LewisGale Physicians
October 16, 2017

Tinnitus, sometimes known as ringing in the ears, is the perception of abnormal ear or head noises without any external sound. Noises may be high pitched, ringing, clicking, or buzzing. Pulsatile tinnitus is caused by the flow of blood that accompanies each heartbeat.

What Causes Tinnitus?

Anatomy of the Ear

a diagram of the inner, middle, and external ear

Copyright© Nucleus Medical Media, Inc.

Tinnitus may be caused by:

  • Cochlear damage from exposure to loud sounds.
  • Hearing loss.
  • Damage to the auditory system, including the eardrum and nerves.

Occasional episodes of tinnitus lasting at most a few minutes are quite common in most people, especially after exposure to loud noises. Regular exposure to loud sounds can lead to longer-lasting tinnitus, or even permanent hearing loss.

Risk Factors for Developing Tinnitus

Factors that may increase your chance of tinnitus include:

  • Occupations or activities that expose you to loud noises.
  • Wax or a foreign body in the ear canal.
  • Stress.
  • Fatigue.
  • Certain medications, such as aspirin, antibiotics, or diuretics.
  • Toxins, such as heavy metals, carbon monoxide, or alcohol.
  • Certain health conditions, such as:
    • Ear infection
    • Meniere's disease
    • Allergies
    • High or low blood pressure
    • Diabetes
    • Depression
    • Anxiety
    • Tumors
    • Thyroid problems
    • Temporomandibular joint disorder (TMJ)
  • Blood vessel disorders, such as an aneurysm, fistula, or hardening of the arteries.
  • Fluid in the ear.
  • Ruptured membrane in the ear.
  • Injury to the head or neck.

Symptoms of Tinnitus         

The sensations of tinnitus may have the following characteristics:

  • Ringing, roaring, buzzing, whistling, or hissing sounds.
  • Intermittent, continuous, or pulsatile quality.
  • Same or varying intensity.
  • Single or multiple tones.
  • More annoying symptoms at night or when there are fewer distractions.
  • Sensation of normal internal events, such as blood pulsing or muscles contracting.
  • Sometimes tinnitus is accompanied by hearing loss and vertigo, a sensation of spinning while standing still.

Call your doctor if you have tinnitus, especially if it:

  • Is associated with hearing loss, vertigo, personality changes, speech, or weakness in any part of the body.
  • Starts after head or neck injury.
  • Is associated with new medication.
  • Is pulsatile (heard with each heartbeat).
  • Is associated with pain in the ear, fever, nausea, or vomiting.
  • Interferes with your activities.


The doctor will ask about your symptoms and medical history, and a physical exam will be done. Special attention will be paid to your head, neck, and ears. You will be asked questions about:

  • The sensations that you have.
  • The factors that may increase or decrease the sensation.
  • The medications that you take.
  • History of trauma.

The doctor will look at your ear canal and eardrum using an instrument with a light that is held at the external opening of the ear. A tuning fork can help evaluate hearing. You should receive a complete hearing test and imaging tests, such as a CT or MRI scan, may be ordered to rule out serious conditions.

In addition to hearing tests, others tests may include:

  • Tympanogram to measure air pressure in the ear canal.
  • Auditory brain response.
  • Electrocochleoraphy—to test for Meniere's disease, a disorder of the inner ear.

Treatment Options

Tinnitus treatment depends on what is causing the symptoms. This may mean:

  • Wearing a specially made splint to help manage temporomandibular joint disorder.
  • Taking antibiotics for a sinus or ear infection.
  • Having the wax removed from your ear canal.
  • Stopping or changing medications to see if tinnitus goes away.

Therapy aims to eliminate or reduce bothersome sensations. Treatment may include:

  • Medication
    No medication has been shown to be very effective in treating tinnitus, though your doctor may prescribe some medications to help ease symptoms related to tinnitus. These may include antidepressants and sedatives. If you have Meniere's disease, your doctor may prescribe medication to treat that condition.
  • Mechanical Devices, including:
    • Hearing aid—can relieve tinnitus and improve hearing in some people with hearing loss
    • Tinnitus masker—a device that emits a low level of white noise to help cover up the internal sensations of tinnitus and block out external noises
  • Lifestyle and Self-care Measures

Measures to discuss with your doctor if no cure or specific treatment is available include:

  • Stress management and relaxation techniques.
  • Repetitive transcranial magnetic stimulation.
  • Cognitive behavioral therapy.
  • Joining a support group.
  • Avoid anything that makes tinnitus sensations worse, such as:
    • Loud noises
    • Alcohol
    • Smoking
    • Salt
    • Caffeine
  • Exercise regularly to improve circulation.
  • Make time to relax and get enough sleep.
  • Playing a radio or a white-noise machine for about 30 minutes at bedtime may help relieve the ringing sensations at night.
  • Surgery
    Surgery may help relieve certain causes of tinnitus. These include:
    • Tinnitus caused by a tumor frequently subsides after the growth is removed.
    • Abnormalities in blood vessels that lead to tinnitus may be corrected with surgery.
    • Surgery also may be an option for people with Meniere's disease, but is usually done only for disabling vertigo.

Preventing Tinnitus

Loud sounds can permanently damage sensitive parts of the ears. Many people assume that hearing loss and associated conditions, like tinnitus, arise from occasional exposure to loud noise, like rock concerts. In fact, people are exposed to loud sounds on a daily basis that can cause just as much damage, but many are so accustomed to these noises that their sense of what loud means has actually changed over the years. These may include sirens, lawn mowers, and listening to music through earbuds. According to a recent report from the Centers for Disease Control and Prevention (CDC), 40 million American suffer from some loss of hearing. Some ways to help reduce your chances of experiencing tinnitus and hearing loss are: 

  • Avoid exposure to excessively loud noises.
  • Wear earplugs in noisy situations.
  • Wear earmuffs when mowing the grass or using any other loud machinery.
  • Learn and practice stress management and relaxation techniques.
  • Limit use of medications that damage hearing.

Centers for Disease Control and Prevention - Hearing Loss: www.cdc.gov

If you have symptoms of tinnitus, please consult your healthcare provider. Dr. Brian Gross of LewisGale Physicians is available to answer all of your questions. To schedule an appointment, call the practice at (540) 444-8100 or book an appointment online below.

Book An Appointment Online with Dr. Brian Gross