Tinnitus

Tinnitus is pronounced “TIN-ih-tuss,” not “tin-EYE-tis” since there’s no “-itis” on the end, which would mean inflammation or infection.  It means “ringing in the ears” (from Latin), but can be any type of noise or clicking; it’s a symptom, not a disease.  It amuses me no end when a patient tells how they sought care for the “ringing,” and was told they “have tinnitus.”  They didn’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 “fortunately,” since it means they don’t have an underlying disease.  In a sense, for many people, tinnitus may be analogous to hair turning gray, though there’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 don’t often need to function in life.

Medically-speaking, we’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 clinician’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 – Anatomy.

Ceruminosis (wax in ear canal)

Eustachian Tube Dysfunction (common with colds / allergies)

1.  We look in the ear:

• So much wax in the canal that we can’t see the eardrum?  →  suspect Ceruminosis
  • Wash it out
  • If tinnitus disappears, we have the diagnosis
• No Ceruminosis, but eardrum looks retracted?  →  Eustachian Tube Dysfunction
  • Treat with Allergy Medicine
  • If symptoms resolve, that was the diagnosis

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

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

→  Possibly Eustachian Tube Dysfunction  →  Treat as above

• If gets better, we have the diagnosis
• If not, refer to Ear-Nose-Throat (ENT) Specialist (Otorhinolaryngologist) to rule out rare tumors, and the Superior Semicircular Canal Dehiscence Syndrome famous for its weird symptoms

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

• Significant loss in just One Ear (with normal ear canal and eardrum) would be very unusual without patient realizing it   →  See topic Hearing Loss if <2 weeks; and/or Refer to ENT
• Significant loss in Both Ears – 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.  You’ll notice major improvement in quality of life (& overall happiness).

I’ve heard of small-store owners who play annoying high-pitched sounds which they themselves can’t hear, to keep teenagers away.  And I’ve heard of school students who download high-pitched ring tones so their teachers won’t hear their cell phones; except they get caught by the teachers who aren’t that old yet.