What is ear-ringing or tinnitus?
Sounds in-ear come from time to time and we all have a unique experience of these unusual sensations. These sounds vary in their impressions and their frequencies ranging from buzzing, hissing, muffled hearing, and even ringing. These sounds also include popping or crackling in the ear. If you pour milk over a bowl of rice crispies, the noise coming out is similar to a crackling sound in the ear. Ringing or buzzing in the ears is termed tinnitus officially. Most people complain about these sounds like ringing in the ears. You may hear sounds more than ringing, you have tinnitus, you may also hear hissing or whistling or roaring, etc.
There is no external sound source although you hear different types of sounds. These tinnitus sounds are considered phantom sounds since there is no sound close to your head. This can be considered quite frustrating since the sounds you hear can be interfered with the unreal sounds. Anxiety, stress, or depression may contribute greatly to develop tinnitus. Tinnitus may occur in one or both ears. It’s more common in older people and adults although any age can experience it due to any underlying reason. Tinnitus may be either objective or subjective, in which you and other people equally share certain noises in your ears, or only you may hear the ringing, roaring, or other noises respectively. Abnormal blood vessels around or in your ears may cause objective tinnitus. It is very rare while subjective tinnitus is very common.
Causes of tinnitus:
The causes of earaches may range from irritation, infection, injury, or some referred pain, the pain that has some underlying origin of the pain that lies at a place other than the infected site. Sometimes pain in the jaws or teeth or head can be felt in the ear due to a vestibulocochlear pathway coinciding with the eighth cranial nerve providing information to the higher brain centers of the body. Other causes of earaches may include:
Inner or middle ear damage:
Any damage to the inner ear or middle ear is a common cause of tinnitus. The middle ear is meant to pick up sound waves approaching from the external ear in the normal frequency range and they are conducted towards the inner ear that prompts the inner ear to transmit electrical impulses to your brain. The neurons in the brain accept these signals and translate them into sounds that you become capable to hear. Inner ear damage alters the way your brain proceeds sound or middle ear parts as tiny bones or any damage to the eardrum may interfere with the proper conduction of sound. Ringing in the ears must be taken into serious consideration since sometimes it may be a cause of a tumor in the ear or auditory nerve.
A very common cause of ear ringing is an ear infection that may occur either in any one part of the ear or all parts depending upon the situation. The ear has anatomically three basic parts, the outer ear, middle ear, and inner ear, each part further subdivided into different bones and tissues.
- Outer Ear Infections: The pinna of the ear or lobe of the ear surrounds a very small hole that leads to the outer ear where infection can be caused by continuously using headphones, wearing hearing aids that may damage the ear canal from inside or swimming, or putting fingers or cotton swabs in the ear canal for long. Any irritation or scratch that may occur in the skin of the ear canal may lead to infection. The ear canal skin can be softened with continuous water and may create a favorite area for bacteria to develop.
- Middle Ear Infections: The middle ear consists of three bones and the middle ear infection may be caused by infections stemming from the respiratory tract. Bacteria can breed in the fluid buildup behind the eardrums causing certain infections.
- Inner Ear Infections: The inner ear disorder that is most commonly observes is labyrinthitis caused by bacterial or viral infections from respiratory illness.
Exposure to loud noise:
If you experience listening to loud noise regularly then it may sometimes cause tinnitus. Users of chainsaws, jackhammers, or other heavy equipment are more likely to face tinnitus. Regular use of headphones or listening to loud music at a concert may produce temporary symptoms of tinnitus.
Use of certain medications:
Hearing damage or tinnitus or ototoxicity may be caused by certain medications. These drugs include:
- Heavy dosing or than twelve doses per day or more prolonged use of aspirin.
- Loop diuretic medications such as bumetanide
- Choloroquine and other antimalarial drugs
- Certain type of antibiotics as gentamicin and erythromycin
- Vincristine and some other anti-cancer drugs.
Hereditary issue: A family history of ear tumor or ear infection may infect the next generation to suffer from the effects of chronic ear issues leading to either ototoxicity or earaches or ear ringing. It may pass on from parents to offsprings or in some cases to grandchildren too.
Long term stress: Long term stressful situation renders disturbed life pattern as a sleep disorder, digestive disorder, periodical disorder, vestibular disorder, etc. The vestibular disorder plays a role to create ear ringing and earaches.
Sleep disorders: A disorder of sleep that changes the balance and vestibular control of the body. Improper sleep patterns keep your brain disturbed creating pressure on the head and ears causing ear ringing.
