Topic Resources Ringing in the ears (tinnitus) is noise originating in the ear rather than in the environment. It is a symptom and not a specific disease. Tinnitus is very common—10 to 15% of people experience it to some degree. Subjective tinnitus is by far the most common type. It is caused by abnormal activity
in the part of the brain responsible for processing sound (auditory cortex). Doctors do not fully understand how this abnormal activity develops. Objective tinnitus is much less common. It represents actual noise created by structures near the ear. Other people can sometimes hear the sounds of objective tinnitus if they listen closely. More than 75% of ear-related
disorders include tinnitus as a symptom, and people who have hearing loss, regardless of cause, often develop tinnitus. The most common causes of subjective tinnitus include Exposure to loud noises or explosions (acoustic trauma)
Other causes of tinnitus include
middle ear infections
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Objective tinnitus usually involves noise from blood vessels near the ear. In such cases, the sound comes with each beat of the pulse (pulsatile). Causes include
Turbulent flow through the carotid artery or jugular vein
Certain middle ear tumors that are rich in blood vessels
Malformed blood vessels of the membrane covering the brain
Not all tinnitus requires evaluation by a doctor. The following information can help people decide whether a doctor's evaluation is needed and help them know what to expect during the evaluation.
Certain symptoms and characteristics are cause for concern. They include
Tinnitus in only one ear
Any neurologic symptoms (other than hearing loss), particularly difficulty with balance or walking, but also vertigo or difficulty seeing, speaking, swallowing, and/or talking
People with warning signs should see a doctor right away. People without warning signs in whom tinnitus recently developed should call their doctor, as should people with pulsatile tinnitus. Most people with tinnitus and no warning signs have had tinnitus for a long time but should see their doctor about it if they have not already done so.
In people with tinnitus, doctors first ask questions about the person's symptoms
and medical history. Doctors then do a physical examination. What they find during the history and physical examination may suggest a cause of the tinnitus and the tests that may need to be done (see table
Some Causes and Features of Tinnitus
Some Causes and Features of Tinnitus
During the medical history, doctors ask about the following:
The nature of the tinnitus, including whether it is in one or both ears and whether it is constant or pulsatile
Whether the person has any neurologic symptoms
Whether the person has been exposed to loud noise or to drugs that can affect the ears
During the physical examination, doctors focus on examining the ears (including hearing) and the neurologic system. They also listen with a stethoscope over and near the person's ear and on the neck for sounds of objective tinnitus.
Possible tests for people with tinnitus include
Treatment of stress and other mental conditions (such as depression) may help. Many people are reassured if they learn that their tinnitus is not caused by a serious disorder. Caffeine and other stimulants can worsen tinnitus, so people should try to avoid these.
Most tinnitus is due to causes that are not dangerous, for example, exposure to loud noise, aging, Meniere disease, and use of certain drugs.
In many cases, the cause is unknown.
Findings that are of concern include tinnitus accompanied by any neurologic symptoms and tinnitus in only one ear (particularly when accompanied by hearing loss, dizziness, and/or balance difficulty).
Tinnitus rarely can be stopped, but certain techniques help people manage their symptoms effectively.
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