Ear, Nose & Throat

Tinnitus

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Tinnitus (Ringing in the ears)

Tinnitus is a word used by doctors to describe a condition when patients hear noises in their ears or in their heads.

Tinnitus has sometimes been described as ‘the sound of silence’ because all people, if they are seated in a completely quiet soundproofed room, will hear a type of rushing or hissing sound.

Usually this noise is masked by environmental sounds. Hearing words, songs or voices is not included in the definition of tinnitus.

It is when this type of noise becomes intrusive into everyday life that it can become immensely irritating and becomes known as ‘tinnitus’. The noises of tinnitus may vary in pitch from low frequency to high frequency; they maybe intermittent or permanent and they usually vary in the intensity of sound. Some people spend a long time looking around the house for whatever it is that must be making the noise, other people fear that they may be developing a brain tumour.

Sometimes people notice that the intensity of the noises can alter according to various activities such as exercise, the drinking of coffee or wine and other stimuli.

Children can suffer from tinnitus as well as adults, which can be frightening for them when they do not understand what is happening. When tinnitus is first noticed, it can be very worrying.

Types of tinnitus

Tinnitus is generally divided into two types:
  • noises that can be heard by somebody examining the patient (objective tinnitus)
  • noises that can only be heard by the patient (subjective tinnitus)
Objective tinnitus
This type of tinnitus is uncommon. Noises may be caused by spasms of small muscles in the middle ear (often heard as a clicking sound) or by abnormalities of the blood vessels in and around the ear.
It is the turbulent blood flow that is heard directly by the inner ear, and it usually occurs in time with the heart beat (pulsatile tinnitus). Pulsatile tinnitus can occur when there is an increased blood flow to the ear, such as during an infection and inflammation, but also because of anatomical abnormalities of the blood vessels.

Vascular tumours of the middle ear are rare, but also can give a pulsatile tinnitus. Such objective tinnitus which can be heard by the examining doctor may require further investigation by an ear, nose and throat surgeon or audiological physician, and may in some instances have a surgical cure.

Subjective tinnitus
This is by far the most common type of tinnitus. Everyone, if sitting in a soundproof room, hears noises in their heads. Usually these noises are masked in everyday life by all the noise going on in the world around us. If you cannot hear sounds in the outside world so well, you tend to notice the natural noises inside your head much more because they are not being masked (drowned out) by the environmental noises.

Tinnitus is often, but not always, linked to a hearing loss. If the tiny hair cells of the cochlea are damaged, for example through certain drugs, noise exposure or as part of the aging process, the cochlea becomes less good at discriminating sounds, and your hearing is affected.

It is possible that these damaged hair cells also give rise to random noises which we hear as tinnitus. This is the reason that when you consult a specialist about tinnitus, you will have a hearing test.
Hearing loss is not the only cause of tinnitus, but it occurs in many people who do have some problem with their hearing, even if it is only mild, and perhaps unnoticed by the patient themselves.
The loudness of tinnitus is not linked to the degree of hearing loss, nor does the loudness of tinnitus always increase with time. Only about 20% of people with tinnitus perceive it as a great irritation; the majority are able to ignore it most of the time.

Certain types of diseases that affect the inner ear can also be associated with tinnitus (eg Menière's disease).


If tinnitus is only affecting one ear or if it is causing great distress, further investigation is warranted and is generally carried out by an ear nose and throat surgeon.

Investigations usually include hearing tests, and can also involve blood tests and radiological investigations (x-rays or scans). Not everyone with tinnitus will need every investigation. Sometimes no definite cause for the tinnitus is found. On other occasions a readily identifiable cause will be found such as a hearing loss.

Very rarely a more serious condition will be found, such as a tumour of the auditory nerve. Whilst specific causes such as this will be directly addressed, the majority of patients may benefit from other types of medical treatment.

Fortunately, the majority of patients who suffer from tinnitus will either find it gets better by itself, or that they will learn to tolerate the noises after a short period of time of only a few weeks or months.


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