Pregnancy: During pregnancy, all parts of the body become over-sensitive. Sometimes disturbed sleep patterns and disturbed vestibular control may cause temporary ear ringing that may vanish away after delivery.
Age-related hearing loss: During the aging process, all the parts of the body are towards decay and may cause loss of certain powers of the body including hearing loss.
Muscle spasms: Muscle spasms in the middle ear may cause hearing loss temporarily.
Meniere’s disease: An inner ear damage that may cause loss of hearing and balance known as Meniere’s disease that may sometimes cause serious damage to ears and cause ear tingling.
High blood pressure: The increased flow of blood and its pressure towards the ears may cause ear tingling, tinnitus, or loss of hearing in the long run.
High cholesterol: High level of cholesterol in the blood may cause tingling or loss of hearing.
Head and neck injuries: Any damage to the head or neck influencing the pressure of blood and its flow towards the arteries and veins of the neck may create ear tingling or hearing loss in severe cases.
Temporomandibular joint disorder: Mandibular area of the jaws and the temporal lobes of the brain on the right and left sides are interconnected through a joint called temporomandibular joint and any disease of the said may cause chronic pain in your head and jaws leading to hearing loss.
Abundant ear wax: Abundant amount of ear wax staying for long in the ears may become a reason for ear tingling or tinnitus.
Change in pressure: While flying on a plane or traveling towards a hilly area or a sudden flow through slope may create a change in pressure thus causing ear tingling.
Foreign object: Any foreign object in the ear may cause some damage and may become a reason for hearing loss or ear tingling.
Sore throat: Any disease of the throat causing pain in the throat or sore throat may cause sudden loss of hearing or ear tingling.
Sinus infection: Sinus infection rising from respiratory tract infections or cold sores may affect the ears and their sensation.
Perforated eardrum: Any damage or perforation in the eardrum may give rise to unlike sounds and tingling sensations.
Arthritis: Any inflammation in the joints may cause an effect on the temporomandibular joint too ultimately causing hearing defects.
Infected tooth: Infected tooth may lead to defective ear functions due to the direct link between ears and the mandibular region.
Eczema of the ear canal: Eczema or any infection of the ear canal may lead to ear tingling or hearing loss.
Trigeminal neuralgia: Chronic facial nerve pain may cause ear tingling.
Shampoo or water in the ear: Any drops of shampoo or water staying for long in the ear may cause temporary loss of hearing.
Symptoms of tinnitus:
The very first symptom of tinnitus appears to be loss of hearing with other problems. The most common signs and symptoms of tinnitus are:
- Loss of hearing: Loss of hearing may occur ranging from deafness for a minimum sound to maximum sound.
- Vertigo: Vertigo may last for twenty hours once it starts due to vestibular disturbance created by the loss of transmission in the vestibulocochlear nerve.
- Tinnitus: A sensation of ringing or tinnitus in the affected ear or both ears.
- Aural fullness: Feeling that ear is full or plugged, that is aural fullness appears.
- Loss of balance: Loss of balance may occur due to loss of water balance in the inner ear.
- Headaches: Headaches may occur as a sign and symptom of tinnitus.
- Sweating, nausea, vomit: Severe vertigo may cause sweating, vomiting, nausea.
Treatment options for tinnitus:
Tinnitus may occur abruptly, stay for long, may have certain solid reasons, or may sometimes be quite temporary with no underlying reasons. This all may be assessed by your doctor through physical examination or symptomatic appearance. Your physician might treat any underlying medical conditions causing tinnitus. He or she may address any vessel abnormalities or may remove excess ear wax considering it a reason for tinnitus. The doctor may switch your prescriptions to restore normal hearing inside your ear.
Drug therapy for treating tinnitus:
Certain drug therapies and classes of drugs are used to treat tinnitus or ear ringing sounds. Not everyone responds to the drug therapy and sometimes the side effects are quite bothersome making it hard work to do. These drug therapies include:
These drugs may lessen the ear sounds or their strength in some cases but they have remarkable side effects that limit the use of these therapies for patients as nausea, fatigue, constipation, and blurred vision. Rarely these medications may cause cardiac problems. Antidepressants and anti-anxiety drugs are often used for tinnitus. These include imipramine, clomipramine, desipramine, nortriptyline, and protriptyline.
At-home Treatment Strategies for tinnitus:
Relaxing noises may be imparted to suppress the noises by using noise-suppression machines which may help dull the buzzing, roaring, or ringing to mask your ear sounds. A masking device similar to a hearing aid may be used by inserting it in your ear.
