Tinnitus has two pronunciations: ti-NIGHT-us or TIN-i-tus. Both are correct, though the American Tinnitus Association uses ti-NIGHT-us. Tinnitus is the medical term for “ringing in the ears” although some people hear other sounds. It is the subjective complaint of hearing a noise in the absence of any external sound. This noise may be heard in one ear, both ears, the middle of the head or it may be difficult to pinpoint its location. The noise may be low, medium or high-pitched. There may be a single noise or two or more components to the sound. The noise may be continuous or it may come and go. Experiences of tinnitus are very common in all age groups, especially following exposure to loud noise, but it is unusual for it to become a major problem unless the exposure becomes chronic.
An important distinction must be made between a simple case of tinnitus and Meniere’s disease, a more serious condition characterized by tinnitus, vertigo, and hearing loss.
Approximately 10 to 20% of Americans suffer from mild tinnitus and 80% of those hear ringing constantly. Of the elderly, 30% experience tinnitus. Besides loud noises, other causes include severe head trauma, sinus and respiratory infections, ear infections, wax build-up, high blood cholesterol, TMJ problems, food allergies, certain types of tumors and a long list of other conditions. In one database of 1,687 tinnitus patients, noise exposure was the cause of 24% of cases and no known cause was identifiable in 43%.
The effects of tinnitus can be magnified by at least 200 different drugs. This list includes some commonplace drugs such as aspirin, alcohol, caffeine, quinine, birth control pills and antibiotics such as gentamicin. It should be noted however, that special gentamicin applications have cured tinnitus also.
Many patients recover spontaneously – with or without treatment – during the first 6 months of suffering. Chronic tinnitus results when the disturbing symptom is present for more than 6 months.
Pulsatile Tinnitus
Sometimes a tinnitus noise beats in time with your pulse. This is called pulsatile or vascular tinnitus. Approximately 3% of tinnitus patients experience this kind of tinnitus; people with pulsatile tinnitus typically hear a rhythmic pulsing, often in time with a heartbeat. The most common cause of pulsatile tinnitus is arterial turbulence, a noisy blood flow caused by plaques or kinks in the arteries in the head or neck. It can be made worse if there is also hypertension. Many forms of pulsatile tinnitus are treatable.
Here is a list of the possible causes of pulsatile tinnitus:
- Arteriovenous malformations (AVMs.) AVMs are abnormal collections of arteries and veins that sometimes occur within the cranial cavity near the auditory nerve. AVM pulsation against the auditory nerve stimulates the nerve, resulting in a pulsating tinnitus.
- Carotid artery-cavernous sinus fistula. This is an abnormal connection between a very large artery and a very large venous pool within the cranial cavity. It is usually the result of severe head trauma. Treatment is nonsurgical, requiring the services of a radiologist.
- Chronic inflammation and/or infection of the middle ear. Chronic inflammation is almost always accompanied by increased blood flow to the inflamed tissue; since this tissue is in the ear, some people are able to hear the increase in blood flow.
- Middle ear fluid. The middle ear is normally an air-filled space. If due to infection, inflammation or eustachian tube dysfunction, fluid accumulates behind the middle ear and pulsating tinnitus may result.
- Vascular tumors in the middle ear are most commonly referred to as glomus tumors or paragangliomas. They are benign but can be troublesome. Surgery is required for correction of this problem.
- Venous hum. Patients who are pregnant, anemic, or have thyroid problems may develop increased blood flow through the largest vein in the neck, the jugular vein. The jugular vein carries blood from the brain back to the heart; in so doing, it traverses the middle ear. Turbulent blood flow anywhere in the course of the jugular vein can be heard in the middle ear as a “hum” which may or may not fluctuate with the pulse. Correction or resolution of the underlying problem often results in improvement.
Conditions that suggest Tinnitus
Depression
Many tinnitus sufferers become depressed simply from having to deal with the constant noise. Treating the depression may make the tinnitus seem less severe. Certain anti-depressants may worsen tinnitus, while others may improve it. SRI anti-depressants may temporarily worsen tinnitus for the first few weeks.
