Tinnitus—What's That?

© May 2003 (revised February 2013) by Neil Bauman, Ph.D.

Question: I've begun hearing an annoying buzzing or ringing sound in my ears. What's going on?—T. S.

Answer: The fancy name for the sounds you are hearing is tinnitus. Some people pronounce it "TIN-ih-tus" and others "tih-NYE-tus." Either way is correct. Both are in the dictionary.

The Phantom Strikes Again

Tinnitus is the word we use to describe hearing certain phantom sounds. Tinnitus is not a disease. Rather it is generally a symptom of something wrong in your auditory system. The dictionary defines tinnitus as the sensation of noise, often ringing or roaring, in your ears that comes from inside your head in the absence of any external sound.

Since there is normally no external sound corresponding to the sounds you are "hearing," tinnitus is truly a phantom sound. Your brain actually detects signals in your auditory system or in its own auditory circuits, and you perceive and "hear" them as real. Make no mistake about it; to you the phantom tinnitus sounds are just as real as any external sounds.

One person wrote his ear specialist, "Doctor, please confirm that this noise is not all in my head, and that I am not going mad."

The ear specialist wrote back, "With pleasure! You are not going mad! And yes, it is all in your head, but then, so are your ears!"

What Does Tinnitus Sound Like?

There are a variety of tinnitus sounds. Many people say their ears are ringing or buzzing (mine are ringing right now as I write this-as they have for decades). These are just two of the common tinnitus sounds. Your tinnitus may be a ringing, roaring, beating, clicking, banging, buzzing, hissing, humming, chirping, clanging, sizzling, whooshing, rumbling, whistling or dreadful shrieking noise. To some people, tinnitus sounds like rushing water, breaking glass, owls hooting or chain saws running.

About half the people with tinnitus only hear one tinnitus sound at a time. However, about one quarter of tinnitus sufferers hear two tinnitus sounds at the same time. For example, Ruby heard the roar of Niagara Falls in one ear and what sounded like a broken washing machine in her other ear after taking anti-cancer drugs. To me tinnitus is usually a high-pitched ringing or whine in my ears (much like a high-speed turbine running), and less often a soft shhh sound or a low rumbling noise. Pam hears what sounds like birds chirping and occasionally an owl hooting. When Una shakes her head she hears the pure tone "F ". The rest of the time she hears what sounds like a piece of sheet metal being hammered or a constant high-pitched tone.

About 16% of the people with tinnitus hear three or more tinnitus sounds at the same time. One poor lady, Mrs. P___, used to hear what sounded like a cow bell, a door bell, a tune, a noise like rushing water and a roaring like traffic in a tunnel—all at once.

Because of the variety of tinnitus sounds, sometimes people confuse it with another class of phantom sounds (auditory hallucinations) called Musical Ear syndrome. Tinnitus is always a simple sound. In contrast, Musical Ear syndrome sounds are more complex sounds such as voices, singing or music. (Read the eerie yet fascinating account of Musical Ear syndrome.)

Tinnitus comes in a variety of sounds, volumes and patterns. You may perceive its volume as ranging from subtle to shattering!

Your tinnitus may be constant. It may come and go. In one survey, 72% experienced their tinnitus all the time, 18% heard their tinnitus frequently and only 10% had occasional tinnitus.

About half the people with tinnitus hear their tinnitus in both ears at the same time. About 10% hear it in their left ear, and another 10% hear it in their right ear. For the remainder, they just hear their tinnitus inside their head somewhere.

At times tinnitus can be just plain weird. Occasionally other people may hear your tinnitus (objective tinnitus) as a clicking sound, just like you do. This kind of tinnitus occurs when a muscle in your ear contracts making this clicking sound.

A few people have a type of tinnitus that pulses with every heartbeat (pulsatile tinnitus). This kind of tinnitus results from a (big) artery too close to your middle ear.

Perhaps the weirdest kind of tinnitus is where people can change their tinnitus by doing ordinary, everyday things such as moving their eyes (gaze evoked tinnitus), moving their jaw (temporomandibular joint—TMJ), turning their head, applying pressure to parts of their bodies or even just by bending over which increases their blood pressure—and for them, their tinnitus.

Anita once told me, "When I move my eyes side to side or up and down the pitch of my tinnitus varies with my eye movement." Neat, huh?—until it begins to really bother you. She added, "It also varies with the muscular movement of my jaw, like when eating. Opening and closing my mouth can make the pitch of my tinnitus vary too."

How Common Is Tinnitus?

Tinnitus is relatively common. At least 17 out of every 100 people around the world have some degree of tinnitus. Here in the United States, the American Tinnitus Association estimates that about 50 million Americans have tinnitus to some degree while about 12 million have tinnitus severely enough that they seek medical advice. About 2 million of these have tinnitus so bad that they cannot function normally.

What Causes Tinnitus?

Tinnitus is a symptom, not a disease. Among the more common things that cause or trigger tinnitus are exposing your ears to loud sounds, taking various drugs, eating certain foods, hearing loss, allergies, stress and various ear conditions.

1. Loud Noise

Loud noise is the most common cause of preventable tinnitus. A study of 1,687 people with tinnitus revealed that noise exposure accounted for one out of four cases of tinnitus. Tinnitus from noise exposure and hearing loss generally go together. The American Tinnitus Association reports that up to 90% of all people with tinnitus have some level of noise-induced hearing loss. If you are around loud sounds for a while, perhaps you've noticed that your ears rang for a while after. This is tinnitus.

