Ringing in the Ears (Tinnitus)

Topic Overview

Many people experience an occasional ringing (or roaring, hissing, buzzing, or tinkling) in their ears. The sound usually lasts only a few minutes. Ringing in the ears that does not get better or go away is called tinnitus. You may hear a sound, such as a ringing or roaring, that does not come from your surroundings (nobody else can hear it). The sound may keep time with your heartbeat, it may keep pace with your breathing, it may be constant, or it may come and go. Tinnitus is most common in people older than age 40. Men have problems with tinnitus more often than women.

See a picture of the ear.

There are two main types of tinnitus.

• Pulsatile (like a heartbeat) tinnitus is often caused by sounds created by muscle movements near the ear, changes in the ear canal, or blood flow (vascular) problems in the face or neck. You may hear sounds such as your own pulse or the contractions of your muscles.
• Nonpulsatile tinnitus is caused by problems in the nerves involved with hearing. You may hear sounds in one or both ears. Sometimes this type of tinnitus is described as coming from inside the head.

The most common cause of tinnitus is hearing loss that occurs with aging (presbycusis), but it can also be caused by living or working around loud noises (acoustic trauma). Tinnitus can occur with all types of hearing loss and may be a symptom of almost any ear disorder. Other possible causes of tinnitus include:

• A buildup of earwax.
• Medicines, especially antibiotics or large amounts of aspirin.
• Drinking an excessive amount of alcohol or caffeinated beverages.
• Ear infections or eardrum rupture.
• Dental or other problems affecting the mouth, such as temporomandibular (TM) problems.
• Injuries, such as whiplash or a direct blow to the ear or head.
• Injury to the inner ear following surgery or radiation therapy to the head or neck.
• A rapid change in environmental pressure (barotrauma).
• Severe weight loss from malnutrition or excessive dieting.
• Repeated exercise with the neck in a hyperextended position, such as when bicycle riding.
• Blood flow (vascular) problems, such as carotid atherosclerosis, AV malformations, and high blood pressure (hypertension).
• Nerve problems (neurologic disorders), such as multiple sclerosis or migraine headache.
• Other diseases. These may include:
  • Acoustic neuroma.
  • Anemia.
  • Labyrinthitis.
  • Ménière's disease.
  • Otosclerosis.
  • Thyroid disease.

Most tinnitus that comes and goes does not require medical treatment. You may need to see your doctor if tinnitus occurs with other symptoms, does not get better or go away, or is in only one ear. There may not be a cure for tinnitus, but your doctor can help you learn how to live with the problem and make sure a more serious problem is not causing your symptoms.

Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a doctor.

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Author:	Jan Nissl, RN, BS	Last Updated: February 13, 2008
Medical Review:	William M. Green, MD - Emergency Medicine Donald R. Mintz, MD - Otolaryngology
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