Tinnitus

Tinnitus is pronounced โ€œTIN-ih-tuss,โ€ not โ€œtin-EYE-tisโ€ since thereโ€™s no โ€œ-itisโ€ on the end, which would mean inflammation or infection.  It means โ€œringing in the earsโ€ (from Latin), but can be any type of noise or clicking; itโ€™s a symptom, not a disease.  It amuses me no end when I hear a patient has sought care for the โ€œringing,โ€ and is told they โ€œhave tinnitus.โ€  They didnโ€™t seek a Latin lesson!  They want to know why they have it.

Unfortunately, there are no good explanations for the vast majority of people with tinnitus.  Or maybe โ€œfortunately,โ€ since it means they donโ€™t have an underlying disease.  In a sense, for many people, tinnitus may be analogous to hair turning gray, though thereโ€™s no good treatment for it, other than learning to distract oneself and ignore it. 

Fortunately, people can usually do so, although a very few can have it quite severely.  Tinnitus is very common, especially as we get older.  It usually occurs among people with hearing loss, which is most commonly high frequency, in a range we donโ€™t often need to function in life.

Medically-speaking, weโ€™re more concerned about any hearing loss associated with the tinnitus, than about the ringing / noise itself.  New, acute hearing loss in one ear is a special entity: see symptom topic Hearing Loss.

The clinicianโ€™s main job is to rule out underlying causes, like rare tumors or brain diseases, but also identify two very common causes.  See Diagram:  The Ear โ€“ Anatomy.

Ceruminosis (wax in ear canal)

Eustachian Tube Dysfunction (common with colds / allergies)

1.  We look in the ear:

Assuming neither of Above, and that Ear Canal & Eardrum look normal (by otoscope):

2.ย  Is the tinnitus Pulsatile (ring / noise comes with each heartbeat)?ย  If YES:

โ†’  Possibly Eustachian Tube Dysfunction  โ†’  Treat as above

3.  Test Hearing in Each Ear (block other ear: can they hear whisper 6 feet away?)

  • Significant loss in just One Ear (with normal ear canal and eardrum) would be very unusual without patient realizing it   โ†’  See topic Hearing Loss if <2 weeks; and/or Refer to ENT
  • Significant loss in Both Ears โ€“ Most likely cause of Tinnitus (see below)
  • No obvious hearing loss  —  Do formal audiometry by office machine or referral to Audiologist (see below)

Age-related high-frequency hearing loss is very common, maybe universal.  Because it mainly occurs with high-pitched sounds, most of us may not notice it, unless it begins to affect lower frequencies as well.  But it can cause tinnitus.  If  symptoms are relatively new, especially if the patient is not very old, it may be worth a referral as above, to rule out rare causes.

The only treatment is for the hearing part, with a hearing aid.  For those with profound hearing loss who are too proud to wear one, give it a try.  Youโ€™ll notice major improvement in quality of life (& overall happiness).

Iโ€™ve heard of small-store owners who play annoying high-pitched sounds which they themselves canโ€™t hear, to keep teenagers away.  And Iโ€™ve heard of school students who download high-pitched tones so their teachers wonโ€™t hear their cell phones ring; except they get caught by the teachers who arenโ€™t that old yet.

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