Tinnitus may be present in only one or in both ears. Some people say it feels like the sound is coming from inside their head, whereas others say it sounds like it is coming from outside. Tinnitus may be constant or it may come and go. It is also sometimes very quiet and then really loud again.

Most people with tinnitus have normal hearing otherwise. Tinnitus can be, but isn’t necessarily, associated with hearing loss.

Tinnitus is very often caused by loud sounds that damage the sensory cells of the cochlea in the inner ear. Most of those affected have spent a lot of time in loud places or had what is known as an acoustic trauma. This is when your ears are briefly exposed to an extremely loud noise, such as an explosion or nearby gunshots.

Other possible causes of tinnitus include:

• a blocked ear (auditory) canal due to a build-up of ear wax
• a chronic middle ear infection
• a ruptured (perforated) eardrum
• otosclerosis: a bone disease in the middle ear and inner ear that can lead to hearing loss
• Ménière’s disease: a disease of the inner ear, causing symptoms such as tinnitus, vertigo and hearing loss
• problems affecting the muscles or joint of the jaw

Some medication can also cause ringing in the ears, for example very high doses of the pain medication acetylsalicylic acid (ASA). Therefore it is important to pay attention to the correct dosage of medication.

For many people, though, no cause of tinnitus can be found. Doctors call this type of tinnitus “primary” or “idiopathic” tinnitus, after the Greek words “idios” and “pathos”.

It is not completely clear how and why hearing damage caused by loud sounds can lead to tinnitus. According to one of several theories, the damaged or irritated sensory cells in the cochlea can no longer send signals to the brain. The nerve cells in the brain’s center of hearing become more active and produce “phantom sounds” anyway. This is similar to how phantom pain develops following amputation.

It is also debated whether tinnitus can be caused by stress. But there isn’t a clear link. So far, relaxation techniques haven’t been shown to have a direct impact on tinnitus.

Tinnitus is quite common: around 5 to 15% of all adults experience a longer-lasting episode of tinnitus at some point in their lives. In about 10% to 20% of people who have tinnitus, the symptoms are so bad that they have a considerable impact on quality of life, and treatment is needed.

Tinnitus is most common in people over the age of 50, but in rare cases it can also affect children.

Nobody can predict the exact course of tinnitus. If the cause is known and treatable, it may soon go away again. If it isn’t clear what is causing the tinnitus, it may continue and become chronic. Some people’s hearing becomes more sensitive too, which can be unpleasant in loud places (hyperacusis).

Chronic tinnitus can affect quality of life and lead to problems with sleep and concentration. If it gets very bad, some people may withdraw socially and go out less. This can sometimes even lead to depression or contribute to its development.

The problems and trouble caused by chronic tinnitus may also improve over the years.

It is generally always a good idea for people to protect themselves from noise and sounds that are too loud. Places with a lot of loud noise should be either avoided or visited only with protection like earplugs, for instance. This lowers the risk of developing tinnitus in the first place, or of existing tinnitus becoming chronic.

In order to diagnose tinnitus, the doctor first asks about the symptoms: what sounds the person hears exactly, in what situations they hear them, and whether they are accompanied by other symptoms such as earache or a feeling of pressure in the ear.

In primary (idiopathic) tinnitus, i.e. tinnitus with no identifiable cause, both ears are usually affected. If the sounds are only heard in one ear and are accompanied by other symptoms such as earache, the tinnitus is likely to have a specific cause which is usually treatable.

To diagnose tinnitus, the talk with the doctor is usually followed by an ear examination and a hearing test. It may be a good idea for the person to have a dental examination to rule out any problems with their jaw.

Based on the outcomes of the doctor’s examination, he or she will determine which type of tinnitus the person has. Doctors distinguish between the following types of tinnitus:

• Subjective and objective tinnitus: subjective tinnitus can only be heard or perceived by the person who has it. Possible causes include problems with the auditory (hearing) system or the nerves that belong to it. In objective tinnitus, which is very rare, it can be caused by pulsing noises from a narrowed blood vessel, for instance. The doctor can also hear the sounds with their stethoscope.
• Primary and secondary tinnitus: if no clear cause can be found, it is referred to as primary or idiopathic tinnitus. If there is an identifiable cause, it is known as secondary tinnitus. Possible causes include a perforated eardrum or a vascular (blood vessel) disease.
• Acute and chronic tinnitus: if the sounds last longer than three months, it is considered to be chronic tinnitus.
• Various levels of severity: tinnitus can be mild and hardly affect people’s everyday life, or only occur from time to time but then be distressing when it does. Sounds that are constantly and clearly heard are more serious. They can have a big impact on people’s daily lives and work, for instance because it is hard to sleep or concentrate properly.

The treatment options for tinnitus will depend on the cause. If there is a specific underlying condition, this is then treated – for instance with medication to lower blood pressure. If treatment of the condition causing it is successful, the tinnitus will usually go away.

However, it is harder to treat tinnitus if the cause is unknown. The main aim of treatment is then to reduce the symptoms and find ways to cope well in everyday life despite having tinnitus. If the tinnitus is associated with hearing loss, a hearing aid might be considered.

A wide variety of products are available for the treatment of tinnitus, including herbal products, dietary supplements and various medications such as steroids or carbamazepine. None of these treatments have been proven to help. And some may have side effects.

The best-studied treatment is cognitive behavioral therapy (CBT), in which sufferers learn how to cope better with chronic tinnitus. Although this doesn’t make the sounds go away, it can lead to an improvement in quality of life.

If tinnitus arises suddenly, doctors often suggest immediate treatment with an infusion (a drip), for instance with a saline (salt) solution – particularly if the tinnitus is associated with sudden hearing loss. Sometimes people are given an infusion with hydroxyethyl starch (HES) instead. But no studies have shown that infusions with this drug help. On the contrary, HES can trigger severe allergic reactions, with itching all over the body. 

For more detailed information, such as which treatments help with tinnitus and which don’t, visit gesundheitsinformation.de.