All About Tinnitus and Ringing in the Ears: Causes, Diagnosis and How to Manage It

Article by Hearing Partners, contributed by Joanne Loo, Senior Clinical Audiologist and Aiman Fikri, Clinical Audiologist at Hearing Partners

Tinnitus is a common condition, with approximately 20% of adults experiencing it, according to Gleneagles Hospital Malaysia¹. While it affects people of all age groups, it’s particularly common among those aged 40 to 70. Men are also generally more likely to experience tinnitus than women.

Although almost 1 in 5 individuals experience tinnitus, the Ministry of Health Malaysia notes that only 0.5% to 2% of cases significantly affect one’s daily life². This article will discuss the causes of tinnitus, how it is diagnosed and managed, and how to prevent it. We’ll also address some commonly asked questions about the condition.

Key Takeaways

• Tinnitus is the perception of ringing, buzzing, or other sounds in the ears without an external source.
• It may be caused by underlying issues such as hearing loss, impacted earwax, head injuries, certain medications, psychological factors, tumours, or vascular conditions.
• Tinnitus management options include hearing aids, earwax removal, lifestyle changes, sound therapy, attention therapy, and Tinnitus Retraining Therapy (TRT).
• Steps to prevent tinnitus include protecting your ears from loud noise, maintaining a healthy lifestyle, and attending regular hearing tests.

• What Is Tinnitus?
• What Causes Tinnitus?
• How is Tinnitus Diagnosed?
• How to Manage Tinnitus
• How to Prevent Tinnitus
• FAQs About Tinnitus and Ringing in the Ears

What Is Tinnitus?

Tinnitus is a condition characterised by the perception of ringing, buzzing, or other sounds in the ears without an external source. It is a symptom that may be linked to underlying hearing or health issues. Tinnitus can vary from mild and occasional to persistent and bothersome, and it can affect one or both ears.

What Causes Tinnitus?

Ringing in the ears, or tinnitus, can arise from various underlying issues. While the following list highlights some common causes, it is not exhaustive, and there may be other factors contributing to tinnitus.

Hearing loss

Conductive hearing loss

Conductive hearing loss occurs when a problem with the outer or middle ear prevents sound from being effectively transmitted to the inner ear. Causes can include ear infections, fluid buildup, earwax blockages, or abnormalities in the ear structures, resulting in associated tinnitus.

Sensorineural hearing loss

Sensorineural hearing loss results from damage to the inner ear (cochlea) or the auditory nerve pathways to the brain. Genetics and illnesses can affect the auditory nerves and inner ear, and are possible reasons for this form of hearing loss. This condition is usually permanent and may result in associated tinnitus.

Presbycusis

Presbycusis is an age-related hearing loss that can affect the ability to hear high-frequency sounds. As people age, the sensory cells in the cochlea gradually deteriorate, leading to reduced hearing sensitivity. As a result, speech becomes harder to hear, especially in noisy environments. Presbycusis can also result in tinnitus for some individuals.

Noise-induced hearing loss

Noise-induced hearing loss occurs from prolonged exposure to loud noises or a single intense sound. This damage affects sensitive structures in the cochlea, leading to permanent hearing loss and often tinnitus.

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Impacted earwax

Impacted earwax can cause tinnitus by creating pressure on the ear canal and eardrum, disrupting normal hearing. The auditory system may also overcompensate for the hearing loss by generating phantom ringing or buzzing sounds.

Head injury

Head injuries such as concussions, skull fractures and severe trauma can cause tinnitus. When the inner ear, auditory nerve, or brain regions involved in hearing get damaged, abnormal sound perceptions can develop. The severity of tinnitus depends on the extent of the damage.

Ototoxic drugs

Ototoxic drugs can lead to tinnitus by causing damage to the inner ear or auditory nerve. These medications can interfere with normal auditory function, leading to abnormal sound perceptions such as ringing or buzzing in the ears. 

Examples of these ototoxic drugs include:

• Some antibiotics such as aminoglycosides
• Some cancer treatments
• Loop diuretics and water pills
• Non-steroidal anti-inflammatory drugs (NSAIDs)

Psychological disorders

Tinnitus has been linked to higher rates of psychological disorders such as depression, sleep disorders, and stress. These disorders may exacerbate tinnitus symptoms by amplifying one’s perception of the sound, possibly resulting in increased self-consciousness and anxiety.

