Tinnitus is the perception of noise or ringing in the ears. It is a common condition that affects around 15% to 20% of people. For most people, tinnitus is just an annoyance. But for around 1% of the population, tinnitus severely affects their quality of life.
What causes tinnitus?
There are two types of tinnitus:
- Subjective tinnitus – No external sound is present. It is caused by problems in the auditory system.
- Objective tinnitus – An external sound is present that can be heard by the examiner. It is caused by problems in the vascular, muscular, or respiratory system.
The most common causes of subjective tinnitus include:
- Noise exposure – This can damage the inner ear hair cells that allow us to hear.
- Aging – Hearing tends to decline with age. The elderly often develop tinnitus.
- Ear wax blockage
- Ear bone changes
- Meniere’s disease
- Acoustic neuroma – A benign tumor of the cranial nerve that runs from the brain to the inner ear.
- Medications – Over 200 medications are known to cause tinnitus as a side effect.
What are the symptoms of tinnitus?
The main symptom is hearing phantom noises like ringing, buzzing, roaring, clicking or hissing without any external sound source. The noises can be intermittent or continuous and vary in pitch and loudness.
Other symptoms may include:
- Headache
- Irritability
- Fatigue
- Anxiety
- Difficulty concentrating
- Insomnia
How is tinnitus diagnosed?
A doctor will perform a physical exam of your ears and take a medical history. They will ask about the noises you hear, any medications you take, and possible causes like noise exposure.
Hearing tests are done to determine if hearing loss is present. The tests measure the softest sounds you can hear at different pitches and evaluate your ability to understand speech.
Imaging tests like CT or MRI scans may be done to rule out structural abnormalities affecting the ears or auditory nerves.
What are the treatment options for tinnitus?
Treatments aim to address the underlying cause of tinnitus or help you cope with the condition.
Treating the underlying cause
- Medications – Switching medications may stop tinnitus caused by a drug side effect.
- Wax removal – Ear wax blocking the ear canal can be removed by irrigation.
- Noise protection – Preventing further noise exposure and hearing loss can help stabilize tinnitus.
- Surgical treatments – Correcting problems like ear bone changes, tumors, and malformed blood vessels may resolve tinnitus.
Managing tinnitus symptoms
- Sound therapy – Background noise from a fan, quiet music, or sound generators can mask tinnitus sounds.
- Hearing aids – These amplify external sounds and improve communication ability.
- Counseling – Helps develop coping techniques like mindfulness exercises.
- Relaxation therapy – Reduces stress that can worsen tinnitus.
- Cognitive behavioral therapy (CBT) – Changes negative thought patterns about tinnitus.
Experimental treatments
Research is ongoing into potential drug and neurostimulation treatments for tinnitus relief:
- Low doses of anti-anxiety drugs like Valium or Xanax may reduce tinnitus symptoms.
- Antidepressants like nortriptyline and amitriptyline may provide some relief.
- Experimental electrical and magnetic stimulation of the tongue, ears and brain is being studied.
How does tinnitus impact daily life?
For many people, tinnitus is just a minor annoyance. But about 1% suffer from severe tinnitus that significantly impacts their quality of life. Ways that tinnitus can affect daily activities include:
Sleep problems
The constant noise makes it difficult to fall asleep and stay asleep.
Concentration difficulties
The distracting noises make it hard to focus at work or school.
Hearing difficulties
Tinnitus masks outside sounds, making it difficult to understand speech.
Emotional disturbances
Severe tinnitus can cause anxiety, depression, and irritability.
Reduced social engagement
Avoiding social situations where hearing and communication are important.
Work impairments
Problems concentrating reduce work performance and productivity.
What is the economic impact of tinnitus?
In addition to impacts on quality of life, tinnitus has significant economic impacts including:
- Lost wages – Tinnitus reduces productivity and causes work absences.
- Healthcare expenditures – Billions are spent annually on doctor visits, surgeries, medications and more.
- Disability payments – Severe tinnitus may prevent working entirely.
One study estimated the total economic cost of tinnitus in the UK to be £750 million to £850 million annually. In the US, costs range from $60 billion to $84 billion each year.
Does tinnitus get worse over time?
The course of chronic tinnitus is unpredictable. For some people, the symptoms may worsen over time. But for many, the condition remains stable after the initial onset. In about 12% of cases, the tinnitus improves or goes away completely.
Factors that increase the risk of worsening tinnitus include:
- Untreated underlying condition – Fixing issues like ear wax blockage may prevent worsening.
- Continued exposure to loud noise
- Advancing age
- High stress levels
- Smoking – Reduces blood flow to the structures of the ear.
What is the prognosis and long-term outlook?
Tinnitus is a chronic condition with no cure. The goal of treatment is to help patients live with their tinnitus as comfortably as possible.
With treatment, most people achieve some improvement or relief from tinnitus symptoms.
Counseling and sound therapy enable patients to better cope with the condition on a daily basis. Doing so can significantly improve quality of life.
Reducing stress levels also helps to diminish the perception of tinnitus sounds. Relaxation therapies like meditation, hypnosis, and exercise help relieve stress.
However, for some severe cases there is little improvement. About 1-2% of people with tinnitus require hospitalization for treatment of anxiety, depression, and other psychiatric disorders.
Can children get tinnitus?
Yes, children can develop tinnitus, although it is less common than in adults. The noise exposure that leads to tinnitus may come from:
- Loud toys, video games, music
- Noisy sporting events
- Power tools
- Traffic sounds
According to one study, noise-induced hearing loss affected 12.5% of children ages 6-19. Tinnitus is associated with noise-induced hearing loss in children.
Other causes of tinnitus in children include:
- Ear infections
- Foreign objects in the ear
- Allergies
- Exposure to certain medications
- Head or neck injuries
Younger children may have difficulty expressing the symptoms of tinnitus. Parents should be alert for signs like loss of concentration, behavioral problems, sleep disturbances, and headaches.
Treating underlying causes, sound therapy, and counseling are recommended for tinnitus in children.
Conclusion
In summary, tinnitus affects about 15% to 20% of people. Its severity varies greatly – from a mild annoyance to a debilitating condition. While there is no cure, treatment can help most people successfully manage their tinnitus. Protecting hearing from excessive noise and quickly treating ear problems are the best ways to prevent tinnitus from developing or worsening.