Many people have experienced ringing in their ears, for instance after a loud concert, a sports event or after using a very loud machine like a chainsaw. It usually goes away on its own. Sometimes people start hearing sounds in their ear (tinnitus) for no known reason – these normally don’t last longer than a minute.
But in some people the sound continues over a longer period of time. In Germany and other countries, tinnitus is considered to be chronic if it lasts for more than three months. It is usually quite mild: Although it is annoying, people can learn to live with it. Yet sometimes it’s so bad that their everyday lives and quality of life are severely affected. The sounds can lead to constant stress and make it hard to concentrate and sleep properly.
Tinnitus can be caused by a number of things, including a blocked ear canal or high blood pressure. It is only very rarely caused by a serious medical condition.
The word “tinnitus” comes from the Latin word for “ringing.” But the sounds that people with tinnitus hear also include whistling, buzzing, humming, hissing, clicking or knocking. They may be heard in one or both ears. Some people say it feels like the sound is coming from inside their head, whereas others say it sounds like it is coming from outside. Tinnitus may be constant or it may come and go. It is sometimes very quiet and then really loud again.
Some people who have tinnitus also have hearing loss. But this isn’t always the case. Most people with tinnitus have normal hearing otherwise.
Tinnitus is very often caused by damage to the sensory cells in the cochlea in the inner ear as a result of exposure to loud sounds. Most of those affected have spent a lot of time in loud places or had what is known as an acoustic trauma. This is when your ears are briefly exposed to an extremely loud noise, such as an explosion or nearby gunshots.
Other possible causes of tinnitus include the following:
- Blocked auditory (ear) canal due to a build-up of ear wax
- Chronic middle ear infection
- A ruptured (perforated) eardrum
- Otosclerosis: a bone disease in the middle ear and inner ear that can lead to hearing loss
- Ménière’s disease: a disease of the inner ear, causing symptoms such as tinnitus, vertigo and hearing loss
- Problems affecting the muscles or joint of the jaw
In rare cases, tinnitus is a side effect of medication such as certain kinds of antibiotics, cancer drugs or anti-malarials.
For many people, though, no cause of tinnitus can be found. Doctors call this type of tinnitus “primary” or “idiopathic” tinnitus.
It is not exactly clear how and why hearing damage caused by loud sounds can lead to tinnitus. This also makes it harder to find an effective treatment. According to one of several theories, the damaged or irritated sensory cells in the cochlea can no longer send signals to the brain. As a reaction to the lack of real signals, the nerve cells in the brain’s center of hearing become more active and “create” sound anyway. This is similar to how phantom pain develops following amputation.
It is sometimes claimed that tinnitus can be caused by stress. But there isn’t a clear link: So far, relaxation techniques haven’t been shown to have a direct impact on tinnitus.
Tinnitus is quite common: Between 5% and 15% of all adults experience a longer-lasting episode of tinnitus at some point in their lives. In about 10% to 20% of those who have tinnitus, the symptoms are so bad that they have a considerable impact on quality of life, and treatment is needed.
The risk of getting tinnitus increases with age. It is most common in people over the age of 45. But in rare cases it can already arise in childhood.
Nobody can predict the exact course of tinnitus. If the cause is known and treatable, it may go away again. If it isn’t clear what is causing the tinnitus, it may last a long time and become chronic. But the symptoms often become milder over time.
Some people’s hearing becomes more sensitive too, which can be unpleasant in loud places (hyperacusis). As a result, they may start avoiding loud environments and go out less. This can sometimes even lead to depression or contribute to its development.
The doctor first asks about the symptoms: what sounds you hear exactly, in what situations you hear them, and whether they are accompanied by other symptoms such as earache or a feeling of pressure in the ear. In primary (idiopathic) tinnitus, both ears are usually affected. If the sounds are only heard in one ear and are accompanied by other symptoms such as earache, the tinnitus is likely to have a specific cause which is usually treatable. It is also important for the doctor to know whether you are taking any medications. This is because some medications, such as acetylsalicylic acid (the drug in medicines like Aspirin) can cause tinnitus sounds if you take too much of them.
