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Tinnitus is the medical term for "ringing in the ears" although some people hear other sounds. It is the subjective complaint of hearing a noise in the absence of any external sound. This noise may be heard in one ear, both ears, the middle of the head - or it may be difficult to pinpoint its location. The noise may be low, medium or high-pitched; there may be a single noise or two or more components to the sound; the noise may be continuous or it may come and go. Experiences of tinnitus are very common in all age groups, especially following exposure to loud noise, but it is unusual for it to become a major problem unless the exposure becomes chronic.
An important distinction must be made between a simple case of tinnitus and Meniere's disease, a more serious condition characterized by tinnitus, vertigo, and hearing loss.
Incidence; Causes & Development
Approximately 10 to 20% of Americans suffer from mild tinnitus and 80% of those hear ringing constantly. Of the elderly, 30% experience tinnitus.
Besides loud noises, other causes include severe head trauma, sinus and respiratory infections, ear infections, wax build-up, high blood cholesterol, TMJ problems, food allergies, certain types of tumors and a long list of other conditions. In one database of 1,687 tinnitus patients, noise exposure was the cause of 24% of cases and no known cause was identifiable in 43%.
Pulsatile Tinnitus
Sometimes a tinnitus noise beats in time with your pulse. This is called pulsatile or vascular tinnitus. Approximately 3% of tinnitus patients experience this kind of tinnitus; people with pulsatile tinnitus typically hear a rhythmic pulsing, often in time with a heartbeat. The most common cause of pulsatile tinnitus is arterial turbulence, a noisy blood flow caused by plaques or kinks in the arteries in the head or neck. It can be made worse if there is also hypertension. Many forms of pulsatile tinnitus are treatable.
Here is a list of the possible causes of pulsatile tinnitus:- Arteriovenous malformations (AVMs.) AVMs are abnormal collections of arteries and veins that sometimes occur within the cranial cavity near the auditory nerve. AVM pulsation against the auditory nerve stimulates the nerve, resulting in a pulsating tinnitus.
- Carotid artery-cavernous sinus fistula. This is an abnormal connection between a very large artery and a very large venous pool within the cranial cavity. It is usually the result of severe head trauma. Treatment is nonsurgical, requiring the services of a radiologist.
- Chronic inflammation and/or infection of the middle ear. Chronic inflammation is almost always accompanied by increased blood flow to the inflamed tissue; since this tissue is in the ear, some people are able to hear the increase in blood flow.
- Middle ear fluid. The middle ear is normally an air-filled space. If, due to infection, inflammation or eustachian tube dysfunction, fluid accumulates behind the middle ear then pulsating tinnitus may result.
- Vascular tumors in the middle ear. These are most commonly referred to as glomus tumors or paragangliomas. They are benign but can be troublesome and surgery is required for correction of this problem.
- Venous hum. Patients who are pregnant, anemic, or have thyroid problems may develop increased blood flow through the largest vein in the neck, the jugular vein. The jugular vein carries blood from the brain back to the heart; in so doing, it traverses the middle ear. Turbulent blood flow anywhere in the course of the jugular vein can be heard in the middle ear as a "hum" which may or may not fluctuate with the pulse. Correction or resolution of the underlying problem often results in improvement.
Prognosis
Many patients recover spontaneously - with or without treatment - during the first 6 months of suffering. Chronic tinnitus results when the disturbing symptom is present for more than 6 months.
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Conditions that suggest Tinnitus: | | | | | Mental |  Depression | Many tinnitus sufferers become depressed simply from having to deal with the constant noise. Treating the depression may make the tinnitus seem less severe. Certain anti-depressants may worsen tinnitus, while others may improve it. SRI anti-depressants may temporarily worsen tinnitus for the first few weeks.
