Tinnitus: Causes, Symptoms, Treatment

01. What is tinnitus?

Doctors use the term “tinnitus” to describe sounds such as ringing, buzzing, clicking, whirring, beeping, whistling, hissing, and the like—sounds that people with tinnitus perceive in their ears but for which there is no external sound source. Tinnitus is a symptom, not a disease in its own right. The sounds occur in either one or both ears. Generally, these sounds are not dangerous, but they are often perceived by those affected as extremely bothersome and can significantly impair their quality of life.

In medicine, a distinction is made between different types of tinnitus, which differ primarily in duration. These include:

• acute tinnitus (lasting less than three months)
• subacute tinnitus (lasting three to six months)
• chronic tinnitus (lasting longer than six months)

A further distinction is made between subjective and objective tinnitus:

• Subjective tinnitus: The ringing in the ears is perceptible only to the person affected. This is the most common form among those affected.

• Objective tinnitus: The ringing in the ears is audible to the person affected and measurable by a doctor. However, this type of tinnitus is extremely rare. In contrast to classic tinnitus, there is an underlying medical condition that causes a sound source that patients can actually hear. For example, objective tinnitus is diagnosed when patients hear the rhythmic pulsing of their pulse in their ear, beating in time with their heartbeat.
  

02. Causes of Tinnitus

Since the causes of tinnitus can be so varied, it is often difficult to identify THE single trigger for the ringing in the ears. If you hear ringing in your ears and find it bothersome, have an ENT specialist take a detailed medical history and investigate the possible triggers. Only then can they tailor a suitable treatment plan. The most common causes of tinnitus include:

• Noise exposure: Loud noises to which you are—or have been—exposed over a prolonged period can damage the sensory cells of the cochlea in your inner ear and trigger tinnitus. This includes not only occupational noise exposure (such as loud construction site noises from drills, cordless screwdrivers, and the like), but also loud music at concerts and in clubs.
  Acoustic trauma—also known as noise trauma or blast trauma —can also lead to tinnitus. This means that a loud bang right next to you (such as a gunshot or an explosion) generates such intense sound pressure that it damages the delicate hair cells in the inner ear.
  
• Stress and anxiety: Although stress has not yet been scientifically proven to trigger tinnitus, a large proportion of people who suffer from ringing in the ears are often also exposed to stress. Some patients also report that their tinnitus is more severe during stressful periods than during relaxed times. Tinnitus itself can, in turn, trigger stress, as the constant perception of ringing in the ears often leads to a significant reduction in quality of life. Learning stress management techniques can help you cope better with stress and, as a result, reduce your tinnitus.
  
• High blood pressure: Blood pressure ensures that blood flows through our arteries and reaches all vital organs and tissues. If blood pressure is elevated, this can also affect the ears. This is because when you notice ringing or buzzing in your ears, you’re essentially hearing your blood flow through your body. Arteriosclerosis, which often accompanies high blood pressure, disrupts blood flow to the inner ear, which can cause ringing in the ears. Important: Regardless of whether you have tinnitus, high blood pressure should always be treated to prevent long-term damage to the cardiovascular system.
  
• Malocclusion/Teeth Grinding: If you grind your jaw or clench your teeth (bruxism) while sleeping, this can also manifest as tinnitus. This is because the constant pressure on the temporomandibular joint and the masticatory muscles strains and overworks the jaw muscles. One of the deep chewing muscles is even directly connected to the middle ear via individual fibers. Most often, unresolved everyday problems are the trigger and manifest as nighttime grinding. Since the constant pressure can also damage your teeth, you should learn stress management techniques and, if necessary, have your dentist prescribe a nightguard that prevents direct contact between your teeth while you sleep. If the temporomandibular joints are also affected, as in the case of craniomandibular dysfunction (CMD), a custom-fitted splint—adjusted over the course of muscle relaxation therapy—may be necessary, provided by a dentist specializing in CMD.
  
• Inner ear disorders: These include, for example, middle ear infections or Meniere’s disease, which causes symptoms such as dizziness, hearing loss, and phantom sounds. Once the underlying conditions are treated, the accompanying symptoms usually disappear as well.
  
• Cervical Spine Syndrome: Cervical spine syndrome refers to symptoms in the area of the cervical spine. If there are functional disorders, degenerative changes, or blockages in the cervical spine, this can cause tinnitus or cause it to worsen. Cervical Spine Syndrome is often caused by poor posture—for example, at work or due to improper smartphone use—which can lead to “text neck,” muscle tension, and pain.
  
• Side effects of medications: Some medications used to treat cancer and malaria, as well as certain antibiotics, can cause tinnitus as a side effect. If you notice tinnitus while taking such a medication, ask your doctor to prescribe alternative medications.
  
• Earwax blockage: If there is an excessive buildup of earwax, it can block the ear canals, leading not only to hearing loss and pain but often to tinnitus as well. An ear, nose, and throat (ENT) specialist can clear the ear canal with an ear irrigation procedure.
  
• Tumor: A very rare cause of tinnitus is a tumor on the auditory and vestibular nerve, known as an acoustic neuroma. This tumor is benign, grows slowly, and is confined to the inner ear. It is diagnosed using imaging techniques such as a CT scan.
  
• Nutrient Deficiency: A deficiency in nutrients such as magnesium, zinc, iron, omega-3, coenzyme Q10, B vitamins, or antioxidants is also a possible cause of tinnitus. A doctor can perform a blood test to detect a nutrient deficiency and recommend appropriate dietary supplements or advise you to make changes to your diet.

