What is Tinnitus?

According to the Academy of Otolaryngology-Head & Neck Surgery, over 50 million Americans have experienced ringing in the ear, also known as tinnitus. Tinnitus is defined as the perception of sound without the presence of an external source. It is important to realize that tinnitus is not an illness itself but most commonly a normal, physiologic response to hearing loss of any degree. It can come in many forms but is most commonly described as a high pitched ringing, whooshing or humming that can be intermittent or constant in one or both ears.

Primary tinnitus is ringing without any identifiable cause other than hearing loss. It most often occurs secondary to due to reorganization of the primary area of the brain that deals with hearing, aka the primary auditory cortex. This occurs due to damage to the auditory system resulting in hearing loss. When hearing loss occurs, the auditory cortex in the brain is thought to be rearranged away from this damaged area and the rearrangement causes sound perceived as tinnitus.

Secondary tinnitus is ringing that is associated with a specific underlying problem that can be corrected. Common causes of secondary tinnitus include excessive ear wax and middle ear infection. Less common causes include Otosclerosis, where the tiny ear bones are hardened, or muscle spasms of one of two tiny muscles located in the middle ear.

Pulsatile Tinnitus

Sometimes tinnitus can be perceived as a rhythmic pulsing or whooshing in one of both ears that follows a steady beat. This is often caused by vascular abnormalities that range from normal variants to tumors in close approximation to the hearing system. Let your doctor know if your tinnitus fits this description as it may require work up with imaging studies to determine the cause and treatment.

 

What is the treatment for Tinnitus?

Treatment of tinnitus depends on its source. The first step is for your doctor to perform a detailed history and physical exam focusing on the auditory, vestibular and neurologic systems. Your doctor may perform a hearing test, known as an audiogram, to determine if there is any hearing loss that may not have been noticed during every day activity. There is typically no need for imaging (CT, MRI) studies unless tinnitus is one sided, pulsatile or if there are other abnormalities on exam.

Unfortunately, there is currently no “cure” for primary tinnitus. However, there are strategies that can help patients with the ringing.

  • If your doctor finds a specific cause for your tinnitus, there may be a treatment able to reverse it.
  • Some patients with tinnitus and hearing loss may benefit from hearing aids, with or without built-in maskers. Maskers emit a low level sound that works to dampen or “drown out” the tinnitus.
  • Sound therapy includes using background music or noise as maskers to partially or completely relieve the patients tinnitus

Routine prescription of medications including antidepressants, anticonvulsants, anxiolytics, or intratympanic injection of medications is not recommended for treating tinnitus without an underlying or associated medical problem that may benefit from such treatment.

Dietary supplements for tinnitus treatment are frequently advertised on the internet, television, and radio, but there is no definitive evidence that supplements such as ginkgo biloba, melatonin, zinc, Lipoflavonoid, and vitamin supplements are beneficial for tinnitus.



  1. American Academy of Otolaryngology – Head & Neck Surgery Health Foundation