Tumours

Vestibular schwannoma is a benign tumour growing on the vestibulocochlear nerve that could cause tinnitus. As the tumour grows, it can compress or damage the nerve fibres. This disruption to nerve function can result in tinnitus, as the brain perceives these irregular signals as ringing or buzzing sounds.

Vascular abnormalities 

Vascular abnormalities, such as malformed blood vessels near the ear, can lead to tinnitus by creating irregular blood flow and increased blood turbulence. These abnormalities can alter the normal circulation patterns around the auditory structures, creating abnormal sounds that are perceived as tinnitus.

How is Tinnitus Diagnosed?

If you are experiencing tinnitus, the process of diagnosis typically involves consultations with either an audiologist or an Ear, Nose and Throat (ENT) specialist. At Hearing Partners, here is how the diagnosis and management of tinnitus would be approached:

1. Review your medical history

We will begin by conducting a thorough review of your medical history. This helps the audiologist understand any underlying health conditions or previous issues contributing to your tinnitus.

2. Complete a questionnaire to understand the severity of the tinnitus

To gain insight into the severity and impact of your tinnitus, you will be asked to fill out a detailed questionnaire. This helps in assessing how tinnitus affects your daily life and guides the audiologist in tailoring your care.

3. Take a hearing test to detect potential hearing loss

A comprehensive hearing test will be conducted to determine if there is any associated hearing loss. The results of this test can provide crucial information about the potential causes of your tinnitus and help in developing a management plan.

4. Audiologist will explain tinnitus

The audiologist will explain what tinnitus is, including its possible causes and how it might be impacting you. Understanding the condition can be an important first step in managing tinnitus. 

5. Explore different tinnitus management options

Depending on the findings, the audiologist will discuss various tinnitus management options with you. These may include hearing aids, sound therapy, or other interventions designed to alleviate symptoms. If necessary, you may be referred to an ENT specialist.

Think you might have tinnitus?

How to Manage Tinnitus

Managing tinnitus involves a range of strategies tailored to alleviate symptoms. This section will explore different methods and tools available to help you cope with tinnitus.

Hearing aids

Hearing aids can play a crucial role in managing tinnitus, especially when it is linked to hearing loss. For many individuals, tinnitus is exacerbated by reduced auditory input, making the internal ringing more noticeable. 

Hearing aids address this through “masking”, offering auditory distractions that can reduce the perception of tinnitus. For example, using Oticon hearing aids with an accompanying Tinnitus SoundSupport™ allows soothing white noise or ocean-like sounds to be played over tinnitus noises. 

These sounds are selected to comfort and distract, making it easier for you to focus on everyday activities without being overwhelmed by tinnitus.

Earwax removal

Earwax removal can be an important step in addressing tinnitus. By removing impacted earwax, the blockage in the ear canal will be cleared, reducing the associated ringing or buzzing in your ears.

Professional earwax removal is typically performed by an ENT specialist who uses specialised tools and techniques to safely and effectively clear the ear canal. This process often involves using instruments such as ear curettes, suction devices, or irrigation systems to remove the wax without causing damage to the sensitive structures of the ear. 

It is important to avoid attempting to remove earwax on your own at home. Using cotton swabs may push the earwax deeper into the ear canal, potentially causing further impaction or injury. On top of that, improper techniques can lead to infections or damage to the delicate ear tissues.

Note: Hearing Partners does not provide ear cleaning or earwax removal services.

Lifestyle changes

Managing tinnitus frequently involves adopting positive lifestyle changes that provide significant relief and help you cope more effectively. Here are some lifestyle changes that can support tinnitus management:

• Doing neck stretching exercises to alleviate some tension that may contribute to tinnitus symptoms
• Taking up new hobbies to distract you from your tinnitus
• Sticking to a consistent sleep schedule, as a lack of sleep can worsen tinnitus
• Avoiding caffeine-containing products (e.g. coffee, tea, cola, alcohol) because caffeine raises your blood pressure and exacerbates tinnitus

Joining a tinnitus support group is a possible option as well. Such a support group provides an opportunity to learn how others are managing their symptoms and share coping strategies.

Sound therapy 

Sound therapy manages tinnitus by introducing external sounds that help mask or reduce the perception of internal ringing or buzzing. This approach distracts the brain from the tinnitus and creates a more pleasant auditory environment.

