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Tinnitus - Head noise - ringing in the ears

Published by BUPA's Health Information Team
October 2003

Tinnitus is the sensation of a sound in the ear or head that is not being produced by an external source. The sound can be of any pitch or type, continuous or intermittent. There are many different disorders that can produce such symptoms.

It is quite common to have mild tinnitus, and around one in five people report they are occasionally affected. Around one in 200 people has tinnitus so badly that it affects their ability to lead a normal life.

Symptoms of tinnitus

The sensation of tinnitus is the sound of high-pitched whistling or buzzing, ringing or hissing. It can also be a quite complex sound, like the roar of an ocean. The sounds may be constant or come and go.

Whatever the cause of the tinnitus, it is almost always made worse by stress, which can be physical, emotional or psychological. Some people can clearly hear the sound of their tinnitus and are able to live with it quite happily. In others, the sound is terribly annoying and can often drive them to distraction. The sound can be in one or both ears, or perceived elsewhere in the head. It is equally common in men and women and can be associated with almost any disorder of the ear.

Causes and risk factors for tinnitus

Most tinnitus is caused by a problem with the "sensorineural" system, which is involved in transmitting signals from the inner ear to the brain. Tinnitus is often associated with hearing loss. For this reason it is more common in older people who have age-related hearing loss.

Exposure to loud noise at work may also be responsible. For instance, operators of pneumatic drills, workers in noisy factories, musicians and DJs may be at particular risk. Other possible causes of tinnitus are listed below.

• Ménière's disease, which results from an increased pressure in the inner ear and also causes deafness and vertigo
• otosclerosis, a condition in which the small bones of the middle ear become immobile
• ear infections and inflammation
• wax in the ear
• otitis media with effusion (an ear infection often known as 'glue ear' in children)
• acoustic neuroma, a benign (non-cancerous) tumor of the auditory nerve, which carries signals from the inner ear to the brain
• high doses of drugs including aspirin, quinine and some antibiotics
• anemia
• head injury
• low thyroid hormone levels (hypothyroidism)
• disorders of the heart and blood vessels, particularly in the head
• high blood pressure
• an autoimmune disorder, such as lupus (systemic lupus erythematosus)
• problems with the temporomandibular joint (TMJ) - the joint between the jaws, which can also lead to pain in the head or face
• an abnormality of the Eustachian tube, that can result in a wooshing sound

• Ear infection, middle ear
• Ear infection, outer ear
• Hypothyroidism
• Lupus
• Systemic lupus erythematosus
• Vertigo

Diagnosis

The type of sound heard with the tinnitus does not necessarily indicate what the underlying cause might be, nor whether the cause is serious or trivial. You will be carefully examined by a specialist, usually an ENT (ear, nose and throat) surgeon or an audiological physician (doctor specialising in hearing).

He or she will take account of your symptoms and may perform a number of tests, which include hearing tests, balance tests and blood tests.

If the doctor feels that a further investigation of the inner parts of the ear is required, a magnetic resonance imaging (MRI) scan of your head may be organised.

Treatment

Any underlying disorder, such as an ear infection, acoustic neuroma or Ménière's disease, must be treated appropriately.

People with chronic tinnitus without an easily treatable cause, are encouraged not to listen for their tinnitus and aim to concentrate on other things.

If the hearing is impaired, wearing a hearing aid often helps by "masking out" the problem sound with the amplified external signal. In much the same way, special devices (that look like hearing aids) are used as part of tinnitus retraining treatment. These produce particular sounds to mask out the noise of the tinnitus which is accompanied with training to help block out the annoying aspects of tinnitus.

The psychological attitude that you have towards your tinnitus is crucial and people with a positive attitude to dealing with it tend to find it more manageable.

Depression or anxiety can make tinnitus more of a problem and treatment of these conditions may help bring some relief. A range of other treatments including dietary supplements, electromagnetic stimulation and medicines (including antiepileptics and anti-sickness drugs) have been tried, but their effectiveness has not be proven.

• Anxiety
• Depression
• Ear infection, middle ear
• Ear infection, outer ear

Complementary therapy

Any therapy that promotes relaxation and a sense of wellbeing may be useful in relieving tinnitus or the distress it causes. Techniques include yoga, the Alexander technique, meditation, hypnosis and acupuncture. The herbal remedy ginkgo biloba is promoted as a cure for tinnitus but good-quality scientific studies have shown it does not work any better than a placebo (dummy treatment).

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