You must change your lifestyle by managing to reduce stress levels. Stress may not cause tinnitus but it may worsen the state by the aggravation of the brain neurotransmitters that may create the tinnitus worsening. You may try to engage in a favorite hobby or talk with a friend or family member to reduce stress in your own life. You may lessen the severity of your tinnitus by avoiding exposure to loud noises.
You may use other hearing aids to make a benefit for the reduction of tinnitus for some people. You can reduce the trouble of hearing normal noises due to tinnitus by using sound amplification.
Hearing loss may be restored by using cochlear implants. The cochlear implant is a device that may help you listen more effectively by letting your brain bypass the damaged part. A microphone implanted over your ear works in coordination with the electrode set inserted into your inner ear. Electrical stimulation is used by cochlear implants to help your brain interpret sounds properly.
Hearing loss appears as the first symptom of tinnitus most often. Generally, after losing hearing capacity, certain changes occur in the brain creating a potential difference in the way that sound frequencies are changed. A small electronic device using a microphone, an amplifier, and a speaker to increase the volume of external noises is called a hearing aid. Neuroplastic changes in the brain can be mollified in the brain’s ability to process sound. According to an international report, roughly sixty percent of the people with tinnitus experience at least some relief with the use of a hearing aid.
Sound masking devices:
A pleasant or benign external noise is provided by certain sound-making devices that partially drown out the internal sounds of tinnitus. A traditional sound-making device may be a tabletop sound machine but the modern ones are small electronic devices that just fit into the ears. These devices may play white noise, nature noises, ambient sounds, music, or pink noise that may soothe your ears rather than make rough sounds or noise. Some people prefer external sound slightly louder than their tinnitus while others may prefer a masking sound that may completely drown out the ringing. Headphones, television, music, or even fan can be used by some people to help relax or fall asleep.
Customized or modified sound machines:
Specialized, modern medical-grade devices are preferred nowadays over standard masking devices with no long-lasting effects that may use customized sounds tailored specifically to your tinnitus. These devices may be worn intermittently unlike regular sound machines. The devices are beneficial long after even the device is turned off and overtime. Long-term improvement in the perceived loudness of your tinnitus may be experienced.
A high level of emotional stress may worsen tinnitus along with depression, anxiety, and insomnia. Some people may use cognitive behavioral therapy (CBT), a type of talk therapy that helps people with tinnitus learn to live with their condition. CBT teaches you how to accept loud sounds rather than to reduce them. The real goal is to prevent your personality from driving crazy with tinnitus and to improve your quality of life. A counselor or a therapist may involve in CBT, ideally once a week to identify and change negative thought patterns.
Progressive tinnitus management:
A therapeutic treatment program offered by the U.S. Department of Veteran Affairs is Progressive tinnitus management. One of the most common disabilities seen in the veterans of the armed services is tinnitus. The loud noises of war and training often lead to noise-induced hearing loss.
Treatment of obstructions and dysfunctions:
Occasionally tinnitus happens without hearing loss otherwise most cases of tinnitus are caused by hearing loss. Tinnitus may be caused by a problem with the temporomandibular joint or by irritation to the auditory system etc. A realignment of bite or a dental procedure may relieve your problem if the tinnitus is caused by temporomandibular joint disturbance. An examination of any obstruction by earwax or something else may be performed by the ENT specialist (ear, nose, throat specialist).
Regular exercise may contribute significantly to your overall well-being. Tinnitus is most of the time aggravated by depression, stress, illness, and lack of sleep. Regular exercise may help you to manage stress, sleep better, and stay healthier.
Mindfulness-based stress reduction (MBTSR):
Participants develop skills to control their attention through mindfulness training during an eight-week course. The mindful-based stress reduction program was designed to draw people’s attention away from their chronic pains but the program can be found equally effective for tinnitus. The program was developed due to similarities between tinnitus and chronic pains. Anxiety and depression are also reduced by the MBTSR program.
Meditation as DIY Mindfulness:
Meditation and breathing techniques can help you draw your focus away from tinnitus despite the MBTSR program. Practicing mindfulness in daily life is a DIY used to get rid of stress related to tinnitus by not getting enrolled in an eight-week program.
Several alternative treatments or complementary tinnitus treatment options including:
- Homeopathic remedies
- Acupuncture treatment
- Nutritional supplements
Although none of these treatments are supported by science and medicine, still many people are convinced that the herb Gingko Biloba is quite helpful as nutritional supplements like zinc, ginkgo, vitamin B-12 claiming to be tinnitus remedies.
How to stop ringing in your ears?
Although you cannot treat tinnitus immediately but still you can avoid certain things to avoid ringing in the ears. You may alleviate the noise pollution in your ears as well as any stress caused by the ringing.
