Kim Richard Jones, M.D., Ph.D.
Adult and Pediatric Otolaryngology
Kathy Yu, M.D., M.P.H.
Adult and Pediatric Otolaryngology
Carolina ENT Associates 55 Vilcom Center Drive, Suite 140
Chapel Hill, NC 27514
phone: 919.942.7278
fax: 919.942.9029
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Tinnitus is the fancy name for what everyone else calls “ringing in the ears”. This condition is very common, with almost everyone experiencing it at one time or another. It is generally indicative of some degree of damage to the inner ear, which may or may not be reversible. For example, if a firecracker goes off next to your ear, almost everyone will experience ringing in that ear for a time, but it will gradually go away and your hearing will be normal. On the other hand, if your inner ear is exposed to loud noises for many minutes a day (construction workers, race car drivers, etc.), then the damage may occur gradually and lead to tinnitus that is constant. If enough damage has been done to actually kill some of the sensory cells in the inner ear, you may experience a hearing loss as well.

Causes of Tinnitus

There are a number of causes of tinnitus, and in many cases we can’t really pinpoint a specific one. The best-known cause is probably noise exposure, although this is becoming less common as the noise levels in factories, etc. are monitored and workers are wearing ear protection. Another cause may be a loss or reduction of blood supply to the inner ear. This can occur suddenly, like a small “stroke” of the inner ear, or it can occur gradually, as in patients with diabetes. Finally, certain medicines, such as aspirin, some anti-depressants, and some antibiotics can cause tinnitus. In most patients, tinnitus probably results from the cumulative effect of lots of different factors, and it is rare that someone over forty or fifty doesn’t have some degree of tinnitus.

I should mention that there is an interesting new theory about tinnitus that suggests that it is a natural condition that is present in all people, but that our perception of it is usually suppressed subconsciously. In persons that are conscious of their tinnitus, so the theory goes, these “suppressive mechanisms” have failed. This theory is behind a new treatment of tinnitus in which an attempt is made to restore these suppressive mechanisms by psychological counseling, use of tinnitus maskers, etc.

Pulsatile Tinnitus

Although most tinnitus is constant, some people have a noise in one or both ears that rises and falls in time with their heartbeat. This is called “pulsatile tinnitus” and is usually caused by a different mechanism than constant tinnitus. As one would imagine, it has to do with the flow of blood in and around the ear. Although the exact cause is often unknown, the most likely explanation is that pulsations from either the carotid artery or the internal jugular vein are transmitted up the Eustachian tube and cause the eardrum to vibrate back and forth. Why this occurs is unclear, but it may have to do with the thinning of the cartilage of the Eustachian tube that occurs over time and makes it easier for the pulsations to be transmitted to the ear.

There are other causes of a more serious nature that fortunately are very rare. These include benign tumors of the middle ear, abnormalities of the carotid artery, and abnormalities of the blood vessels of the brain.

Should You See Your Doctor About Your Tinnitus?

Most cases of bilateral (heard in both ears) tinnitus are benign, especially if they are soft enough so that the tinnitus can only be heard when things are quiet. However, constant tinnitus that is only on one side can sometimes be an early sign of a benign tumor of the nerve going from the inner ear to the brain, so this should always be checked. Similarly, pulsatile tinnitus that is only on one side also has a slightly higher likelihood of representing something more serious, so this also deserves further workup. Finally, any new onset of tinnitus that is accompanied by other symptoms or is getting worse should be mentioned to your doctor.

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