Tinnitus: Causes, Symptoms, Risk Factors, Diagnosis, Treatment, Prevention and Complications

Tinnitus is when you hear noises, like ringing, in one or both of your ears. The noise you hear when you have tinnitus is usually inaudible to other people and isn't caused by ambient noise. Tinnitus is a common problem. It affects 15% to 20% of persons, with older adults being more prone to have it.

Tinnitus can be made less noticeable for many people by treating the underlying cause of the condition or by utilising alternative therapies that mask or reduce noise.

Causes Of Tinnitus

Tinnitus can be brought on or made worse by various health issues. It is frequently not possible to pinpoint the exact cause.

Typical tinnitus causes

One of the following is commonly responsible for tinnitus:

• Hearing loss: The cochlea in your inner ear responds to sound waves by moving its tiny, fragile hair cells. Along the auditory nerve, which connects your ear to your brain, this movement generates electrical signals. For your brain, these signals translate into sound.
• Inner ear hairs that are twisted or broken due to ageing or repeated exposure to loud noises can cause tinnitus. To your brain, these hairs have the ability to "leak" erratic electrical signals.
• Ear infection or blockage in the ear canal: Your ear canals may become clogged by a buildup of fluid (ear infection), earwax, debris, or other foreign things. A blockage that modifies the pressure inside your ear can cause tinnitus.
• Damage to the neck or head: Head or neck trauma can affect inner ear function, hearing nerves and brain function related to hearing. Usually, tinnitus from these kinds of incidents only affects one ear.
• Medicines: Many medicines have the potential to cause or exacerbate tinnitus. When the dosage of these medications is increased, tinnitus typically grows worse. The irritating noise normally goes away when you stop taking these medications.
• NSAIDs (nonsteroidal anti-inflammatory meds), antibiotics, diuretics (water pills), antidepressants, cancer drugs, and some antibiotics are among the medications that have been linked to tinnitus.

Less frequently, diseases that affect the nerves in the ear or the brain's hearing centre, chronic illnesses, traumas, or other ear issues result in tinnitus.

• Meniere's disease: Meniere's disease, an inner ear condition that may be brought on by aberrant inner ear fluid pressure, may have tinnitus as a precursor.
• Eustachian tube problem: Because of this problem, the tube connecting your middle ear to your upper throat is constantly expanding, which could make your ear feel full.
• Ear bone changes: Tinnitus may result from otosclerosis or the stiffening of the bones in the middle ear. This disorder frequently runs in families due to faulty bone growth.
• Muscular spasms in the inner ear: Tinnitus, hearing loss, and an impression of fullness in the ears can all be brought on by spastic contractions of the inner ear muscles. This may be caused by neurological conditions like multiple sclerosis, but it can also happen for no apparent reason.
• Anomalies related to the temporomandibular joint (TMJ): Problems with the TMJ, which is the joint where your lower jawbone meets your skull on each side of your head in front of your ears, can cause tinnitus.
• Head and Neck Tumours, including acoustic neuromas: The cranial nerve, which sends signals from your brain to your inner ear and controls balance and hearing, is the source of a benign (noncancerous) growth known as an acoustic neuroma. Other tumours within the head, neck, or brain.
• Diseases affecting the blood vessels: If you have diseases connected to blood vessels, such as high blood pressure, atherosclerosis, or kinked or malformed blood vessels, blood may flow through your veins and arteries more strongly. Blood flow variations can cause tinnitus or exacerbate its symptoms.
• Longer-lasting illnesses: Many medical illnesses, including diabetes, thyroid problems, migraines, anaemia, and autoimmune diseases including lupus and rheumatoid arthritis, have been related to tinnitus.

Also Read: Disorders of the voice: Causes, Symptoms, Risk Factors, Diagnosis and Treatment

Symptoms Of Tinnitus

Even in the absence of external sound, tinnitus is most commonly described as a ringing in the ears. However, tinnitus can also cause a variety of phantom sounds to appear in your ears, including:

• Hissing
• Clicking
• Buzzing
• Humming.
• Ecstatic

Most cases of tinnitus are caused by subjective tinnitus or tinnitus that you can only hear. Tinnitus can affect one or both ears, and the sounds it makes can range in pitch from a low rumble to a high shriek. There are moments when the music is so loud that it is hard to concentrate or hear outside noise. Your tinnitus could be continuous or sporadic.

Rarely, tinnitus may cause a rhythmic whooshing or pulsing sound that often coincides with your heartbeat. This is referred to as pulsatile tinnitus. If your tinnitus is pulsatile (objective tinnitus), your doctor may be able to identify it during an examination.

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Risk Factors Of Tinnitus

Anybody can experience tinnitus, although you may be especially vulnerable if you have any of the following conditions:

• Exposed to loud noise: Loud noises from guns, chainsaws, and machinery are common sources of noise-related hearing loss. Noise-induced hearing loss can also be brought on by listening to loud music for extended periods on portable music players, such as MP3 players. Those who work in noisy environments, including soldiers, musicians, and workers in manufacturing and construction, are more sensitive.
• Age: As you age, fewer nerve fibres remain in your ears, which could result in hearing problems that are often associated with tinnitus.
• Sexual: Men experience tinnitus more frequently than women.
• Usage of tobacco and alcohol: Smokers have an increased risk of developing tinnitus. The chance of tinnitus is also higher by alcohol consumption.
• Specific medical conditions: Obesity, heart problems, high blood pressure, and a history of arthritis or head injuries enhance your risk of acquiring tinnitus.

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Diagnosis Of Tinnitus

Usually, your doctor will make the diagnosis of tinnitus based just on your symptoms. Sometimes there is no apparent cause.