Alprazolam (Xanax) in a double-blind study showed 76% of the subjects benefited with tinnitus reductions of at least 40%, whereas only 5% of the placebo subjects had an improvement. [Arch Otolaryngol Head Neck Surg. 1993:119: pp.842-845]
Insomnia
In a double-blind study of people who had difficulty sleeping because of tinnitus, supplementation with 3mg of melatonin per night for one month resulted in improved sleep.
Risk factors for Tinnitus
Hyperthyroidism
Ringing in the ears is a symptom of an overactive thyroid gland.
Anemia, Megaloblastic
In one report, 47% of people with tinnitus and related disorders were found to have vitamin B12 deficiencies. Supplementation may therefore be of benefit. [Vitamin B12 deficiency in patients with chronic-tinnitus and noise-induced hearing loss. Am J Otolaryngol 1993;14: pp.94-9]
TMJ Problems
The findings of a recent study were very interesting. Of a group of twenty patients with tinnitus, ten tested positive for TMJ dysfunction in all diagnostic tests used. Nine tested positive to one or more of the diagnostic procedures. Only one patient of the twenty had no positive evidence of any jaw joint dysfunction. Dr. Morgan’s findings were published in The Journal of Craniomandibular Practice. [“Tinnitus of TMJ Origin: A Preliminary Report,” Vol.10, No.2]
Another research project was headed by Richard L. Goode, MD, professor of ENT and Head and Neck surgery at Stanford University’s School of Medicine. Drs Morgan and Goode were able to establish the mechanical connection between the ossicles in the middle ear and the capsule and disk of the TMJ. [“The TMJ-Ear Connection”, Journal of Craniomandibular Practice, Vol. 13, No.1).]
You may get an idea if the tinnitus is connected to your TMJ in some way, by
Zinc Requirement
High concentrations of zinc are found in the inner ear. A Japanese study tested the theory that insufficient levels of zinc may therefore contribute to tinnitus. Researchers found that tinnitus sufferers with low zinc levels in their blood experienced an improvement in their symptoms when, after two weeks of zinc supplementation, their zinc levels rose significantly.
Another study found that 25% of those with tinnitus and low serum zinc reported improvement after 3 to 6 months of supplementation. [ Am J Otol 1985;6: pp.116-7]
Tinnitus suggests the following may be present
Tinnitus can lead to
Depression
Many tinnitus sufferers become depressed simply from having to deal with the constant noise. Treating the depression may make the tinnitus seem less severe. Certain anti-depressants may worsen tinnitus, while others may improve it. SRI anti-depressants may temporarily worsen tinnitus for the first few weeks.
Alprazolam (Xanax) in a double-blind study showed 76% of the subjects benefited with tinnitus reductions of at least 40%, whereas only 5% of the placebo subjects had an improvement. [Arch Otolaryngol Head Neck Surg. 1993:119: pp.842-845]
Insomnia
In a double-blind study of people who had difficulty sleeping because of tinnitus, supplementation with 3mg of melatonin per night for one month resulted in improved sleep.
Recommendations for Tinnitus
Ginkgo Biloba
Studies have shown a range of responses from nothing more than a placebo to an effectiveness rate of 50%. Gingko must be administered long term (many months) to achieve benefit. Amongst patients suffering from cerebrovascular insufficiency, a common problem associated with normal aging, a gingko extract produced a significant improvement in the symptoms of vertigo, tinnitus, headache and forgetfulness.
Vinpocetine
Personal testimonies indicate that vinpocetine, acting as a cerebral vasodilator, may be effective in some people for reducing tinnitus. A typical dosage for this purpose is 20 to 40mg per day.
Aerobic Exercise
Regular exercise may help increase blood circulation to the head and thus reduce the symptoms of tinnitus if it is caused by poor circulation.
