What is tinnitus?
Tinnitus is the perception of ringing, buzzing, humming or whistling in the ear or head without any external sound source. It is very common; most people experience brief tinnitus at some point in their lives. Tinnitus is not a disease but a symptom — what matters is identifying the underlying cause.
What causes tinnitus?
The most common cause is hearing loss related to changes in the inner-ear hearing cells; age-related hearing decline and exposure to loud noise (concerts, gunfire, loud music through headphones, noisy workplaces) lead the list. Earwax build-up, middle-ear infection or fluid, eardrum problems and Eustachian tube dysfunction can also cause tinnitus. In Meniere's disease, tinnitus is accompanied by vertigo and fluctuating hearing loss. Certain medications (high-dose aspirin, some antibiotics), stress, poor sleep and excessive caffeine can trigger or worsen tinnitus. Pulsatile tinnitus (in time with the heartbeat) and one-sided tinnitus with hearing loss are rarer but may point to important causes, so they are investigated in detail.
When should you see a doctor?
Tinnitus that affects one ear only, is accompanied by hearing loss or dizziness, pulses like a heartbeat, or lasts longer than a few weeks requires an ENT examination. Tinnitus that comes with sudden hearing loss is an emergency; starting treatment within the first 72 hours is important.
How is it diagnosed?
The ENT examination assesses the eardrum and ear canal; a hearing test (audiometry) is the key investigation for tinnitus. In one-sided tinnitus or asymmetric hearing loss, an MRI may be requested to evaluate the inner ear and the hearing nerve.
Treatment of tinnitus
Treatment is planned according to the cause: earwax is removed, middle-ear problems are treated, and medications are adjusted if drug-related. In chronic tinnitus due to hearing loss, a hearing aid noticeably relieves both the hearing and the tinnitus. In persistent tinnitus the aim is less to eliminate the sound than to reduce the brain's reaction to it: sound therapies (masking), tinnitus retraining therapy and relaxation techniques are effective. Cutting down caffeine, keeping a regular sleep routine and using soft background sound in quiet rooms bring relief in daily life.
Protecting your ears
Use ear protection in loud environments, keep headphone volume below 60%, and do not poke your ears with cotton swabs.
This article is for general information; please consult your physician for diagnosis and treatment.