03. Symptoms and Effects of Tinnitus

One of the main symptoms of tinnitus is the perception of sounds in the ear that others cannot hear. The sounds can have different characteristics—such as whistling, thumping, hissing, humming, buzzing, or beeping—and can range from a continuous tone to intermittent sounds. Those affected may hear the sounds in only one ear or in both, and the volume of the perceived sound can vary from very faint to very disruptive.

How those affected perceive the impact of these noises varies greatly. Tinnitus can be very distressing and can trigger anxiety, stress, difficulty concentrating, and even depression. Because of the increased focus on the symptoms, the noises may also be perceived as louder, often creating a vicious cycle. Sleep disturbances, social withdrawal, and a reduced quality of life are therefore common consequences of tinnitus.

Can tinnitus go away?
The fear that ringing in the ears will accompany those affected for the rest of their lives is completely understandable. And yet, tinnitus can not only improve but also disappear completely. In many cases, the ringing in the ears is only temporary and can subside once the ear is no longer exposed to the triggers. For example, after attending a concert, the ears may initially feel a bit numb and ring, but they usually recover within 24 to 48 hours.

The likelihood that tinnitus will subside also depends on how long it has been present.

• If it lasts up to three months, doctors still refer to it as acute tinnitus.
  
• If the ringing, whistling, beeping, and other sounds persist longer, the tinnitus is classified as chronic. Even then, the sounds may disappear, but the likelihood decreases as the duration of the ear noises increases. Generally, those affected can live well with the sounds in their ears, as they even get used to them over time.
  
  Tip: So when you first notice sounds in your ears, the most important thing is to stay calm! In most cases, they’ll go away on their own after a short time. If you get stressed out or put yourself under pressure on top of the tinnitus, you may perceive the sound in your ear even more intensely. If you experience severe hearing loss, you may be dealing with sudden hearing loss. In that case, you should see a doctor right away to prevent long-term consequences as much as possible.

05. Treatment Options for Tinnitus: Medication, Home Remedies, Self-Help

The treatment of tinnitus depends on the underlying cause and the symptoms. There is no direct cure for all forms of tinnitus, but those affected can take steps to improve their quality of life. Here are a few common treatment options for tinnitus:

• Treating the Underlying Cause: If the ringing in the ears is caused by a blocked ear canal, simply having an ENT specialist remove the earwax plug may eliminate the noise. If it is induced by medication, switching to a different medication may provide relief. For tinnitus caused by changes in the cervical spine, a visit to a physical therapist, osteopath, or chiropractor can help restore balance to the muscles, nerves, and blood flow. If you suffer from neck pain and tinnitus, our exercise program can also help you reduce and prevent pain.
  
• Relaxation Techniques and Stress Management: Tinnitus can be exacerbated by stress and the resulting tension in the neck, shoulder, and jaw areas, and may also be perceived as more bothersome in stressful situations. Learning relaxation methods such as progressive muscle relaxation, autogenic training, tai chi and qi gong, meditation, or yoga can help reduce the ringing in the ears and enable those affected to cope with it more effectively.
  
• Lifestyle Changes: Those who suffer from ringing in the ears should therefore pay close attention to their bodies—and keep stress levels as low as possible. Taking regular relaxation breaks at work and balancing work with physical activities, a relaxation program, or other hobbies can reduce the risk of developing tinnitus and distract from the ringing in the ears. A healthy, balanced diet and sufficient sleep also enhance well-being.
  
• Tinnitus Retraining Therapy (TRT): This is a technique designed to diminish the acoustic and emotional impact of the tinnitus sound and thereby reduce the stress response to tinnitus. Following a detailed medical history, auditory distraction from the tinnitus is achieved using broadband noise delivered via a tinnitus device (noiser) worn as a hearing aid, combined with a non-standardized psychological therapy method. TRT is primarily performed in specialized tinnitus clinics.
  
• Tinnitus Masking: The use of a noiser or masker can provide significant relief for those affected in their daily lives. The device helps mask the tinnitus sounds with other sounds. Typically, this involves white noise, which distracts and calms those affected. Those affected can obtain the small device, which resembles a hearing aid, from a hearing aid specialist.
  
• Hearing Aids: They can reduce the bothersome sounds associated with tinnitus by amplifying ambient sounds and providing greater distraction. Those affected also have the option of purchasing a hearing aid that already has the special noise-generator function (see above) built in.
  
• Behavioral therapy: To improve coping with tinnitus and reduce the burden it causes, those affected can learn to better manage the sound in their ears through behavioral therapy with a psychologist. Participating in support groups can also help alleviate psychological distress through interaction with others who share the same condition.
• Medication: A wide variety of remedies—whether herbal or pharmaceutical—have gained a reputationfor supposedly curing or alleviating tinnitus. However, there is insufficient data on the effectiveness of medication specifically for tinnitus. Instead, there is evidence of potentially significant side effects. Based on systematic reviews and randomized trials, it is highly likely that betahistine, ginkgo, antidepressants, benzodiazepines, melatonin, cannabis, oxytocin, steroids, and gabapentin are not effective against chronic tinnitus and are therefore not recommended. This distinction must be made from the treatment of symptoms associated with tinnitus—such as anxiety disorders and depression. If these symptoms are caused by tinnitus, they should, of course, also be treated with medication.

Note: In cases of acute tinnitus, cortisone is often recommended, either as an infusion or in tablet form. However, the medication can only have a positive effect if the tinnitus is caused by an acute hearing disorder or hearing loss, results from an inflammation in the ear, and is acute . In such cases, the so-called “Sudden Hearing Loss” guideline is recommended, and treatment is carried out according to the criteria outlined therein.

For the treatment of chronic tinnitus—that is, tinnitus lasting longer than three months—the administration of cortisone is considered ineffective.