Causes

There are two primary causes of tinnitus: environmental and physical.

Environmental Causes

Just over half of all tinnitus cases are caused by external influences. These can include:

Exposure to Loud Noises
A loud work environment that involves the use of power tools, power saws, drills or other noisy equipment may cause temporary bouts of tinnitus. Attending a rock concert can often cause ringing in the ears afterwards and depending upon the length of the exposure, the ringing sound may not go away even after a few days. The longer a person remains in that loud environment, the better their chances will be of developing the condition permanently. These environments can also cause hearing loss.
Smoking. Contrary to popular belief, there are some external irritants that can cause tinnitus. For example, Nicotine has been proven to be an irritant that can cause someone to develop a ringing in their ears. Smokers may find that their chances of developing the condition may be higher than someone who is a non-smoker. If you’re suffering from tinnitus and you’re a smoker, we recommend quitting as soon as possible.

Medications, Prescription Drugs and Food Additives
Other external irritants that can cause tinnitus are over the counter medications and prescriptions. Even something as simple as aspirin can generate tinnitus. Certain antibiotics and other prescription drugs are also known to cause tinnitus. Two very common ones that have shown to cause tinnitus are quinine and chloroquine which are in malaria medications. Certain diuretics and cancer medications can also cause tinnitus. And some artificial sweeteners have also been linked to tinnitus and other side effects in clinical studies.

Physical Causes

Ringing in the ears can also have physical causes as well. The five most common include:

① Vascular issues. Some people have blood vessels near their ears that are capable of causing tinnitus. When the blood pressure is elevated, this increased pressure can cause ringing in the ears or a whooshing sound. Because pregnant women often have elevated blood pressure, they are easily susceptible to tinnitus. An overactive thyroid has also been shown to causes vascular issues that bring on tinnitus.

② Changes in the bones of the middle ear. A person’s ear is made up of several different bones: the malleus, Incus and Stapes. In some individuals, these bones may actually change shape or harden over the years. This process is known as otosclerosis and often runs in the family. This can cause ringing in the ears to begin or, if it has already started, to get worse over time.

③ Ear wax. Our ears naturally produce ear wax. If that wax becomes impacted and hard the resulting blockage may cause someone to experience ringing in the ears. I have found that clearing someone’s ear canals before damage can take place can be an ideal way to manage tinnitus and help provide relief from the symptoms.

④ Natural aging. As a person ages, they may begin to suffer from hearing loss. In some cases, this has caused some of the tinnitus suffers that have reached out to me to begin hearing a ringing or whistling that is characteristic of tinnitus.

⑤ Diseases, illnesses and injuries. There are several medical conditions that can cause tinnitus including Meniere’s disease, temporomandibular joint disorders (TMJ), head or neck injuries, and ear infections.

Diagnosis

The first step in addressing tinnitus is to determine the underlying cause. At SEA, diagnosis begins with an initial interview and evaluation and then is followed by a series of diagnostic tests. This includes a comprehensive hearing test to determine if hearing loss is present and ostoacoutic emission testing to evaluate inner ear function.

Depending upon the cause of tinnitus, there a number of treatment options available.

Treatment

Audiological Treatment Options

Acoustic Neural Stimulation/Neuromonics
This relatively new treatment has shown to be effective in reducing, and in some cases eliminating, symptoms in patients whose tinnitus just won’t go away or is very loud. The treatment utilizes a device small enough to fit into the palm of your hand that delivers a broadband acoustical signal embedded in special music you can listen to via headphones. The treatment eventually desensitizes you to the ringing in your ears by stimulating changes in the neural circuits in your brain. Treatment is conducted over a period of about six months and neuromonics has been shown through tinnitus research and clinical trials to result in significantly reduced awareness and disturbance for up to 90% of people who suffer from tinnitus and hyperacusis. It can also lead to better relaxation and sleep and improved quality of life.

Cochlear Implants
These implants are a treatment option for patients that have a severe hearing loss along with tinnitus. Cochlear implants are designed to bypass any damaged parts of the inner ear and send the electrical signals sound makes directly to the auditory nerve. By bringing in outside noise, these implants can effectively mask your tinnitus, as well as stimulate your neural circuits to change.

Tinnitus Retraining Therapy
Tinnitus Retraining Therapy (TRT) combines a wearable device that is individually programmed to mask the specific tonal frequency of that person’s tinnitus, with psychological therapy that teaches a patient to ignore the sounds his tinnitus is creating. I consider it the best of all of the above noise suppression techniques, as it is individually tailored for each person and involves support from a trained psychological therapist. It is also the most expensive and time consuming, but in my medical opinion, the most beneficial of all the noise suppression techniques listed above. Tinnitus retraining therapy (TRT) uses a combination of counseling and noise generators to help patients eliminate the noise perceptually. Shohet Ear Associates is one of the first centers in Southern California to offer TRT.

Lenire
The Lenire system uses bimodal neuromodulation to reduce the severity of tinnitus. It does this by retraining the brain to become more attentive to other stimuli and sounds. The system delivers mild pulses to the tongue combined with sound played through headphones to help your brain pay less attention to tinnitus.

Medical Treatment Options

Identifying And Treating Any Vascular Issues
In some cases, tinnitus is a result of an underlying blood vessel condition known as pulsatile tinnitus. Sometimes this condition is caused by pregnancy or strenuous exercise and other times it’s the result of a single blood vessel or a group of blood vessels experiencing increased blood flow that the rest of the body is not experiencing. On rare occurrences, the cause is a benign tumor known as an acoustic neuroma (AKA vestibular schwannoma). These tumors, although very rare, can cause the development of abnormal blood vessels which can result in pulsatile tinnitus. Treatment options include medication and surgery.

Removing Excess Earwax
Tinnitus can also be caused by an excess buildup of ear wax that is blocking the ear canal. This is especially common in older patients who have a lot of ear hair that ear wax has been building up on over the years. By removing both the excess hair and ear wax, especially if it’s in contact with your ear drum, your tinnitus can improve.

Changing Prescriptions, OTC Medications and Food Additives
Sometimes the cause of tinnitus is a prescription (such as an antibiotic), an over the counter medication or a food additive. There are over 200 prescriptions and over the counter medications that can cause tinnitus or make your existing symptoms worse. Generally speaking, the higher the dosage of these medications, the worse your tinnitus will become. Depending on the medication dosage, your tinnitus might go away after removing it from your system. Even something as simple as OTC aspirin can generate tinnitus in some people. The food additives NutraSweet, Splenda and Aspartame have all been linked to tinnitus, and a whole host of other side effects, in clinical studies.

Addressing TMJ Disorders
Some people will experience tinnitus if they are having problems with their temporomandibular joint. This joint is located in front of the ears, on each side of the head, where the lower jawbone meets the skull. In these cases, a dental treatment or bite realignment may relieve you of the ringing you hear in your ears.