The talk with the doctor is usually followed by an ear examination and a hearing test. The doctor will also listen to the blood vessels in your neck and recommend further tests if necessary. It may be a good idea to have a dental examination to rule out any problems with your jaw.
Based on the outcomes of the doctor’s examination, he or she will determine which type of tinnitus you have. Doctors distinguish between the following types of tinnitus:
- Subjective and objective tinnitus: Subjective tinnitus can only be heard or perceived by the person who has it. Possible causes include problems with the auditory (hearing) system or the nerves that belong to it. In objective tinnitus, which is very rare, the doctor can hear the sounds too or detect the nerve signals causing the sounds. This is the case with tinnitus that is caused by blood-vessel-related problems, for instance. Here the doctor can hear a pulsing noise in the carotid artery in the neck with the help of a stethoscope.
- Primary and secondary tinnitus: If no clear cause can be found, it is referred to as primary tinnitus or idiopathic tinnitus. If there is an identifiable cause, it is known as secondary tinnitus. Possible causes include a perforated eardrum or a vascular (blood vessel) disease.
- Acute and chronic tinnitus: If the sounds last longer than three months, it is considered to be chronic tinnitus.
- Various levels of severity: Tinnitus can be mild and hardly affect your everyday life, or only occur from time to time but then be distressing when it does. Sounds that are constantly and clearly heard are more serious: They can have a big impact on your daily life and work, for instance because it is hard to sleep and concentrate properly.
It is generally always a good idea to protect yourself from sounds that are too loud. This lowers the risk of developing tinnitus in the first place, or of existing tinnitus becoming chronic.
The treatment options for tinnitus will depend on the cause. If it is caused by an underlying medical condition, that medical condition is treated. Effective treatment will usually make the tinnitus go away too.
If the cause isn’t known, it is more difficult to treat. The main aim of treatment is then to reduce the symptoms and develop strategies to cope well in everyday life despite having tinnitus. If the tinnitus is associated with hearing loss, a hearing aid might be considered.
A wide variety of products are available for the treatment of tinnitus, including herbal products, dietary supplements and various medications such as steroids or carbamazepine. None of these treatments have been proven to help. And some may have side effects.
The best-studied treatment is cognitive behavioral therapy (CBT), which involves learning how to cope better with chronic tinnitus. Although this doesn’t make the sounds go away, it can lead to an improvement in quality of life.
If tinnitus arises suddenly, doctors often suggest immediate treatment with an infusion (a drip), for instance with a saline (salt) solution – particularly if the tinnitus is associated with sudden hearing loss. Sometimes people are given an infusion with hydroxyethyl starch (HES) instead. But no studies have shown that infusions with this drug help. On the contrary, HES can trigger severe allergic reactions, with itching all over the body.
There are many sources of support for people living with tinnitus. These include self-help groups and information centers. But many of these facilities are organized quite differently. Our list may help you find and make use of local services in Germany.
Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V. Chronischer Tinnitus. S3-Leitlinie. 02.2015. (AWMF guidelines; Volume 017-064).
Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V. Hörsturz. S1-Leitlinie. 01.2014. (AWMF guidelines; Volume 017-010).
Kreuzer PM, Vielsmeier V, Langguth B. Chronic tinnitus: an interdisciplinary challenge. Dtsch Arztebl Int 2013; 110(16): 278-284.
Robert Koch-Institut (RKI). Hörstörungen und Tinnitus. Berlin: RKI; 2006. (Gesundheitsberichterstattung des Bundes, Heft 29).
Savage J, Waddell A. Tinnitus. BMJ Clin Evid 2014.
Yew KS. Diagnostic approach to patients with tinnitus. Am Fam Physician 2014; 89(2): 106-13.
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