One simple way to implement sound therapy is by using everyday sounds to mask tinnitus. For example, turning on the TV or opening a window to let in natural ambient noises can provide immediate relief. 

For more targeted sound therapy, specialised devices such as white noise generators or specialised sound generators can be used. These devices produce consistent background noise, including white noise or natural sounds like ocean waves or rain, effectively masking tinnitus. 

Pillows with built-in speakers are another option, offering a convenient way to listen to soothing sounds while resting, enhancing comfort during sleep.

Attention Therapy

Attention therapy, particularly Cognitive Behavioural Therapy (CBT), is a widely recommended approach for managing tinnitus. It’s often recommended to individuals who experience tinnitus symptoms but have been diagnosed with normal hearing during a hearing test with an audiologist.

The goal is to promote habituation, where the brain gradually reduces its emotional reaction and attention to tinnitus. This makes it easier to live with the condition. Here’s how attention therapy can help:

Cognitive Behavioral Therapy (CBT)

CBT is a form of psychotherapy that helps individuals change negative thought patterns and behaviours associated with tinnitus. It focuses on:

• Cognitive restructuring: Identifying and challenging negative thoughts about tinnitus, and replacing them with more positive, realistic ones.
• Behavioural techniques: Encouraging relaxation and engagement in enjoyable activities to reduce the focus on tinnitus.

Mindfulness-Based Cognitive Therapy (MBCT)

MBCT combines traditional CBT with mindfulness strategies. It helps individuals accept their tinnitus rather than trying to change it, which can reduce the emotional impact.

Acceptance and Commitment Therapy (ACT)

ACT is another form of CBT that emphasises accepting tinnitus and committing to actions that align with personal values, despite experiencing tinnitus symptoms.

Tinnitus Retraining Therapy (TRT)

Tinnitus Retraining Therapy (TRT) is a therapeutic approach combining sound therapy with counselling to address both the auditory and emotional aspects of tinnitus. By making tinnitus less of a focus in daily life, it aims to reduce the impact of this condition, helping individuals regain a sense of normalcy and control.

As mentioned above, sound therapy uses background noise, such as white noise, to help mask the tinnitus and decrease its prominence. This helps to habituate the brain to the tinnitus sounds. On the other hand, counselling changes the emotional response to tinnitus, helping individuals manage their reactions and reduce anxiety or stress associated with the condition.

How to Prevent Tinnitus

While it may not always be possible to prevent tinnitus entirely, adopting certain preventive measures can significantly reduce your risk and help maintain your overall auditory health. In this section, we will outline effective strategies for preventing the onset of tinnitus.

Protect your ears

Preventing tinnitus involves protecting your ears from excessive loud noise exposure. In general, sounds at and above 85 dBA are considered harmful.

At 85 dBA, you can be exposed for up to 8 hours a day without significant risk of hearing damage. However, for every additional 3 dB increase in volume, the safe exposure time is halved. For example, at 88 dBA, the maximum safe exposure is reduced to 4 hours, and this trend continues with increasing volume levels. 

To protect your ears from noise-induced hearing loss and reduce the risk of tinnitus, consider the following methods:

• Avoid loud places whenever possible.
• Use hearing protection, e.g. earplugs.
• Limit listening session durations.
• Keep your headphone volumes below 70%.

Make lifestyle adjustments

Smoking constricts blood vessels and causes reduced blood flow to the ears, while alcohol consumption can increase blood pressure. These habits interfere with blood circulation, contributing to the onset or worsening of tinnitus. Obesity is another risk factor for tinnitus, as excess weight may also lead to increased blood pressure. 

Leading a healthy lifestyle plays a crucial role in preventing tinnitus. Your blood pressure can be easily regulated by avoiding smoking, limiting alcohol consumption and maintaining a healthy weight. The risk of tinnitus caused by vascular abnormalities would thereby be greatly reduced.

Take charge of your hearing health

Taking regular hearing tests is key to detecting early signs of hearing loss or other ear problems that could lead to tinnitus. Regular hearing tests can reveal subtle shifts in hearing ability that might not be immediately noticeable but could contribute to tinnitus if left unaddressed. Early detection allows for timely intervention, which can prevent the progression of hearing loss and reduce your risk of developing tinnitus.

FAQs About Tinnitus and Ringing in the Ears

References

¹Referenced from the Gleneagles Hospital Malaysia
²Referenced from the Ministry of Health Malaysia