If you’ve ever experienced ringing in the ears, you may wonder what it means and how to treat it.
Naushad M. Khakoo, MD, works in otolaryngology at Mercy Health — Anderson Ear, Nose and Throat as well as Mercy Health – Ear, Nose and Throat, Clermont. He sees patients with a full range of ears, nose and throat conditions ranging from disorders of hearing or balance, issues with sinuses or voice and swallowing concerns.
Ear ringing, or tinnitus, is defined as the sensation of sound when no external sound is present. Typically, it can be described as ringing, crickets, humming, whooshing, music or even a pulsation or heartbeat type of sound.
“Causes of tinnitus vary, but commonly we think of damage to the inner ear, typically from noise – or age-related hearing loss, medications or drugs that are damaging to the hearing system,” Dr. Khakoo shares. “Conditions of the ear that cause hearing loss can be too much wax in the ear, an ear infection or fluid behind the eardrum, which can also cause tinnitus.”
Dr. Khakoo adds, “there has been a lot of research into the true cause of tinnitus. We think of it as a change in the way the brain works due to loss of hearing, similar to phantom limb pain. Essentially, because the brain loses hearing in certain frequencies, it makes up a sound to fill the lack of input. However, because tinnitus can also happen in situations without hearing loss, for example, with emotional stress, we know that loss of hearing is not always the cause.”
Temporary tinnitus can be caused by short-term exposure to loud noises, such as a loud concert, without hearing protection. Usually, this improves over several days, but can occasionally take weeks to resolve. However, more permanent tinnitus can occur with repeated exposure to damaging noise over time. Typically, this happens to people in noise-heavy environments, like factories with loud machinery, construction sites or in military veterans with exposure to artillery or jet engines.
For those that find tinnitus intrusive or bothersome, quality of life can be affected.
For example, sleep quality can be compromised as the tinnitus can prevent falling asleep. Trying to follow a conversation is another difficulty. As with many medical conditions, prevention is the first step to reduce or eliminate ringing in the ears.
“Wearing ear protection in noisy environments like when operating heavy machinery, at the firing range or during concerts can prevent hearing loss and tinnitus in the future,” Dr. Khakoo advises. “Costs can vary significantly; however, effective hearing protection such as foam ear inserts can be bought in bulk for 25 cents apiece. On the higher end, earplugs with noise filtering functions can range from 20 dollars for a basic model to several thousand dollars for custom-made designs.”
If the tinnitus occurs in the setting of other neurological changes, such as slurred speech, double vision, weakness of the arms or legs or trouble with balance, it may be part of a more concerning medical issue, such as a stroke or other neurologic disease. Tinnitus that occurs in the absence of any factors should always be evaluated, as this could be the first sign of underlying hearing loss.
Choosing the correct treatment for tinnitus depends on several factors, such as how much the tinnitus is affecting you and the primary cause of tinnitus.
“If the tinnitus is due to hearing loss, correction of the loss with either hearing aids or surgery can be effective,” Dr. Khakoo says. “If it is associated with a disorder of balance, addressing these pathologies with appropriate therapy can also help the tinnitus. If you have mild hearing loss, tinnitus that is only bothersome in a quiet environment and does not desire hearing aids, we may discuss noise suppression such as using a white noise machine, turning a fan on or playing the radio or television to create background noise that masks the tinnitus. With more intrusive tinnitus we may discuss behavioral counseling, such as cognitive behavioral therapy, in which you learn coping strategies to reduce stress and anxiety from tinnitus.”
If you are experiencing symptoms of tinnitus, we recommend calling and scheduling an appointment with one of our audiologists for a hearing test, followed by an evaluation by one of our physicians to check for conditions such as fluid behind the ear, impacted wax or a vascular issue that may be the underlying cause.
“For my patients, I perform a comprehensive head and neck examination and may augment this with further procedures such as ear microscopy or high-resolution endoscopy of the nose or throat,” Dr. Khakoo explains. “We then discuss the findings, outline the most likely diagnoses and discuss any further studies needed such as imaging or balance testing, treatment and follow up.”
Learn more about the ear, nose and throat services we offer at Mercy Health.