Causes of Tinnitus
There are a multitude of causes (often more than one):
Age. As we age, years of wear and tear causing chronic injury to the hearing organ can lead to tinnitus (and typically hearing loss as well). As we lose our hearing, the brain sometimes compensates by creating noise. Tinnitus is especially common in those over 55.
Blockage or earwax impaction. Blockage of the ear canal or earwax pressing against the eardrum can cause ringing in the ears (the “outside world” gets quieter, so the “inside world” is amplified. One cause is impaction of wax when patients use a cotton-tipped swap to try cleaning their ears. Removal of the wax usually alleviates the tinnitus, although once the patient is aware of it the noise can return again.
Anxiety. Chronic stress and anxiety are known potential causes of tinnitus (anything that alters brain chemistry can cause it). A 2020 study from Taiwan lent further credence to this. Stress can also cause jaw tension, clenching, and bruxism (tooth grinding), discussed below.
TMJ. As a potential cause of tinnitus, TMJD or Temporomandibular Joint Disorder can alter the physiology of the jaw joint (TMJ) and thus affect the ear. These structures are all connected, and while less common than centralized tinnitus (from the brain), those with cooccurring TMJ and tinnitus may wish to explore TMJ treatments.
Medication. Ototoxicity (damage to the hearing and/or balance organ) can be a side effect of specific prescriptions (often aspirin and other NSAIDs) and illicit drugs. Typically, the tinnitus caused by these drugs is temporary and goes away after discontinuing the medication. However, this is only sometimes the case. Speaking to your primary care physician, pharmacist, or ENT is an excellent first step toward understanding if your prescription can be adjusted.
Eustachian tube dysfunction. The eustachian tubes are pressure-equalization structures connecting your nasal cavity to the middle ear. These tubes can become blocked due to allergy, infection, dehydration, etc. Eustachian tube dysfunction is widespread in children under ten but less so in adults. That said, Eustachian tube dysfunction can lead to tinnitus which usually clears up as the dysfunction does. Longer-term, untreated eustachian tube dysfunction can cause more severe concerns.
Injury to the ear. Injuries to the ear can occur from physical trauma or loud noises. Many people have experienced ear ringing after significant noise caused by, for example, fireworks, nightclubs, loud concerts, or shouting nearby. The resultant tinnitus can be temporary or more permanent. To assume that only constant loud exposure leads to tinnitus would be incorrect. Some patients can develop tinnitus after a single loud noise exposure event, while others never will. We’ve also seen an uptick in hearing loss in younger individuals due to loud earphone use.