Tinnitus

Tinnitus: Overview

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 and 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.

Tinnitus

Information On This Page

Signs, symptoms & indicators of Tinnitus:

Symptoms - Head - Ears

Sound of blood rushing in one ear is often a sign or symptom of TinnitusSound of blood rushing in both ears or sound of blood rushing in one ear
People with pulsatile tinnitus typically hear a regular sound that occurs in time with their heartbeat.

Conditions that suggest Tinnitus:

Mental

Depression may suggest TinnitusDepression
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]

Metabolic

Insomnia may suggest TinnitusInsomnia
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.

Symptoms - Head - Ears

Risk factors for Tinnitus:

Allergy

Circulation

Megaloblastic Anemia / Pernicious Anemia may increase risk of TinnitusMegaloblastic 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]

Environment / Toxicity

Mental

Stress may increase risk of TinnitusStress
Many people say their tinnitus is worse when they are tired or stressed.

Metabolic

Musculo-Skeletal

TMJ Problems often increases risk of TinnitusTMJ Problems
A study of twenty patients with tinnitus found that ten tested positive for TMJ dysfunction in all diagnostic tests used, and nine more 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.

Nutrients

Zinc Requirement may increase risk of TinnitusZinc 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]

Supplements and Medications

Frequent aspirin use may increase risk of TinnitusFrequent aspirin use
Aspirin can cause tinnitus at high doses.

Tinnitus suggests the following may be present:

Circulation

Tinnitus often suggests Megaloblastic Anemia / Pernicious AnemiaMegaloblastic 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]

Mental

Tinnitus often suggests StressStress
Many people say their tinnitus is worse when they are tired or stressed.

Tinnitus can lead to:

Mental

Tinnitus often leads to DepressionDepression
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]

Metabolic

Tinnitus often leads to InsomniaInsomnia
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.

Recommendations for Tinnitus:

Botanical

Ginkgo Biloba may help with TinnitusGinkgo 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 may help with TinnitusVinpocetine
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.

Diet

Drug

Conventional Drug Avoidance often helps with TinnitusConventional 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.

Habits

Aerobic Exercise may help with TinnitusAerobic 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.

Mineral

Magnesium often helps with TinnitusMagnesium
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]

Skin

DMSO Topically may help with TinnitusDMSO 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]

KEY

Weak or unproven link: may suggest; may increase risk of
Weak or unproven link:
may suggest; may increase risk of
Strong or generally accepted link: is often a sign or symptom of; often increases risk of; often suggests; often leads to
Strong or generally accepted link:
is often a sign or symptom of; often increases risk of; often suggests; often leads to
Definite or direct link: strongly suggests; increases risk of
Definite or direct link:
strongly suggests; increases risk of
May be useful: may help with
May be useful:
may help with
Moderately useful: often helps with
Moderately useful:
often helps with