Tinnitus is the presence of a sound in one or both of your ears that is not caused by an external source. To put it into context, it is a ‘phantom’ sound that generally cannot be heard by others, due to which reason it is said to be subjective.

In rare cases, the noise that is heard might be rhythmically associated with one’s heartbeat, making it possible to be detected through a stethoscope. These cases are referred to as pulsatile tinnitus, and are said to be objective.

Tinnitus affects about 15-20% of the global population, and is more common among older adults.

Symptoms

Tinnitus is often described as a ‘ringing in the ears’ as this is the most common form of manifestation. However, tinnitus may also occur in the form of humming, buzzing, clicking, hissing, pulsing, whooshing, squealing, whistling, roaring. Some patients also claim to hear sounds like music.

This noise might be continuous, or may fluctuate, sometimes varying in intensity as well. The condition might be felt more obviously when there is less or no background noise, such as when going to sleep at night.

Complications

Some people with tinnitus may be more sensitive to sound, a condition referred to as hyperacusis. This could lead to much discomfort, as well as require measures to be taken to mask or muffle even normal levels of noise.

Chronic tinnitus that a patient finds challenging to deal with could also subsequently lead to conditions such as irritability, anxiety and depression.

Causes

Although a definitive cause for tinnitus has not been determined, it is often usually associated with one of the following circumstances:

• exposure to noise – This could be long-term exposure to loud noises such as at the workplace (e.g. airport tarmac staff, pilots, carpenters, military), or even short-term exposure to loud noises such as at concerts, sporting events, etc.
• hearing loss – This could be the result of aging, or even exposure to noise.
• ear wax or fluid – Build-up of ear wax, or fluid from an ear infection could cause blockage of the ear canal.
• head/neck injury – Injury to the head and/or neck region could cause damage to ear structures, the nerve carrying sound signals to the brain, or parts of the brain associated with processing sound.
• medication – Sometimes, certain NSAIDs, antibiotics, antidepressants, anti-cancer drugs and anti-malaria drugs can trigger tinnitus, specially at higher doses.

Less commonly, tinnitus may also be associated with:

• ear problems, such as Meniere’s disease (inner ear fluid pressure disorder), ear muscle spasms, ear bone changes, eustachian tube (tube connecting middle ear to upper throat) dysfunction
• temporomandibular joint (TMJ) disorder
• tumours, such as acoustic neuroma (benign tumour in the cranial nerve), head and neck tumours
• blood vessel disorders, such as high blood pressure, atherosclerosis
• chronic conditions such as diabetes, thyroid dysfunction, anaemia, migraines, autoimmune disorders (e.g. lupus, rheumatoid arthritis), cardiovascular disease, circulation problems, traumatic injuries to the head/neck region

Diagnosis

Your GP would generally give you a diagnosis of tinnitus based on the symptoms that you describe. The clearer your description of the noise and its occurrence, the better the chance of determining what underlying factors may or may not be associated with its incidence. A GP might conduct a few basic examinations such as checking your ears for wax or fluid and inquire about your lifestyle / work background, after which they might refer you to an otolaryngologist (or ear, nose, throat – ENT – specialist).

An ENT specialist would carry out further examination of your ears and head/neck region, and might check for any effect of body movements on the intensity of tinnitus. They might also carry out an audiological (hearing) test. Based on your condition, further laboratory testing (e.g. for thyroid or cardiac conditions, anaemia, vitamin deficiencies) and/or scans (MRI or CT – to determine any structural problems) might be recommended.

Prevention

Preventive measures for tinnitus are in fact preventive measures against underlying conditions that might be associated with the incidence of tinnitus. As such, these include:

• avoiding exposure to loud noises, long-term and short-term
• wearing protective gear (e.g. ear muffles) if your line of work involves exposure to loud or prolonged noises
• avoiding listening to music at high volume
• avoiding activities that pose a higher risk of injury, particularly to the head/neck region
• maintaining a healthy lifestyle that would benefit your cardiac, circulatory, mental and overall health

Treatment

Treatment for tinnitus is still largely in the research stage. The principal approach is to address any underlying condition that might be associated with the incidence of tinnitus in an individual.

While there is no definite treatment for the condition itself, some doctors may suggest:

• the use of a hearing aid, in the case of impaired hearing
• sound therapy, mostly targeting tinnitus brought about by neural changes
• cognitive behavioural therapy, to improve one’s well-being
• counselling, to help deal with the emotional and psychological impacts of tinnitus

In addition, medication or supplements might be prescribed to help deal with anxiety, depression, mood and lack of sleep which may manifest as side effects of the condition.

Cover illustration from Brain and Life Magazine