Tinnitus is a condition in which patients perceive noises in the ear. However, external sources do not generate these sounds; typically, no one else can hear them. Instead, the brain essentially creates these noises as an “interpretation” of injury to the ear (loud noises and/or trauma), age-related hearing loss, obstruction (earwax, infection, foreign objects), malignancy, toxicity (medication and otherwise), stress, and more. Tinnitus can vary in intensity and duration from mild and temporary to permanent and debilitating. It is estimated that about 15-20% of the United States adult population suffers from persistent tinnitus, and virtually everyone has experienced temporary ringing in their ears due to loud noise at some point in their lives.

The Symptoms of Tinnitus

The symptoms of tinnitus can vary dramatically. Some may experience ringing, while others may hear whooshing, whirring, humming, chirping, rumbling, clicking, or other noises. No “standard” tinnitus sound exists, and the noise’s intensity can also vary. Some patients experience mild noise that doesn’t interfere with their daily life. Fortunately, only about 10% of tinnitus patients experience more significant symptoms that compromise their daily activity and lifestyle. For most, tinnitus is something they just live with; when distracted by the world around us, it is not noticed much if at all.

While tinnitus is often mild, more severe cases can cause significant psychological concerns. Tinnitus can lead to anxiety, depression, and other mental illnesses. And pre-existing mental illness can worsen the severity.  There have even been reports of suicidal ideations in patients who can’t cope. A tragic example was businessman Kent Taylor, who developed such intense tinnitus after Covid-19 that he took his own life. While these cases are rare, it shows how severe the condition’s impact on mental health can be.

This highlights the need to visit a qualified ENT specialist like Dr. Boger and begin working on an appropriate treatment plan. There are ways to effectively cope with long-standing tinnitus, even if there is no “cure”, or the underlying cause cannot be determined or treated.

>The Symptoms of Tinnitus

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.

Treatments for Tinnitus

Addressing tinnitus starts in your Ear, Nose, and Throat specialist’s office. We will begin by evaluating your exposure to loud noises and any trauma around the time you developed tinnitus. We will also check your ear canal and ear drum for earwax buildup, infection, or structural abnormalities. We will then discuss possible treatment options, taking into account the severity of the condition.

Related Tinnitus Resources