Tinnitus is Latin for “to ring or tinkle like a bell”. It is usually described as “ringing in the ears” but may also include other noises such as buzzing, chirping, metallic sounds, hissing, static, swooshing, pulsing, or whistling. Noise experienced from tinnitus can be periodic or continuous, deviate in loudness, and is often more pronounced in quiet environments.

Tinnitus can be extremely annoying, may cause loss of sleep, difficulty concentrating, and may even be experienced as pain to those who have it. Tinnitus may affect as many as 50 million people in the US and is more common in the elderly but may affect younger people as well.

Tinnitus is only a symptom and not an actual condition or disease state. In some cases, tinnitus may be masked with “white noise” but to fully address the condition, the root cause must be identified.

Noise related hearing loss

Loud noises can damage the cilia (small hairs) in the inner ear which regulate the flow of sound waves. Severe damage to cilia is permanent but even a short period of excessive noise can result in tinnitus or hearing loss for a period of time.

Those who have jobs in high noise environments are often subject to tinnitus. Some of these jobs include:

  • Carpentry
  • Landscaping
  • Logging
  • Working on Street or Road Crews
  • Working in Factories or Refineries
  • Live Music Performance, i.e., Rock Musicians, Security Personnel, Road Crew

People whose hobbies expose them to loud noise conditions such as hunters and those who like to listen to loud music can also have tinnitus – either short or long term. The damaged caused by loud noise builds up over time and symptoms will increase with greater exposure. Rock musicians such as Eric Clapton and Pete Townsend have been public about their hearing loss and tinnitus caused by years of playing and listening to loud music.

In many cases, noise related ear ringing is permanent but it may be masked with “white noise” or reduced with certain types of hearing aids.

Blockages of the Ear Canal

The ear canal can be blocked from the outside by an excessive buildup of ear wax. It can also be blocked from inside the ear drum due to an infection. Some conditions such as nasal allergies and asthma may increase nasal mucous production in the sinuses and can cause fluid buildup in the Eustachian tube. Benign tumor development on the auditory nerve can also cause ear cavity blockage.

Blockages can be resolved by treatment of the underlying condition including ear wax removal, antibiotic treatment for infection, antihistamines, and decongestants for sinus conditions and possible tumor removal.


Certain medications may cause tinnitus, including both prescription and non-prescription medicine. The most commonly known drug that causes ear ringing is aspirin taken in high doses. Tinnitus is a known side effect of up to 200 medications including quinine, anti-inflammatories, sedatives, and anti-depressants. In many cases, tinnitus will resolve after the medication dose is reduced or discontinued but certain types of chemotherapy and anti-biotic treatment may cause ototoxicity or permanent ear damage.

Medical Conditions

Medical conditions such as hypertension, hypothyroidism, cardiovascular disease, and diabetes may cause tinnitus which may be reversed or reduced in severity with treatment of the underlying disease. Meniere’s disease which is characterized by dizziness and hearing disturbance may cause tinnitus. Meniere’s disease may require a variety of medical treatments which may help to alleviate tinnitus. Head and neck injuries may also cause temporary or permanent tinnitus and should be treated immediately by a physician.

Aging Ears

The natural process of aging results in deterioration of the cochlea and inner ear canal which may result in hearing loss and tinnitus. Otosclerosis is an age-related condition which causes stiffening of the small bones of the middle ear – also resulting in hearing loss. Age-related tinnitus may be treatable with some hearing aids.

Stress Related Tinnitus

Neck or jaw problems such as temporomandibular joint disorder (TMJ) may cause spasms of the jaw or neck which change the shape of the ear canal resulting in auditory distortion. Stress or fatigue related tinnitus may be treated with biofeedback or may require treatment with anti-anxiety medication. Smoking or drinking alcoholic or caffeinated beverages may worsen any tinnitus.

Mayo Clinic, Diseases and Conditions: Tinnitus, http://www.mayoclinic.org/diseases-conditions/tinnitus/basics/definition/con-20021487 (2/05/2013)
American Tinnitus Association, About Tinnitus, http://www.ata.org/for-patients/about-tinnitus

Alan S. Berger, M.D.