Ear Ringing or Tinnitus is one of the most common and disturbing patient symptoms.  There are two types of ringing--objective and subjective.  

Objective tinnitus are noises which can be heard by other individuals (although they usually are not).  Usually this type of tinnitus pulsates with the patient's heartbeat.  It can be caused by ear infections, blockage in the major artery to the brain (which can lead to stroke) or by a vascular growth or tumor in the ear (this is a rare cause).   In the elderly, the most common cause of pulsatile tinnitus is a carotid bruit caused by plaques in the carotid artery. 

Subjective tinnitus can only be heard by the patient.  It is generated by the spontaneous firing of nerves when they have lost their connections to the ear end-organ, much like an amputee's phantom limb sensation.  The type of sound and loudness has little diagnostic significance.  Although, it is believed that the "crickets" people hear are from tinnitus produced simultaneously from two different frequencies.  It is almost always associated with a hearing loss from the inner ear (sensorineural hearing loss).  It can be made worse if the patient is in a quiet environment, at night when he tries to sleep.  If the patient has a disease of the eardrum or middle ear bones (causing a conductive hearing loss), outside sounds that are not as loud will make the inner ear tinnitus worse.  In this case, surgery may be beneficial to correct the conductive hearing loss.

If the hearing loss is equal on both sides, the tinnitus is usually benign.  If a unilateral or one-sided hearing loss is present, then one must search further for the cause.  Rarely, a benign intracranial (next to the brain) growth such as an acoustic neuroma is found.  Other causes of tinnitus are possible and an evaluation by a physician is indicated.

Treatment of tinnitus is very difficult.  If a hearing loss is present, correction of the hearing loss will often lessen the tinnitus.  Unfortunately, this is usually only possible in a conductive loss.  Maskers are often used at night to allow the patient to sleep.  Many drug treatments have been tried which use anti-depressants or seizure medications.  These have been reported to be effective in some patients but there are potential side effects from these medications.
 
As the name implies, Tinnitus Maskers produce noise which masks the tinnitus.  These can be obtained from most novelty stores and produce a wide range of sounds from waterfalls, rain, ocean waves and running water.   One may also use a fan or an HEPA Filter to produce white noise and mask tinnitus.

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Page last updated 04/09/2008,   Number of hits since 1/14/2004   

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