Tinnitus
Published by Bupa's health information team, February 2008.
This factsheet is for people who have tinnitus, or who would like information about it.
Tinnitus is the sensation of a sound in the ear or head that is not being produced by an external source. There are many different disorders that can produce such symptoms.
- Animation - How the ear works
- About tinnitus
- Symptoms
- Causes
- Diagnosis
- Treatment
- Further information
- Questions and answers
- Related topics
- Sources
How the ear works
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About tinnitus
It's quite common to have mild tinnitus, and around 12 in 100 people are occasionally affected. One in 200 people have tinnitus so badly that it affects their ability to lead a normal life.
Tinnitus is hearing sounds in the absence of an external source. You may have what you think is tinnitus when in fact the sounds are really there. For instance, the sound of blood flowing in narrowed arteries in the neck, or the "murmur" of turbulent blood through a defective heart valve can give tinnitus symptoms. Problems with the inner ear can also be to blame. Having anaemia or problems with your Eustacian tube (see illustration) can also cause you to hear abnormal sounds.
Doctors call these objective symptoms, as there is a clear sound-producing process going on. If you have tests for your hearing problems, your doctor will try to pick up one of these causes, which may be treatable.
Tinnitus is a condition where these objective sounds have been ruled out.
Symptoms
The sensation of tinnitus is the sound of high-pitched whistling, buzzing, ringing or hissing. It can also be quite a complex sound, like the roar of an ocean. The sounds may be constant or come and go.
Whatever the cause of the tinnitus, it's almost always made worse by stress, which can be physical, psychological or emotional. Some people are able to live with the sound of their tinnitus quite happily. In others, the sound seriously interferes with their quality of life. The sound can be in one or both ears, or elsewhere in the head.
The outer, middle and inner ear
Causes
Most tinnitus is caused by a problem with the inner ear, which converts sounds to nerve signals, the auditory nerve, which carries these signals to the brain, and the parts of the brain involved in decoding those signals into what we sense as sounds.
Tinnitus is often linked to hearing loss. For this reason it's more common in older people who have age-related hearing loss.
Exposure to loud noise at work may also cause tinnitus. If you work with pneumatic drills or in noisy factories, you may be more at risk of having tinnitus.
Other possible causes of tinnitus can come from your ear, auditory nerve (which carries signals from your inner ear to your brain), infections, side-effects of medicines you have taken and because of problems with your jaw or teeth. These include:
- Ménière's disease, which results from an increased pressure in the inner ear and also causes deafness and vertigo
- otosclerosis, a condition in which the small bones of the middle ear become stiff and immobile
- ear infections and inflammation
- hard wax blocking your ear
- middle-ear infection (the type that's often known as "glue ear" in children)
- acoustic neuroma, a benign (non-cancerous) tumour of the auditory nerve
- high doses of medicines including aspirin, quinine and some antibiotics, water tablets (diuretics) and chemotherapy drugs
- head injury or whiplash
- problems with the joint between your jaws (this is called the temporomandibular joint), which can also lead to pain in the head or face
If you have tinnitus, you are more likely to be depressed. It's not clear whether this is because tinnitus makes depression more likely or if being depressed makes you more likely to have tinnitus.
Diagnosis
The type of sound you hear with tinnitus does not necessarily show what the underlying cause might be, or whether the cause is serious or minor. In order to find out the cause of tinnitus, you will need to have some tests.
If you have the symptoms of tinnitus, your GP will refer you to a specialist doctor for some tests. This will usually be an ENT (ear, nose and throat) surgeon or an audiovestibular physician (a doctor who specialises in hearing and balance problems). He or she will take into account all of your symptoms and may perform blood tests and various tests of your hearing, balance and co-ordination.
If the doctor feels that he or she needs to investigate the inner parts of the ear in more detail, you may need to have a magnetic resonance imaging (MRI) scan.
Treatment
The treatment you need will depend on what is causing the tinnitus. If you have an underlying problem, such as an ear infection, acoustic neuroma or Ménière's disease, this may need separate treatment.
Treatment options for tinnitus include the following.
Medicines
If your tinnitus is caused by an ear infection, your doctor may prescribe medicines (such as antibiotics).
Depression or anxiety can make tinnitus more of a problem and treatment of these conditions may help bring some relief. People with some long-term, painful conditions sometimes get relief by taking low doses of antidepressants such as amitriptyline. This may also help if you have tinnitus.
Hearing aids
If you have impaired hearing, wearing a hearing aid can help relieve the symptoms of tinnitus through masking the problem sound by making external sounds seem louder. In much the same way, special devices that look like hearing aids are used as part of tinnitus-retraining treatment.
This combines periods of listening to low levels of specially created sounds with counselling sessions. The counselling aims to encourage you to disconnect the experience of the sounds from the negative feelings they produce. In this way, the retraining may help you to cope better when you have real tinnitus. A full programme of tinnitus retraining takes about one and a half years to complete.
Positive thinking
The attitude you have towards your tinnitus is crucial, and people with a positive attitude find it more manageable. Having a trusting relationship with your doctor, who takes your concerns seriously, and is willing to try several approaches to treatment if necessary, will help you to feel that you are making some progress.
Cognitive behavioural therapy (CBT) is a standard approach. CBT is a combination of cognitive therapy, which examines unwanted thoughts, attitudes, and beliefs (called cognitive processes) and behavioural therapy, which focuses on behaviour in response to those thoughts.
Surgery
If the tinnitus is caused by a benign tumour (neuroma), then your doctor may recommend having surgery to remove the tumour.
If you have long-term (chronic) tinnitus that doesn't have an easily treatable cause, you may be encouraged not to listen for your tinnitus and, instead to try and concentrate other things.
Complementary therapy
Because conventional medicine has not found any reliable treatments for tinnitus, complementary therapies are popular. Any therapy that promotes relaxation and a sense of wellbeing may be useful in relieving tinnitus or the distress it causes.
Techniques include yoga, the Alexander technique, meditation, hypnosis and acupuncture. Ask your doctor for advice on these therapies. He or she may be able to recommend a qualified practitioner.
The herbal remedy ginkgo biloba is promoted as a cure for tinnitus but good-quality scientific studies have shown it does not work any better than a placebo.
Other treatments
A range of other treatments, including dietary supplements, electromagnetic stimulation and medicines (including anti-epileptics and anti-sickness drugs) have been tried, but their effectiveness has not been proven.
Further information
- British Tinnitus Association
0800 018 0527
www.tinnitus.org.uk
Related topics
Sources
- Lockwood AH, Salvi RJ, Burkard RF. 2002. Curent concepts: Tinnitus. New England Journal of Medicine 347(12):904-10
- Tinnitus. BMJ Clinical Evidence. 2006
- Rejali D, Sivakumar A, Balaji. 2004. N. Ginkgo biloba does not benefit patients with tinnitus: a randomized placebo-controlled double-blind trial and meta-analysis of randomized trials. Clin Otolaryngol Allied Sci;29:226
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: February 2008.
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