Tinnitus (Ringing in the Ears)

Perceiving sounds when no sound is reaching us from the outside world is medically called tinnitus, and in everyday language ringing in the ears. Patients describe hearing these sounds sometimes in their ears and sometimes inside their head.

Tinnitus may come and go briefly or be constant. While it often does not affect daily life, it can sometimes be very bothersome and take a psychological toll. During the day, this disturbing sensation is usually masked by the sounds around us and is barely noticed; it tends to become apparent especially in the quiet of night. Depending on the character and loudness of the sound, it can cause serious sleep problems.

Tinnitus may be heard as ringing, humming, wind, running water, rain, insects, buzzing or machine noise. In most cases, the ringing can be heard only by the person themselves (subjective tinnitus); rarely, in vascular or muscular disorders around the neck and ear, it can also be heard by others (objective tinnitus).

Tinnitus often stems from simple causes that do not pose a serious health problem, but at times it can be a sign of a serious health condition.

Causes of tinnitus:

• Earwax buildup (impacted cerumen)
• Outer ear infection
• Perforated eardrum
• Middle ear infection
• Fluid buildup in the middle ear
• Hardening of the middle ear bones (otosclerosis)
• Eustachian tube disorders
• Exposure to loud noise or listening to loud music (acoustic trauma)
• Sudden hearing loss
• Inner ear infection
• Ménière’s disease
• Tumor of the hearing and balance nerve (acoustic neuroma)
• Injuries to the ear area and head
• Nasal conditions such as allergic rhinitis and sinusitis
• Vascular diseases and tumors in the head, neck and ear region
• Neck conditions (arthritis, herniated disc)
• High blood pressure
• Diabetes
• Anemia
• Thyroid diseases
• Age-related hearing loss
• Certain medications (rheumatism drugs, some antibiotics, aspirin, chemotherapy drugs, blood pressure medications)

Evaluating a patient with tinnitus:

An ENT specialist takes a detailed history of the symptoms and then performs an examination. Common causes such as earwax buildup and outer or middle ear infections can be easily identified and treated.

After the examination, hearing tests, blood tests and imaging studies (CT, MRI) to examine the middle and inner ear structures in detail may be performed.

Tinnitus treatment:

If the examinations and tests identify the cause of the problem, the necessary treatment is given. Often, however, the exact cause of tinnitus cannot be found. In such cases, there are some medications that can be used. The effect of drug treatment is not certain, and the degree of benefit varies. The longer the tinnitus lasts, the less effective medications become. The chance of improvement is higher if treatment begins within 7–10 days after the ringing starts.

Besides medication, the sound the person hears can be masked with special tinnitus therapy devices. When tinnitus occurs together with hearing loss, hearing aids may be used.

Retraining therapy, which helps the patient become accustomed to the sound they hear, may be applied.

After the characteristics of the patient’s tinnitus are determined, therapy may be given in sessions using a soft laser device.

Recommendations for people with tinnitus:

• Protect yourself from loud noise
• Avoid consuming too much salt
• Have your blood pressure checked regularly
• Stay away from smoking, alcohol, carbonated drinks and coffee
• Exercise regularly
• Rest well, avoid overexertion and do not go without sleep
• Do not use any medication unless recommended by your doctor
• Try not to focus on the ringing sound as much as possible
• When falling asleep, use devices that produce sounds similar to the ringing to provide natural masking