Health Topic Categories

- Ears -

June 9th, 2015


Ringing in the Ears

What It Is?

Ringing in the ears is technically known as tinnitus, which is the perception of sound in the ears or the head in the absence of any outside sounds.  Although the word comes from the Latin tinnire, “to ring,” it can also be a buzzing, roaring, or static sound.

 

Population

A proportion of 10-15% of the US population is estimated to experience tinnitus according to a US Government Survey of 2012.  Incidence increases with age, male sex, exposure to loud noise, and hearing loss.

 

Causes

Tinnitus is sometimes associated with medical conditions such as high blood pressure or with states of increased blood flow such as anemia, overactive thyroid, or pregnancy. 

 

Occasionally, the cause is an anatomic process within the head or neck. This could be as simple as impacted ear wax. But it could be as serious as a carotid artery problem or tumor.  Indicators of this type of seriousness are tinnitus that changes with heartbeat or tinnitus that is one-sided.  These should be immediately evaluated by a physician.

 

Medications have been known to cause tinnitus.  Some of these are nonsteroidal anti-inflammatory drugs, especially high dose aspirin; diuretics such as ethacrynic acid, furosemide, and bumetanide; chemotherapeutic agents, especially the platinum agents; quinine based medications and herbals; some blood pressure medications; and, some antibiotics.  Medication-induced tinnitus may be permanent or reversible.

 

Frequently, the cause of the tinnitus is never identified.  In this case the more reasonable expectation is that the condition be managed rather than eliminated.

 

Treatment

If the tinnitus results from a medical condition, then that underlying medical condition can be treated and the resulting tinnitus may resolve.

 

If the tinnitus results from a medication, then the medication can be switched and, again, the resulting tinnitus may resolve.

 

Anatomic tinnitus can be treated with simple procedures or with various surgeries.  Again, this can produce resolution or improvement.

 

The remaining cases are more difficult to treat.  

 

Niacin is an old remedy for tinnitus.  If patients can tolerate the flush it produces, they frequently report some relief.

 

Melatonin 3 mg at bedtime may not directly affect the tinnitus, but it can help with the insomnia that tinnitus can help cause.

 

Nortriptyline 50 mg at bedtime can be helpful if it is taken for at least three weeks and patients can tolerate any resulting dry mouth. 

 

Paroxetine 10 mg at night or sertraline 50 mg daily has also been reported helpful. 

 

Otherwise, masking the tinnitus with low-level white noise is a method that has been used for over half a century.  The devices resemble hearing aids and are worn during the day.  Of those referred for such devices, about one-sixth eventually wear the device and report some benefit.  For patients troubled mostly at night, a bedside radio may suffice.  Masking tinnitus during the night often has some residual effect the following day.

 

Relaxation training doesn’t directly reduce the tinnitus but may reduce the distress caused by it.

 

Repetitive transcranial magnetic stimulation stimulates the brain through the intact scalp and seems to induce changes in the brain’s excitability that persist beyond the period of stimulation.  There are reports of its effectiveness in treating tinnitus.

 

Hearing aids have also been used in the treatment of tinnitus.  The best way to determine if a hearing aid will help is through a trial.  Hearing aids seem helpful in about half of cases.

 

Conclusion

Tinnitus can be a complex problem.  Frequently there is no simple solution that works perfectly or for everyone. Nevertheless, tinnitus can be treated. Dedicated patients and understanding physicians together can often find a way to manage the problem.

 

Thomas Falasca, DO

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