By Rod Moser
Tinnitus -- "ringing in the ears" -- affects an estimated 35 million Americans. But tinnitus isn't just a ringing, it can also be heard as a buzzing, roaring, hissing, clicking, high-pitched whining, low-pitched hum, even a heart-like pulsing.
Tinnitus is actually a symptom of some common medical problems, such as:
- ear infection
- wax impaction
- noise exposure (like rock concerts)
- TMJ (temporomandibular joint) disorders
- even a side effect of medications such as aspirin, ibuprofen, caffeine, or birth control pills
Tinnitus may also be a symptom of more serious illnesses such as high blood pressure, anxiety/depression, diabetes, thyroid disorders, Meniere's disease, blood vessel disorders, or tumors.
There are two types of tinnitus:
- subjective tinnitus, when the sounds a sufferer hears may be perceived as very loud and only heard by them
- objective tinnitus, a less common condition when the sounds can be heard by the sufferer and a medical provider using a stethoscope
Finding a cause for tinnitus can be simple or require extensive diagnostic tests. In many cases, a cause is never found -- a frustrating fact for many tinnitus sufferers and their medical providers.
If a cause is determined, then treatment can be quite focused. For example, if a tinnitus sufferer is taking aspirin and is found to have high blood pressure, the aspirin is stopped and medications are given to control the blood pressure.
Even if a specific cause is never found, there is still hope for successful treatment. A combination of therapies over time usually offer the best hope.
- Biofeedback, relaxation training, counseling, and individualized psychotherapy helps manage stress and helps you change your body's reaction to the tinnitus. Tinnitus Retraining Therapy (TRT) combines counseling with special background sounds designed to help people suppress the sounds of their tinnitus.
- Antianxiety medications, such as Valium or Xanax, as well as a wide range of antidepressant medications, are very helpful for tinnitus sufferers. Other medications, such as diuretics (water pills), muscle relaxants, anticonvulsants medications, and antihistamines, are also used.
- Special hearing aids, electronic masking devices, or both, are often used when other methods have failed to achieve control. Cochlear implants and cochlear stimulation devices are being investigated for severe, intractable tinnitus cases. Surgical injections of lidocaine directly into the inner ear are also being used in some cases.
- Alternative treatments such as hypnosis, acupuncture, chiropractic adjustments, vitamin/mineral supplements, and herbal remedies may have some promise, but there is little, if any, meaningful research as to their effectiveness. Ginkgo biloba -- which is being studied to determine its effectiveness for tinnitus -- is said to improve blood flow and nerve function. Use ginkgo biloba with caution if you have a bleeding disorder or take blood thinners. Explore alternative options carefully, with the cooperation of your medical providers.
Certain lifestyle changes are very important for those that have tinnitus.
- Caffeine is one of the most common tinnitus aggravators and should be very limited. Coffee, teas, caffeinated colas, and chocolate all contain significant amounts of caffeine capable of constricting blood flow to the ear.
- Nicotine also constricts blood flow and can aggravate tinnitus, so efforts should be made to stop all tobacco use.
- Aspirin, especially higher doses, can cause or make tinnitus worse. Switch to acetaminophen products.
- A low-salt diet is also recommended by many medical providers, so hide that saltshaker and watch the sodium content of foods you eat.
Take an active role in your care, keeping up with the latest research. You may even have to educate your doctor on various treatments. Quieting the ringing will require a lifelong commitment to lifestyle changes, cooperative medical care, and most importantly, a positive and optimistic attitude.
Tinnitus prevention can include obvious things such as limiting exposure to loud noises, but vitamins and exercise may help, too. Exercising regularly may help by improving blood flow to ear structures, while B-12 can help the body make the material that protects the inner ear's nerves. Good B-12 sources include dairy products, meat, and eggs.
Almost everyone experiences an occasional ringing (or roaring, hissing, buzzing, or tinkling) in their ears; most tinnitus that comes and goes requires no medical treatment. But if your tinnitus is accompanied by other symptoms, becomes persistent, or starts to localize to one ear, visit a health professional.
Rod Moser, PA-C, PhD, is a primary care physician assistant with over 30 years of clinical experience in adult and pediatric health. He is the author of Ears: An Owner's Manual and Primary Care for Physician Assistants.
Originally published June 17, 2002.
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