Play relaxing sounds or white noise:
Soft and ambient noises may help you mask the ringing in your ears.
Distracting yourself with external sounds may help you divert your attention towards sounds other than your ears ringing. Either listen to a podcast or some quiet soft music. Try to avoid playing these sounds at maximum volume since it may damage your ears as attending a concert or some high musical show.
Use helpful relaxing methods like yoga and meditation. It may distract you from your tinnitus sounds.
Mas a precaution, use earplugs where you know that you will be exposed to loud sound.
Avoid any stimulants like caffeine, tea, or alcohol since it may cause blood flow to your inner ear causing the enhanced ringing.
How long does ringing last?
Temporary exposure to a certain source of sound may bring about temporary tinnitus. Ringing accompanied by a muffled sound may indicate noise-induced hearing loss that may cause distress in long term. These symptoms may last for sixteen to forty-eight hours and in some extreme cases may lead to a week or two. If you get exposed to such loud noise again then you may get ear ringing again. Sometimes such tinnitus may last for more than six months. This may lead to deafness or any other serious problem. Take steps to prevent long-term hearing loss by avoiding frequent visits to loud music concerts or musician functions etc.
Diagnostic tests for tinnitus or ear ringing:
Diagnosis of tinnitus may be done by your doctor or physician by conducting a hearing test. Sounds may be transmitted through a set of headphones to one ear at a time by your audiologist. You may make a gesture to raise your hand or nay such gesture to make a response when you hear such a sound. Your doctor may raise a statistical approach to find out about the difference of listening to sounds by you and other people of your age and gender. A magnetic resonance image (MRI) or a computed tomography scan (CT-scan) may be used to see any damages or deformities to your ears because standard film x-rays not always show blood vessel disorders, tumors, or other abnormalities that may affect your hearing.
The tests used to inspect the function of your inner ear are called balanced tests. Electro-nystagmography may be used to test the function of the inner ear by depicting that the affected ear may have a reduced balanced response. Electrodes are placed around your eyes to detect eye movement since the balance in the inner ear may cause balance responses in the eye movements. Both hot and cold water is pushed into the ear during this test. Water causes your balance function to work and track the involuntary eye movement. Any abnormalities may indicate a problem with the inner ear.
The rotary chair test is used very less often. It will be used to differentiate whether the problem is due to an issue in the brain or an issue in the ear. It is used in addition to the ENG testing since the ENG test may be incorrect if you have ear damage or if wax has been blocking one of your ear canals. Your eye movement is carefully recorded while the chair moves during this test.
Vestibular-evoked myogenic potential (VEMP):
The vestibular evoked myogenic potential is a test that measures the sound sensitivity of the vestibule of the inner ear. The vestibule of the inner ear determines the balance of the body along with hearing through a vestibulocochlear nerve.
The posturography test helps to determine the functioning of all parts of your balance system. Your body may react to various balance challenges while wearing a standing barefoot and a safety harness.
Prevention of tinnitus:
At the first step, you always must avoid any exposure to loud noises and unbearable sounds for a long time since they may cause permanent damage to the ears involving creating deafness too. You may prevent the occurrence of tinnitus by following certain measures:
- The volume of household things: Keep an eye on the volume levels of radio, personal music player, and television so that you and people around you are not in the loud noise for long.
- Wear ear protection: Try to wear ear protection around noises louder than eighty-five decibels, a level associated with average heavy traffic noise.
- Cover your ears: If you don’t have earplugs or earphones then cover your ears with your hands or something else while passing through any construction area or other loud noise area so that you don’t let any loud noise trigger your soft tissues to get injured to cause ear ringing.
- Avoid unnecessary medications: Avoid any unnecessary medication that may prompt ear ringing or tinnitus by long-term use disturbing your normal physiology.
- Avoid riding and traveling: Avoid heavy bike exposure and loud noises of buses or horns near heavy busy streets to avoid any unnecessary loud noise pollution thus avoiding ear ringing or any other ear-related problems.
- Alcohol and stimulating food: Avoid such food stat may stimulate the action potential and flow of blood towards the brain thus activating the nerves unnecessarily rising any earaches or ear ringing.
Should I see a doctor and when?
Since there is no cure for tinnitus so there is ongoing research for the condition. Medical professionals are trying to find a solution for the long-term stress issue that may come up with tinnitus. You must make an appointment with a doctor if the tinnitus symptoms last for more than a week. If the ringing accompanies dizziness or hearing loss then you must visit a doctor as soon as possible.