Magnesium
300 young healthy male military recruits undergoing two months of basic training were studied. The trainees were repeatedly exposed to high levels of impulse noises, with ringing of the ears as a consequence. Each recruit received daily either 167mg of magnesium aspartate or a placebo. Permanent hearing loss was significantly more frequent and more severe in the placebo group than in the magnesium group. [Am J Otolaryngol 1994;15: pp.26-32]
DMSO Topically
Patients suffering from tinnitus were given 2ml of a medicated DMSO solution every 4 days. The medication contained anti-inflammatory and vasodilatory compounds and was applied locally to the external ear canal. They were also given an intramuscular injection of DMSO at the same time. After one month, 9 of the 15 subjects had a complete cessation of the tinnitus which didn’t return during the one year observation period. It diminished in two others and in the remaining four occurred occasionally instead of permanently. Cold temperatures seemed to be the main factor causing it to return. [Annals of the New York Academy of Sciences 75:243:468: p.74]
Key
| Weak or unproven link |
| Strong or generally accepted link |
| Proven definite or direct link |
| May do some good |
| Likely to help |
Glossary
Tinnitus
A sensation of noise (ringing or roaring) that is caused by a bodily condition and can usually only be heard by the person affected.
Chronic
Usually Chronic illness: Illness extending over a long period of time.
Vertigo
The sensation of spinning or whirling; a state in which you or your surroundings seem to whirl dizzily.
Cholesterol
A waxy, fat-like substance manufactured in the liver and found in all tissues, it facilitates the transport and absorption of fatty acids. In foods, only animal products contain cholesterol. An excess of cholesterol in the bloodstream can contribute to the development of atherosclerosis.
TMJ
Tempero-mandibular joint - hinge of the jaw.
Allergy
Hypersensitivity caused by exposure to a particular antigen (allergen), resulting in an increased reactivity to that antigen on subsequent exposure, sometimes with harmful immunologic consequences.
Hypertension
High blood pressure. Hypertension increases the risk of heart attack, stroke, and kidney failure because it adds to the workload of the heart, causing it to enlarge and, over time, to weaken; in addition, it may damage the walls of the arteries.
Fistula
An abnormal passageway, allowing movement between organs.
Benign
Literally: innocent; not malignant. Often used to refer to cells that are not cancerous.
Thyroid
Thyroid Gland: An organ with many veins. It is at the front of the neck. It is essential to normal body growth in infancy and childhood. It releases thyroid hormones - iodine-containing compounds that increase the rate of metabolism, affect body temperature, regulate protein, fat, and carbohydrate catabolism in all cells. They keep up growth hormone release, skeletal maturation, and heart rate, force, and output. They promote central nervous system growth, stimulate the making of many enzymes, and are necessary for muscle tone and vigor.
SRI
Serotonin Reuptake Inhibitor. The result of this inhibition action is to maintain higher levels of serotonin.
Placebo
A pharmacologically inactive substance. Often used to compare clinical responses against the effects of pharmacologically active substances in experiments.
Milligram
(mg): 1/1,000 of a gram by weight.
Melatonin
The only hormone secreted into the bloodstream by the pineal gland. The hormone appears to inhibit numerous endocrine functions, including the gonadotropic hormones. Research exists on the efficacy of melatonin in treating jet lag and certain sleep disorders. Dosages greater than l milligram have been associated with drowsiness, headaches, disturbances in sleep/wake cycles and is contraindicated in those who are on antidepressive medication. It also negatively influences insulin utilization.
Cobalamin
Vitamin B-12. Essential for normal growth and functioning of all body cells, especially those of bone marrow (red blood cell formation), gastrointestinal tract and nervous system, it prevents pernicious anemia and plays a crucial part in the reproduction of every cell of the body i.e. synthesis of genetic material (DNA).
Zinc
An essential trace mineral. The functions of zinc are enzymatic. There are over 70 metalloenzymes known to require zinc for their functions. The main biochemicals in which zinc has been found to be necessary include: enzymes and enzymatic function, protein synthesis and carbohydrate metabolism. Zinc is a constituent of insulin and male reproductive fluid. Zinc is necessary for the proper metabolism of alcohol, to get rid of the lactic acid that builds up in working muscles and to transfer it to the lungs. Zinc is involved in the health of the immune system, assists vitamin A utilization and is involved in the formation of bone and teeth.
Serum
The cell-free fluid of the bloodstream. It appears in a test tube after the blood clots and is often used in expressions relating to the levels of certain compounds in the blood stream.