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Disease: Tinnitus Tinnitus
Category: Ear, nose, larynx diseases

Disease Definition:

Tinnitus is the ringing or noise in the ears. Statistically, 20% of people have tinnitus, which is in fact not a condition, but a symptom of another initial cause such as an injury to the ear, a disorder in the circulatory system or hearing loss due to aging.

Usually, tinnitus is not a sign of a serious condition, even though it is annoying. Symptoms improve with treatment, especially if it is targeted to the identified underlying condition. Some treatment methods are used to diminish the symptoms, making them more tolerable.

Work Group:

Prepared by: Scientific Section

Symptoms, Causes


Tinnitus is especially bothersome since it is considered an auditory illusion, which causes the patient to hear sounds like hissing, clicking, buzzing, whistling, roaring, or ringing.

A patient can have these auditory illusions in either or both of the ears, with a tone ranging from very low to very high pitch sounds, sometimes even so intense that interrupts the person’s normal hearing and concentrating abilities. Tinnitus may be chronic or episodic.

The two kinds of tinnitus are:

Subjective Tinnitus:
This is often the result of a problem in any of the three parts of the ear, or a problem in the auditory nerve or in the portion of the brain in charge of nerve signal interpretation as sound. Only the patient can hear this type of tinnitus.

Objective Tinnitus:
This rare type is caused by a problem like muscular issue, an inner ear bone condition or blood vessel problem. This is not considered a sensory illusion, since the physician can actually hear what the patient is hearing.

Medical attention should be sought in the case of experiencing tinnitus for more than one week, and when having an upper respiratory infection, such as cold. If tinnitus occurs suddenly, accompanied with loss of hearing or dizziness without a significant reason, the case may be considered an emergency.


While the exact cause is still unknown, some conditions can initiate or deteriorate tinnitus.

Hearing occurs when the tiny hairs in the inner ear cells are stimulated by the sound waves to generate signals that travel to the brain through the auditory nerve, where they are interpreted as sound. If any of these cells are damaged or their hairs are broken or bent, random faulty generation of signals occur.

Tinnitus can also be caused by other chronic health conditions, ear problems and injuries that might affect the hearing center in the brain or the auditory nerve. Tinnitus is commonly caused by:

Age related hearing loss:
Presbycusis is the name of the condition in which loss of hearing can cause tinnitus. It usually starts around the age of 60.

Exposure to loud noise:
This can affect the hearing ability, ranging from temporary tinnitus to permanent hearing damage, depending on the intensity and duration of the noise. Common sources of noise are headphone misuse, heavy machinery, firearms, and others.

Earwax blockage:
When a considerable amount of wax is accumulated in the ear canal that the body cannot dispose by itself (cerumenal impaction), tinnitus may result, among other hearing problems.

Changes in the ear bones:
This is a hereditary condition, which is the result of abnormally growing bones, or stiffening of middle ear bones (otosclerosis).

Other less common causes of tinnitus are:

Meniere's disease:
This involves the inner ear, and is thought to be due to abnormal composition or pressure of the inner ear fluid.

Stress and Depression:
This is the case when no defects are discovered by tests, but the tinnitus is experienced nonetheless.

Head or neck injuries:
These affect the portion of the brain or the nerves that are related to hearing and end up causing tinnitus in either of the ears.

Acoustic neuroma:
Also referred to as vestibular schwannoma, a benign tumor exists in this condition in the cranial nerve, which is the nerve that connects the inner ear and the brain and controls hearing and balance. This condition can also cause tinnitus in either of the ears.

This type may also be referred to as pulsatile tinnitus; it is a rare case of tinnitus caused by blood vessel disorders as a result of:

Head and neck tumors:
Tinnitus and other symptoms may be caused by a tumor that presses on blood vessels in the head or neck (vascular neoplasm).

This is the case when major blood vessels in the vicinity of the middle and the inner ear become stiff with age or as a result of the formation of fatty deposits and cholesterol, making blood flow more turbulent and forceful, so that heartbeats are detected by both of the ears.

High blood pressure:
This condition causes a more prominent tinnitus. Hypertension can develop from various factors like caffeine, alcohol, stress, etc. Tinnitus caused by hypertension can be reduced by the repositioning of the head.

Turbulent blood flow:
This is caused by the narrowing of the neck vein (jugular vein) or the neck artery (carotid artery), resulting in tinnitus.

Malformation of capillaries:
This is a condition that occurs in the connections between arteries and veins, also referred to as arteriovenous malformation (AVM), leading to tinnitus usually in either of the ears.

Several medications can lead to tinnitus or deteriorate it. Usually, the intensity of tinnitus is proportional to the dose of the medication, and disappears when the medication is stopped. Some of these drugs are:

Aspirin, when taken in irrationally high doses, 12 or more pills daily.

Cancer medications, such as mechlorethamine and vincristine.

Quinine medications that are prescribed for malaria, among other health conditions.

Chloroquine, also a malaria medication

Diuretics (water pills), such as bumetanide, ethacrynic acid, and furosemide.

Antibiotics, such as chloramphenicol, erythromycin, tetracycline, vancomycin and bleomycin.

While tinnitus can occur with everyone, the risks of experiencing tinnitus increase with:


  • Frequent exposure to loud noise without proper protection
  • Old age; being older then 65
  • Age-related loss of hearing
  • Being male
  • Being Caucasian
  • Having post traumatic stress disorder (PTSD), which especially aggravates tinnitus



A person’s quality of life is substantially affected by tinnitus, with varying complications from one patient to another; however, tinnitus may be associated with:


  • Fatigue and stress
  • Sleep problems
  • Concentrating problems
  • Problems of memory
  • Depression
  • Anxiety and irritability

Treating these complications may ease the patient’s condition, but it can’t cure the underlying problem.


In order to resolve tinnitus, first the underlying condition should be identified and treated. If tinnitus is related to the patient's health condition, treatment can reduce the noise by certain methods, such as:

Earwax removal:
If an excessive amount is accumulated in the ear canal, symptoms of tinnitus can be decreased by removing it.

Treating blood vessel conditions:
These are treated by either medications or surgery.

Changing medication:
A medication should be stopped, reduced in dose or replaced with another if it turns out to be the cause of tinnitus.

"White noise" is sometimes used to help in the suppression of tinnitus by a less annoying noise. According to the physician's recommendation, a patient can use one of the following devices:

White noise machines:
These devices produce environmental sounds like rainfall or ocean wave because of the efficiency of these sounds in suppressing tinnitus. Also to help sleeping, pillow speakers are suggested.

Hearing aids:
These are particularly recommended when hearing problems are present in conjunction with tinnitus.

Masking devices:
These devices produce low level white noise continuously, and they are similar to hearing aids

Tinnitus can't be cured by medications, but its symptoms and complications can be reduced by them. Some of these drugs are:

Tricyclic antidepressants:
These drugs are only administered in cases of severe tinnitus and they are successful to some extent but are associated with considerable side effects like heart problems, blurred vision, constipation and dry mouth. Some examples are amitriptyline and nortriptyline

This medication reduces tinnitus symptoms but is potentially addictive with side effects including nausea and drowsiness.

This drug is generally used in treating alcoholism and has proven to be efficient in tinnitus relief in some cases, but still needs further research to determine its eligibility in treatment.


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