Your doctor will probably examine your head, neck, and ears in addition to asking you about your medical history to determine the origin of your tinnitus. Typical exams consist of:

• Hearing test (audiology): You will take the exam while seated in a soundproof room with earbuds that play particular sounds into each ear separately. When you can hear the sound, you'll indicate it, and the findings you get will be compared to what is thought to be typical for your age. This can assist in excluding or locating potential causes of tinnitus.
• Motion: Your doctor could ask you to move your jaw, eyes, arms, and legs in addition to your neck. If your tinnitus changes or worsens, it could be a sign of an underlying medical condition that needs to be treated.
• Imaging tests: MRIs or CT scans may be required, depending on what is thought to be the origin of your tinnitus.
• Lab experiments: Your doctor may draw blood to check for vitamin deficiencies, thyroid problems, anaemia, or heart disease.

Make every effort to describe to your doctor the kinds of sounds you hear when you have tinnitus. 

• Applying pressure: This type of sound suggests that the muscles in and around your ears may be contracting, which could be the source of your tinnitus.
• Humming, throbbing, or rushing: Because these sounds are usually the result of vascular (blood vessel) problems, such as high blood pressure, you may hear them after engaging in physical activity or when you shift positions.
• Low-pitched ringing: This type of sound may be indicative of Meniere's illness, blockages in the ear canals, or stiff inner ear bones (otosclerosis).
• High-pitched ringing: The most common type of tinnitus sound is this one. The most common causes are probably drug use, hearing loss, or exposure to loud noises. An acoustic neuroma may cause chronic high-pitched ringing in one ear.

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Treatment Of Tinnitus

How to manage your tinnitus depends depend on whether it is brought on by an underlying medical condition. If so, your doctor might be able to better control your symptoms if the underlying cause is addressed. Use the following as examples:

• Removal of ear wax: If an earwax blockage is removed, tinnitus symptoms might go away.
• Taking care of a blood vascular problem: Medication, surgery, or other interventions may be used as treatments for underlying blood vessel diseases.
• Assistance-focused listening devices: If you have tinnitus due to age-related or noise-induced hearing loss, wearing hearing aids may help reduce your symptoms.
• Adjusting the medication you consume: If tinnitus appears to be brought on by a medication you are currently taking, your doctor may suggest discontinuing, reducing, or switching to an alternative.

In most cases, tinnitus has no known remedy. Nonetheless, several treatments might be able to make your symptoms less noticeable. Your physician might suggest using an electronic device to drown out the noise. The items include:

• White noise machine: When treating tinnitus, these devices are often quite helpful. Their sounds are similar to static electricity or ambient noises like rain or ocean waves. Using a white noise generator with pillow speakers could be something to think about for improved sleep. White noise from fans, humidifiers, dehumidifiers, and air conditioners in bedrooms can help prevent tinnitus from being as evident at night.
• Tools for masking: These in-ear devices, which work similarly to hearing aids, block out low-level white noise, which tinnitus sufferers find comfortable.

By supporting you in changing your beliefs and feelings about your symptoms, behavioural treatment methods aim to help you manage your tinnitus. With time, your tinnitus may become less annoying. Counselling options include of:

• Tinnitus rehabilitation therapy (TRT): A tailored course called Tinnitus Rehabilitation Therapy (TRT) is usually provided by an audiologist or at a tinnitus treatment facility. TRT combines sound masking with professional therapy. You frequently receive directed counselling and use an in-ear device to help mask your tinnitus sensations. With time, TRT may help you become less conscious of your symptoms and less troubled by your tinnitus.
• Counselling using a different approach or as part of cognitive behavioural therapy (CBT): To help lessen the discomfort of your tinnitus symptoms, you can learn coping methods from a psychologist or certified mental health professional. Other problems, such as depression and anxiety, which are often associated with tinnitus, can also benefit from counselling. Numerous mental health professionals offer CBT for tinnitus in individual or group settings. Programmes for CBT are available online as well.

Substances

Medication may sometimes lower the severity of issues or symptoms, but there is no proven cure for tinnitus. To relieve your symptoms, your doctor might prescribe medication for an underlying condition or to help you deal with the depression and worry that is often associated with tinnitus.

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Prevention Of Tinnitus

Many times, an unavoidable event results in tinnitus. It is still possible to prevent some forms of tinnitus, though.

• Wear a pair of headphones: Long-term nerve damage to the ears brought on by exposure to loud noises can cause hearing loss and tinnitus. Don't expose yourself to too many loud noises. Furthermore, protect your hearing by wearing earplugs if you can't stay away from loud noises. If your job involves using noisy machines, handling firearms (especially pistols or shotguns), using chainsaws, or performing, you should always wear over-the-ear hearing protection.
• Turn down the volume: Long-term loud music exposure without ear protection or listening to certain types of music can cause tinnitus and hearing loss.
• Maintain your heart's health: Regular exercise, a healthy diet, and other blood vessel maintenance techniques can help prevent tinnitus linked to obesity and blood vessel illnesses.
• Reduce your intake of alcohol, caffeine, and nicotine: These medications may change blood flow and worsen tinnitus, especially if used in excess.

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Complications Of Tinnitus

Tinnitus affects each person differently. The presence of tinnitus can significantly lower an individual's quality of life. Furthermore, if you experience tinnitus, you may:

• Exhaustion and tension 
• Sleeping problems
• Problems paying attention
• Memory problems
• Agitation 
• Discomfort 
• Depression
• Headaches 
• Work and family conditions

Even though addressing these related conditions might not cure tinnitus immediately, doing so can nevertheless enhance your quality of life.

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