Tinnitus: Types, Causes, Symptoms, & Diagnosis

by Meenakshi Nagdeve last updated -

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Tinnitus or ringing in the ear is not a disease by itself, but an indication of underlying conditions which may need attention.

What is Tinnitus?

Tinnitus is a condition characterized by the perception of annoying sound inside human ears without the external presence of any actual sound. It means ‘ringing’ in Latin, tinnitus is more of a noisy feeling in the ear, somewhat like humming, buzzing, whistling, or hissing. The sound sensation caused by the condition may be periodical or persistent at all times. The ringing in the ear sensation may be low-pitched or high-pitched and may be felt in one or both the ears. It may be associated with the ear but its real source dwells in the network of brain cells.

A young woman suffering from tinnitus covering her ears with her hands

Types

Tinnitus is generally categorized into two kinds as mentioned below:

  • Objective tinnitus: Usually the person suffering from tinnitus only can feel such sounds. However, in some rare cases, it can also be heard by people around. This type of tinnitus is described as ‘objective tinnitus’ which can be detected by an observer, either by being in close vicinity to the patient’s ear or with the help of a stethoscope pressed around the neck and head area. It is generally related to muscular or vascular malady and accounts for not more than 5 percent of the total cases. It is commonly described as ‘pulsatile tinnitus’ in which the associated noise may be felt beating in sync with the person’s pulse.
  • Subjective tinnitus: ‘Subjective tinnitus’ is a more common type. In this, the associated sound can only be sensed by the sufferer. It is most frequently felt in the general ear disorders which are caused as a consequence of a damaged nerve or hair cell.

Causes

Afflictions like a common cold or being in and around areas with loud noises for a long time such as a musical concert may result in temporary tinnitus which is not a serious concern. Other major causes have been discussed below:

  • Damage to the inner ear: Inner ear damage is the most common reason behind the occurrence of tinnitus. Usually, the sounds which we hear, travel from the outer ear via middle ear and finally reach the inner ear. The inner ear consists of a cochlea, a coiled tube consisting of numerous sensitive hair cells and auditory nerves which convey the sounds to the brain. When the cochlea gets partly damaged, some parts of the brain stop receiving information. These parts of the brain vigorously look out for signals from the functioning part of the cochlea resulting in the imbalance in neural circuits and lead to the noise associated with this condition.
  • Old age: In older people, tinnitus is usually the primary indication of the natural age-related hearing loss. It generally leads to a weakened sensitivity of their hearing nerves.
  • Noise-induced: Individuals who work in environments prone to constant noise for a prolonged duration such as construction sites, musical concerts, or noisy factories and industries, may also eventually develop the condition of tinnitus. The persistent exposures to loud noise harm the delicate sensory hair cells present in the inner ear and interfere in the process of sending sound signals to the brain. People in defense forces such as soldiers who are in the vicinity of loud bomb blasts are also at an enhanced risk of developing such hearing loss due to the damage caused in the sound processing brain tissues. Such conditions are referred to as noise-induced hearing loss.
  • Pulsatile tinnitus: In this kind of tinnitus, rhythmic noises beat along with the patient’s pulse. Causes of ‘pulsatile tinnitus’ include amplified turbulence or altered flow of blood in the neck or head area. This could be due to the buildup of fatty deposits within the artery walls resulting in narrowed arteries which obstruct the smooth flow of blood and cause tinnitus. Brain tumors or deformity in the constitution of the brain may also be the reason behind the occurrence of these sounds.
  • Medication side-effect: The problem of tinnitus may also crop up as a side effect of some medications including antidepressants, cancer medicines, sedatives, anti-inflammatory drugs like ibuprofen and aspirin.

Apart from these, tinnitus may also be caused as a consequence of a range of health conditions such as:

  • high or low blood pressure
  • ear and sinus infection
  • hormonal changes in women
  • abnormality in the functioning of the thyroid gland
  • heart disease
  • otitis media or middle ear infection
  • blockage of the ear canal caused by earwax
  • otosclerosis, a condition characterized by the abnormal growth of bone in the middle ear
  • Meniere’s disease
  • Paget’s disease
  • punctured or perforated eardrum
  • a decrease in the number of red blood cells causing the thinning of blood and rapid circulation

Symptoms

Tinnitus itself is a kind of symptom signaling some disturbance in the auditory system. It may have varied effects on different people with symptoms ranging from mild to severe.

  • Sensitivity to sound: Some people may feel enhanced sensitivity towards music, radio, or television and find it disturbingly loud even if it is at normal volumes. This situation is referred to as hyperacusis. Individuals suffering from prolonged tinnitus and hearing loss may experience musical hallucinations.
  • Worsening at night or in silence: The condition normally gets worse during silent periods such as during the night or when they are trying to sleep. During such period, the sound becomes more noticeable as there is little or no outside noise to divert you from the internal ringing sound.
  • Certain physical positions: Some people may also hear a noise when they get into specific postures like while turning their head or lying down.
  • Low-frequency sounds: People who are in continuous exposure to low-frequency sounds such as traffic noise, underground machinery or pipes, common home appliances such as mixer-grinder or fans, often mistakenly presume the sound to be coming from outside rather than being internally produced from their ears or head.

The intensity of this condition broadly depends upon a person’s response towards the condition. Many individuals find difficulty in sleeping, may feel anxious and depressed, unable to concentrate on their routine tasks. Some of the patients might also suffer from hearing loss. However, tinnitus itself does not signal that the patient is losing the hearing ability.

Diagnosis of Tinnitus

For a proper diagnosis of tinnitus, your doctor will perform several examinations. These will mostly include audiological tests and some simple questions pertaining to your health.

Hearing Test

In this test, you will be required to sit in a soundproof room with headphones on. There, the sound will be played in one of your ears at a time, and on the basis of when you hear the sound, your condition will be evaluated or diagnosed.

The above test will then be followed by a number of questions, such as:

  • How frequently is the disturbance experienced?
  • Is the ringing in the ear constant?
  • Are there any other symptoms like vertigo, hearing loss, etc.?
  • Is the problem impacting your daily life?
  • Does it affect only one ear or both?
  • Are there any high doses of medications that you’re on, like antibiotics or aspirin?

Your doctor will also check your ears inside out for any ear wax build-up that might be causing the buzzing or whistling sound. They can also perform a blood test for any underlying condition like diabetes or anemia that might be causing the problem. Other tests include imaging tests like CT or MRI scans.

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About the Author

Meenakshi Nagdeve is a health and wellness enthusiast and started working on Organic Facts since 2012 and is currently responsible for managing it. She follows naturopathy and believes in healing with foods. She has completed the Nutrition And Healthy Living Cornell Certificate Program, Cornell University. She holds a Post Graduate Diploma in Management from IIM Bangalore and B. Tech in Metallurgical Engineering and Materials Science from IIT Bombay. Prior to this, she worked for a few years in IT and Financial services. In her free time, she loves to travel and taste different types of teas.

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