You may find that tinnitus occurs immediately after you have been exposed to a loud noise. Most often, you get mild, temporary tinnitus, but it may be permanent. The length of time your tinnitus lasts and its severity generally increases each time you expose your ears to loud noise. Finally, one day, if you continue to work, play or live around loud sounds, you may end up with permanent (and distressing) tinnitus, not to mention hearing loss.

This does not have to happen. You can protect yourself from noise-induced tinnitus. The choice is yours. All you need to do is avoid loud sounds or protect your ears from excessive noise by wearing ear protectors.

2. Prescription Drugs

The second most common cause of preventable tinnitus is from taking various prescription or non-prescription drugs. There are hundreds of these drugs in common use. The third edition of my book "Ototoxic Drugs Exposed" lists 529 drugs (and 29 chemicals) that are known to cause tinnitus. Such drugs can either cause tinnitus in the first place, make your existing tinnitus louder or cause a new tinnitus sound.

You can also download a 30-page listing of all the known (to me) drugs, herbals and chemicals that can cause tinnitus. It lists all the drugs in alphabetical order by their generic names and by their brand names. The brand new 2013 edition is called "Prescription Medications, Over-the-Counter Drugs, Herbs & Chemicals Associated with Tinnitus". It's in pdf format.

Tinnitus usually appears first as a continuous high-pitched sound. Often tinnitus precedes or accompanies hearing loss from ototoxic drugs. In fact, tinnitus is the number one indicator that you may be doing damage to your ears. It also may be the only warning you'll ever get. Pay attention to it! If your ears start to ring after you begin taking any drug, you should immediately report this to your doctor. You and your doctor should then decide what to do-whether to reduce the dose, change the medication or stop taking that medication altogether.

3. Certain Foods

Specific foods such as red wine, grain-based spirits, cheese and chocolate can trigger or increase tinnitus in some people. Penny finds that wine, vinegar and certain spices affect the loudness of her tinnitus. She also finds that any foods containing mold will make her tinnitus louder.

Other things to beware of include caffeine, monosodium glutamate (MSG), nicotine, alcohol, marijuana and some spices. For example, Sue finds that eating hot spices such as chili peppers, hot salsa and hot paprika make her tinnitus louder.

Some people find that just eating foods high in sugar makes their tinnitus louder.

4. Hearing Loss

Very often, hearing loss and tinnitus go hand in hand. Tinnitus does not cause hearing loss. Rather, it is the other way around. Hearing loss often results in tinnitus. The good news is that wearing hearing aids to correct the hearing loss often results in the tinnitus going away or fading into the background while you are wearing your hearing aids. Unfortunately, your tinnitus can come back at night when you remove your hearing aids to sleep.

5. Allergies

Allergies can also trigger tinnitus. Penny writes, "Allergies play a big part in the level of my tinnitus. I couldn't walk into a library without having my tinnitus go off the charts—all because of dust." She adds, "Many people have allergic reactions to things and don't even know it's allergy-related. They don't connect what they ate with the level of their tinnitus, or what they smelled, or what plants they're surrounded by, or if there's mold out in their yard."

6. Stress

Uncontrolled anxiety, stress and tension often make your tinnitus worse. Recent studies show that stress can also cause annoying tinnitus. Learning how to deal with the stress in you life can eliminate or greatly reduce tinnitus from this cause.

7. Ear Conditions

Certain ear conditions may also trigger tinnitus. For example, many people, including children, experience tinnitus along with a middle ear infection (otitis media) or a sinus infection. Generally, the tinnitus will lessen and gradually fade away once the infection clears up.

Other conditions that can trigger tinnitus include calcium build-up on the small bones in your middle ears (otosclerosis), pressure problems in the Eustachian tubes connecting your middle ears to your throat, an increase of fluid in your inner ears (Meniere's disease) or any other condition that disturbs the fluid pressure in your inner ears. In addition, tinnitus may be caused by tumors on your auditory nerves (acoustic neuroma), changes in the hair cells of your inner ears, poor nerve function due to pressure on them from surrounding tissues, operations on or around your ears, and even such simple things as wax (cerumen) build-up, foreign bodies or swelling in your ear canals. The truth is that almost anything that can go wrong with your ears or in your auditory system can trigger tinnitus.

The Effects of Tinnitus

The impact tinnitus has on a person's life can vary enormously. Obviously there is a major difference between mild or short lasting tinnitus and loud, severe, constant tinnitus day in and day out. Some people learn to completely ignore their tinnitus. The fancy term for this is "habituation." For many others, tinnitus is only a mild irritation. However, for some, tinnitus is totally debilitating and disrupts their entire life. People with severe tinnitus often have problems sleeping. They may be irritable and cannot concentrate on anything other than their tinnitus. As a result, they are constantly under stress, perform poorly, and lose their joy of living. The great musician, Beethoven, once lamented, "My ears whistle and buzz continually day and night. I can say I am living a wretched life."

What Can You Do About Tinnitus?

You do not have to let tinnitus drive you "buggy." There are a number of ways you can help yourself control your tinnitus. I've touched on five of these in this article-protect your ears from loud sounds, avoid tinnitus-producing medications, avoid certain foods, get your allergies under control and reduce your stress. There are many others. Unfortunately, they require more space than an article of this nature permits. If you would like to learn more about tinnitus and the many things you can do to help bring it under control, see the fifth edition of my book "When Your Ears Ring—Cope with Your Tinnitus—Here's How." Take charge of your tinnitus. You don't have to let these phantom sounds control you.