Alprazolam (Xanax) in a double-blind study showed 76% of the subjects benefited with tinnitus reductions of at least 40%, whereas only 5% of the placebo subjects had an improvement. [Arch Otolaryngol Head Neck Surg. 1993:119: pp.842-845] |
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Metabolic |
Insomnia| | In a double-blind study of people who had difficulty sleeping because of tinnitus, supplementation with 3mg of melatonin per night for one month resulted in improved sleep. |
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Symptoms - Head - Ears |
 Tinnitus (confirmed) |
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Risk factors for Tinnitus: | | | | | Allergy |  Environmental Illness / MCS |
Circulation |
Megaloblastic Anemia / Pernicious Anemia| | In one report, 47% of people with tinnitus and related disorders were found to have vitamin B12 deficiencies. Supplementation may therefore be of benefit. [Vitamin B12 deficiency in patients with chronic-tinnitus and noise-induced hearing loss. Am J Otolaryngol 1993;14: pp.94-9] |
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Environment / Toxicity |
Mercury Toxicity (Amalgam Illness)
Fluoride Toxicity
Electrical Hypersensitivity |
Mental |
Stress| | Many people say their tinnitus is worse when they are tired or stressed. |
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Metabolic |
Meniere's Disease |
Musculo-Skeletal |
TMJ Problems| | The findings of a recent study were very interesting. Of a group of twenty patients with tinnitus, ten tested positive for TMJ dysfunction in all diagnostic tests used. Nine tested positive to one or more of the diagnostic procedures. Only one patient of the twenty had no positive evidence of any jaw joint dysfunction. Dr. Morgan's findings were published in The Journal of Craniomandibular Practice. ["Tinnitus of TMJ Origin: A Preliminary Report," Vol.10, No.2]
Another research project was headed by Richard L. Goode, MD, professor of ENT and Head and Neck surgery at Stanford University's School of Medicine. Drs Morgan and Goode were able to establish the mechanical connection between the ossicles in the middle ear and the capsule and disk of the TMJ. ["The TMJ-Ear Connection", Journal of Craniomandibular Practice, Vol. 13, No.1).]
You may get an idea if the tinnitus is connected to your TMJ in some way, by - Clenching your teeth - does it change the tinnitus in some way? (Get louder/softer, pitch change)
- Pushing in hard on the jaw with your palm. Does the tinnitus change?
- Pushing in hard on the forehead with your hand. Resist with the head. Any changes?
As many as 50% of people using these techniques find a change in their tinnitus and a TMJ correlation they had not known about. |
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Nutrients |
Zinc Requirement| | High concentrations of zinc are found in the inner ear. A Japanese study tested the theory that insufficient levels of zinc may therefore contribute to tinnitus. Researchers found that tinnitus sufferers with low zinc levels in their blood experienced an improvement in their symptoms when, after two weeks of zinc supplementation, their zinc levels rose significantly.
Another study found that 25% of those with tinnitus and low serum zinc reported improvement after 3 to 6 months of supplementation. [ Am J Otol 1985;6: pp.116-7] |
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Tinnitus suggests the following may be present: | | | | | Circulation | Megaloblastic Anemia / Pernicious Anemia| | In one report, 47% of people with tinnitus and related disorders were found to have vitamin B12 deficiencies. Supplementation may therefore be of benefit. [Vitamin B12 deficiency in patients with chronic-tinnitus and noise-induced hearing loss. Am J Otolaryngol 1993;14: pp.94-9] |
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Mental |
Stress| | Many people say their tinnitus is worse when they are tired or stressed. |
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Tinnitus can lead to: | | | | | Mental | Depression| | Many tinnitus sufferers become depressed simply from having to deal with the constant noise. Treating the depression may make the tinnitus seem less severe. Certain anti-depressants may worsen tinnitus, while others may improve it. SRI anti-depressants may temporarily worsen tinnitus for the first few weeks.
