Ringing sound in my ear (tinnitus) – Have I gone mad?

What is tinnitus?

Tinnitus is the perception of sound or noise in the ear. There are two types of tinnitus:

1. Subjective tinnitus – This is by far the most common type of tinnitus encountered by most people. This is the type of tinnitus that only you can hear it.
2. Objective tinnitus – This is fortunately rarer and can be heard by you and your doctor when he or she examines you.

Why do I get tinnitus?

The cause of tinnitus depends on the type of tinnitus that you experience.

1. Subjective tinnitus – Majority of the time (more than 95% of the time), subjective tinnitus is not due a serious condition. Typical description for subjective tinnitus include:

• Ringing (often described as an “eeee” sound)
• Buzzing
• Hissing

We do not fully understand why subjective tinnitus occurs. One of the hypothesis suggests that tinnitus is due to the hearing nerve or hearing organ misfiring electrical impulses that the brain perceives as sounds. Common triggers or causes of subjective include:

1. Hearing loss – This can be due to age-related hearing loss or hearing loss from excessive exposure to loud noises.
2. Earwax buildup
3. Ear infections
4. Stress and anxiety
5. Depression

2. Objective tinnitus:

Objective tinnitus usually indicates that there is a sound generated by structures close to the ear. Typical description for objective tinnitus include:

• Humming
• Clicking
• Pulsatile (rhythmic sound following your heart beat)

These include:

1. Turbulent flow of blood in the vein or artery close to the ear
2. Vascular tumour (growth arising from a blood vessel) in the middle ear
3. Spasms of the muscles controlling the hearing bones
4. Spasms of the muscles in the soft palate

Is tinnitus dangerous?

More than 95% of tinnitus are not dangerous. However, the sound can be distressing to some patients, affecting their quality of life or even sleep.

What are the red flags of tinnitus?

If you have these associated symptoms or type of tinnitus, you should see an ENT Specialist for an assessment:

• Pulsatile nature of the tinnitus (the sound is in rhythm with your heart beat)
• Tinnitus in only one side of the ear for a prolonged period of time
• Hearing loss in one ear (or worse in one ear)
• Accompanying neurological symptoms (e.g weakness or numbness in the face on one side, giddiness, headaches etc)

What should I expect when I see a doctor for tinnitus?

Your doctor will take a full clinical history and perform a complete head & neck examination, including examination of the ear, nose & throat region. Depending on the underlying cause, a hearing test (called an audiometry) is usually performed to detect any potential hearing loss that may be responsible for the tinnitus.

How is tinnitus treated?

Tinnitus is treated by addressing the underlying cause. It may not go away completely in some patients. Correcting the hearing loss (e.g. wearing a hearing aid), removal of earwax, reducing stress and treating depression may reduce or eliminate tinnitus in some patients.

In majority of patients, if there are no red flags, simple reassurance and a tinnitus advice usually helps alleviate their distress or concerns. In most patients, the tinnitus may spontaneously disappear after a period of time or with the help of ginkgo biloba supplements.

What is a tinnitus advice?

A tinnitus advice includes measures taken to help you adapt and cope with your tinnitus.  Avoiding being in an environment that is completely quiet often helps. It is advisable for patients with tinnitus to have some background noises (e.g sound from a working fan or an air-conditioner or from soothing music).  Addressing stress (e.g through meditation, yoga etc) and the lack of sleep may help reduce tinnitus too.

For some patients, a tinnitus masker may help with troubling tinnitus. A tinnitus masker is an electronic device or hearing aid that produces whites noise that helps you “block off” and cope better with your tinnitus. If the sound from a running tap water helps mask your tinnitus, you may benefit from a tinnitus masker.