Pulsatile tinnitus-a type of tinnitus:
Blood circulating in or near your ears may cause pulsatile tinnitus. It is a type of tinnitus that most occasionally has a physical source of sound that your ears pick up. It may be an amplified sound of blood circulating through your arteries and veins. Other kinds of tinnitus hear ringing or buzzing that your nerves pick up on abnormal electric signals movement from your ears to your brain.
Symptoms of pulsatile tinnitus:
The sound that may match your heartbeat or pulse but is listened to as a sound in your ears is called pulsatile tinnitus.
Pulsating sounds: You may even be able to take your pulse while you are hearing the sound in your ears.
Lightheadedness: You may have feelings of lightheadedness.
Palpitations: You may also notice heart palpitations
Chest pain: If you experience sudden chest pain or heartache, you must visit your doctor immediately.
Causes of pulsatile tinnitus:
Although there may be many reasons and causes of pulsatile tinnitus, all of them stem from circulation issues. The most common reasons found may be:
Hypertension or high blood pressure: The force of blood against the inner walls of your arteries increases when your blood pressure rises certain value. More forceful blood flow in the arteries in or around the ears becomes easier for your ears to detect.
Atherosclerosis: Building up of fats, waste, cholesterol or other materials in the arteries may cause blockage of these arteries creating turbulence in the flow of blood. If such is the case, then you may hear a rhythmic noise in one of your ears.
Turbulent blood flow: Carotid arteries or jugular veins are the possible narrowed neck arteries that may also cause a change in blood flow to and from the head. Your ears may pick up on this turbulent or irregular circulation, causing pulsatile tinnitus.
Neck or head tumors: Sometimes a tumor grown up more than a certain limit may cause pressure against a vein also may cause pulsatile tinnitus.
Abnormal capillaries: Any problem with tiny blood vessels that help connect your arteries to your veins can cause pulsatile tinnitus.
Diagnostic tests for pulsatile tinnitus or ear ringing:
If you are experiencing pulsatile tinnitus symptoms then you must make an immediate appointment with your doctor. A review of your symptoms and medical history may start your medical exam. A doctor or physician may use a stethoscope to listen to your chest, neck, and skull for any pulsating or throbbing movement. If your doctor can also hear a pulsatile noise then you may have objective pulsatile tinnitus. If the doctor is unable to hear any noise and still you are complaining about the pulsatile noise then it is called subjective pulsatile tinnitus.
Other tests required to determine whether there may have been a loss of hearing in one or both ears will be recommended by the doctor. Your doctor may order:
- An ultrasound
- A magnetic resonance imaging
- A computed tomography (CT Scan)
- An angiography
Any test for anemia or thyroid disease or other tests for the high blood pressure may also be done. If during initial screening you are found to be a patient of pulsatile tinnitus, then you may be referred to a cardiologist (heart specialist) for an exam and screenings for possible circulation problems or high blood pressure.
Can there be any complications with pulsatile tinnitus?
Pulsatile tinnitus may cause several complications with that may include:
- Poor sleep
- Difficulty concentration
- Low energy
- Cardiovascular problems
- Metabolic issues
- Weight gain
Treatment of pulsatile tinnitus?
Underlying causes must be addressed to treat the pulsatile tinnitus. Conditions of high blood pressure and thrombosis etc. may usually be treated with a combination of lifestyle changes and medications including:
- Regular exercise: Exercise may help to lower down the cholesterol level, high blood pressure maintaining a specific value for each of the body’s metabolic functions.
- A low-sodium diet: A diet low in sodium content may help to reduce blood pressure and may exert a lower pressure on your kidneys for the filtration and purification of your blood
- No smoking: Smoking may exert pressure on the lungs and respiratory system creating bronchoconstriction and nicotinic dependence on a cigarette for the long term.
- Stress reduction: Stress may not cause pulsatile tinnitus but it may worsen the condition by exerting stress induction on all arteries and veins giving hard time managing the intensity and severity of pulsatile tinnitus.
- A catheter procedure or surgery: If the cause of pulsatile tinnitus is a specific problem in an artery or vein then a surgical procedure or a catheter procedure may be needed to treat the condition.
- Stent application: A flexible mesh tube called a stent may be placed in the blocked artery to open it up and improve the blood flow.
- Sound therapy: Sound therapy may be used if the blood vessel cannot be treated. It may involve playing background music or noise as soft music or white noise to distract yourself from the tinnitus or change your brain’s sensitivity to the pitch of the tinnitus.
- Cognitive behavior therapy: A form of talk therapy that is designed to change the perspective of every aspect of your mind and to change the way you think about a problem to change your emotional reaction and the way you behave towards it.