Alprazolam (Xanax) in a double-blind study showed 76% of the subjects benefited with tinnitus reductions of at least 40%, whereas only 5% of the placebo subjects had an improvement. [Arch Otolaryngol Head Neck Surg. 1993:119: pp.842-845] |
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Metabolic |
Insomnia| | In a double-blind study of people who had difficulty sleeping because of tinnitus, supplementation with 3mg of melatonin per night for one month resulted in improved sleep. |
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Recommendations and treatments for Tinnitus: | | | | | Botanical |  Ginkgo Biloba| | Studies have shown a range of responses from nothing more than a placebo to an effectiveness rate of 50%. Gingko must be administered long term (many months) to achieve benefit. Amongst patients suffering from cerebrovascular insufficiency, a common problem associated with normal aging, a gingko extract produced a significant improvement in the symptoms of vertigo, tinnitus, headache and forgetfulness. |
Vinpocetine| | Personal testimonies indicate that vinpocetine, acting as a cerebral vasodilator, may be effective in some people for reducing tinnitus. A typical dosage for this purpose is 20 to 40mg per day. |
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Diet |
Therapeutic Fasting |
Drug |
 Conventional Drug Avoidance| | The effects of tinnitus can be magnified by at least 200 different drugs. This list includes some commonplace drugs such as aspirin, alcohol, caffeine, quinine, birth control pills and antibiotics such as gentamicin. It should be noted, however, that special gentamicin applications have cured tinnitus also. |
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Habits |
Aerobic Exercise| | Regular exercise may help increase blood circulation to the head and thus reduce the symptoms of tinnitus if it is caused by poor circulation. |
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Mineral |
Magnesium| | 300 young healthy male military recruits undergoing two months of basic training were studied. The trainees were repeatedly exposed to high levels of impulse noises, with ringing of the ears as a consequence. Each recruit received daily either 167mg of magnesium aspartate or a placebo. Permanent hearing loss was significantly more frequent and more severe in the placebo group than in the magnesium group. [Am J Otolaryngol 1994;15: pp.26-32] |
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Skin |
DMSO Topically| | Patients suffering from tinnitus were given 2ml of a medicated DMSO solution every 4 days. The medication contained anti-inflammatory and vasodilatory compounds and was applied locally to the external ear canal. They were also given an intramuscular injection of DMSO at the same time. After one month, 9 of the 15 subjects had a complete cessation of the tinnitus which didn't return during the one year observation period. It diminished in two others and in the remaining four occurred occasionally instead of permanently. Cold temperatures seemed to be the main factor causing it to return. [Annals of the New York Academy of Sciences 75:243:468: p.74] |
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KEY | | Weak or unproven link | | | Strong or generally accepted link | | | Proven definite or direct link | | | May do some good | | | Likely to help |
GLOSSARY
Allergy (Allergies)
Hypersensitivity caused by exposure to a particular antigen (allergen), resulting in an increased reactivity to that antigen on subsequent exposure, sometimes with harmful immunologic consequences.
Anti-inflammatory (Antiinflammatory)
Reducing inflammation by acting on body mechanisms, without directly acting on the cause of inflammation, e.g., glucocorticoids, aspirin.
Arterial (Arteries, Artery)
Blood that leaves the heart. When it leaves the right ventricle, it is venous blood; and when it leaves the left ventricle, through the aorta, it is fresh and oxygenated. After it has passed out to the capillaries and started to return, it is venous blood.
Benign
Literally: innocent; not malignant. Often used to refer to cells that are not cancerous; they tend to grow slowly and don't spread (metastasize) like cancer tumors do.
Cholesterol
A waxy, fat-like substance manufactured in the liver and found in all tissues, it facilitates the transport and absorption of fatty acids. In foods, only animal products contain cholesterol. An excess of cholesterol in the bloodstream can contribute to the development of atherosclerosis.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
Cobalamin (B12, B-12, Cobalamine, Vitamin B12)
Essential for normal growth and functioning of all body cells, especially those of bone marrow (red blood cell formation), gastrointestinal tract and nervous system, it prevents pernicious anemia and plays a crucial part in the reproduction of every cell of the body i.e. synthesis of genetic material (DNA).
Fistula
An abnormal passageway, allowing movement between organs.
Glomus tumors (Glomus tumor)
Benign perivascular (around a blood vessel) tumors. They usually are found under the skin of the fingers.
Hypertension
High blood pressure. Hypertension increases the risk of heart attack, stroke, and kidney failure because it adds to the workload of the heart, causing it to enlarge and, over time, to weaken; in addition, it may damage the walls of the arteries.
Magnesium
An essential mineral. The chief function of magnesium is to activate certain enzymes, especially those related to carbohydrate metabolism. Another role is to maintain the electrical potential across nerve and muscle membranes. It is essential for proper heartbeat and nerve transmission. Magnesium controls many cellular functions. It is involved in protein formation, DNA production and function and in the storage and release of energy in ATP. Magnesium is closely related to calcium and phosphorus in body function. The average adult body contains approximately one ounce of magnesium. It is the fifth mineral in abundance within the body--behind calcium, phosphorus, potassium and sodium. Although about 70 percent of the body's magnesium is contained in the teeth and bones, its most important functions are carried out by the remainder which is present in the cells of the soft tissues and in the fluid surrounding those cells.
Melatonin
The only hormone secreted into the bloodstream by the pineal gland. The hormone appears to inhibit numerous endocrine functions, including the gonadotropic hormones. Research exists on the efficacy of melatonin in treating jet lag and certain sleep disorders. Dosages greater than l milligram have been associated with drowsiness, headaches, disturbances in sleep/wake cycles and is contraindicated in those who are on antidepressive medication. It also negatively influences insulin utilization.
Meniere's Disease (Menieres, Meniere's, Ménière's)
An affliction of the middle ear characterized by vertigo, nausea, vomiting, tinnitus and progressive deafness.
Milligram (mg, Milligrams)
0.001 or a thousandth of a gram.
Milliliter (mL)
0.001 or one thousandth of a liter.
Placebo (Placebos)
A pharmacologically inactive substance. Often used to compare clinical responses against the effects of pharmacologically active substances in experiments.
Serum
The cell-free fluid of the bloodstream. It appears in a test tube after the blood clots and is often used in expressions relating to the levels of certain compounds in the blood stream.
Sinuses (Sinus)
Four pairs of air pockets lined with membranes in the bones around the nose. The ethmoid sinuses are located on each side of the nose between the eyes; the maxillary sinuses are located in the cheek above the teeth and below the eyes; the sphenoid sinuses are located deeply behind the eyes; the frontal sinuses are located in the forehead.
SRI
Serotonin Reuptake Inhibitor. The result of this inhibition action is to maintain higher levels of serotonin.
Tempero-Mandibular Joint (TMJ)
The hinge of the jaw.
Thyroid (Thyroid Gland)
The thyroid gland is an organ with many veins, anchored around the front of the throat near the voice box. It is essential to normal body growth in infancy and childhood. It absorbs iodine from the diet and releases thyroid hormones - iodine-containing compounds that help govern the rate of the body's metabolism (its total life processes), affecting body temperature, and regulating protein, fat and carbohydrate catabolism in all cells. They keep up growth hormone release, skeletal maturation, and heart rate, force, and output. They promote central nervous system growth, stimulate the making of many enzymes, and are necessary for muscle tone and vigor. To a high degree, metabolism is regulated by the hormone thyroxine, which can be made by the thyroid if enough organic iodine is available. An enlarged thyroid gland that is not cancer is sometimes called goitre.
Tinnitus (Tinnitis)
A sensation of noise (ringing or roaring) that is caused by a bodily condition and can usually only be heard by the person affected.
Vascular
Relating to the blood vessels of the body. The blood vessels of the body, as a group, are referred to as the vascular system. They are composed of arteries, veins and capillaries - arteries that pass oxygen-rich blood to the tissues of the body; veins which return oxygen-depleted blood from the tissues to the lungs for oxygen; and the capillaries that are the tiniest vessels and are between the arteries and veins.
Vasodilation (Vasodilator)
Widening or enlarging of blood vessels, particularly arterioles, usually caused by nerve impulses or certain drugs that relax smooth muscle in the walls of the blood vessels.
Venous
Pertaining to the veins.
Vertigo
The sensation of spinning or whirling; a state in which you or your surroundings seem to whirl dizzily.
Zinc
An essential trace mineral. The functions of zinc are enzymatic. There are over 70 metalloenzymes known to require zinc for their functions. The main biochemicals in which zinc has been found to be necessary include: enzymes and enzymatic function, protein synthesis and carbohydrate metabolism. Zinc is a constituent of insulin and male reproductive fluid. Zinc is necessary for the proper metabolism of alcohol, to get rid of the lactic acid that builds up in working muscles and to transfer it to the lungs. Zinc is involved in the health of the immune system, assists vitamin A utilization and is involved in the formation of bone and teeth.
Last updated: Aug 01, 2009
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