Ringing or buzzing in the ears is incredibly common and affects millions of people all over the world. But what causes tinnitus? How does it start? Is it preventable? We're going to shed some light on the most commonly asked questions about the condition.
What can cause ringing in the ears?
Did you know 1 in 8 people in the UK have tinnitus?
That’s over 10% of the population battling this silent condition. It can be seriously debilitating, not only affecting hearing but also having a big effect on sleep, stress and mental health.
Tinnitus is a term to describe hearing sounds from inside the body rather than externally. Essentially, you can hear a sound, or sounds, when that sound does not exist in the world outside you.
It is important to clarify that it is not a disease in itself, and often can be a symptom of an underlying cause.
It normally indicates an issue in the auditory system, which consists of:
- the external ear (the ear canal and ear drum)
- the internal ear (where sound gets converted to an electrical signal)
- the auditory nerve (connecting the inner ear to the brain)
- the parts of the brain that process sound
A common phrase people with tinnitus might use to describe tinnitus is a “ringing in the ears” but the sounds heard also include buzzing, humming, grinding, hissing and whistling.
It can be intermittent, permanent, or pulsating and might be heard in one or both ears and be present all or only sometimes.
Tinnitus comes in many shapes and forms, varying uniquely with each person.
We'll split the causes of tinnitus into three broad categories:
- Common causes of tinnitus
- Rarer medical conditions that can cause tinnitus
- Medications that cause tinnitus
What causes tinnitus: common conditions
Let's start by going over the commonest causes of tinnitus.
- Ear wax
- Ear bone changes
- Noise exposure
- Age related hearing loss
Something as simple as a piece of earwax causing an occlusion to the ear canal can cause tinnitus.
Earwax is something we regard as unpleasant and sticky but in reality, it has a lot of protective features for our ear.
It coats our ear canal, trapping dirt and impeding the growth of bacteria inside the ear.
However, a good balance is always needed. When the earwax accumulates and hardens, it becomes difficult to wash away naturally and hence can result in hearing loss or eardrum irritation leading to tinnitus.
Ear bone changes
Otosclerosis is a condition which results in the abnormal growth of bones inside the ear.
Inside the ear, there are 3 tiny bones present which vibrate when sound waves enter. They are responsible for transmitting sound waves to the inner each where the sound waves are converted into signals later sent to the brain.
When otosclerosis is present, one of the three bones (the stapes) fuse its surrounding bones and eventually becomes rigid and immoveable. As a result, this means that sound waves are not efficiently transmitted to the inner ear.
This cause of tinnitus tends to run in families.
Approximately 70% of tinnitus is caused by loud noises.
This is a hard one to avoid. Loud noises are all around us, from fire alarms to concerts. We can’t avoid them all, but we can try to protect against them.
Any loud sudden noise, from any source, can damage our auditory system resulting in tinnitus.
If the loud noise exposure was for a short period of time, the tinnitus tends to resolve and go away but short or long-term exposure can also cause permanent damage leading to lifelong tinnitus.
Tips on protecting against loud noises:
- Plan ahead - if you know you’re going to a loud event (eg. concerts or sports games), bring some earbuds
- Music - I’m sure we’re all guilty of turning up the music too loud to drown out the background noises, but this can be detrimental to your hearing. Try investing in noise-cancelling headphones
- Hearing test - if you are worried about your hearing health, it can be a good idea to get your hearing tested
People grow old, even if we don’t like it.
Old age is linked to many conditions, such as worsening eyesight and hearing. People around the age of 60 tend to gradually start experiencing a worsening in their hearing. This hearing loss can also cause tinnitus.
The medical term for this specific type of hearing loss is presbycusis.
Rarer Medical Problems Causing Tinnitus
There are other medical problems that can cause tinnitus, and in some cases your doctor will send you for further tests to rule these out.
- Meniere's disease
- Acoustic neuroma
- Head or neck injury
- Muscle spasms
- Eustachian tube dysfunction
- Turbulent blood flow
Meniere’s disease is a condition affecting the inner ear resulting in the following symptoms:
- A feeling of pressure in the ear
- Hearing loss
Meniere’s disease is thought to be linked to the inappropriate amount of fluid found in the inner ear, but the exact cause is uncertain.
Tinnitus is considered an early indicator of this disease and can aid in the diagnosis.
Acoustic neuroma (or vestibular schwannoma as they are sometimes called) is the medical word for a non-cancerous tumour in one of the nerves that runs from the brain to the inner ear.
This nerve is responsible for balance and hearing, and when the tumour places pressure on the nerve both of these things are affected.
This will result in tinnitus in one ear.
Head or neck Injury
It is difficult to prevent any injury to the head or neck as no one deliberately tries to get injured.
Sometimes, life just deals us a bad hand. However, some people are at an increased risk of such injuries depending on their profession. Sports professionals such as football or rugby players or manual workers like builders might injure their head and neck at some point in their career.
These traumas may lead to tinnitus. They can also injure the inner ear and any injury to the inner ear can affect one or more of the anatomy linked to hearing.
Depending on the extent of the injury to the inner ear, it will correlate to the severity of the tinnitus.
We have probably at some point in our lives experienced muscle spasms or cramps.
The involuntary movements where the muscles contract but cannot relax. Sometimes we feel as though our muscles are twitching and after some time it goes back to normal.
We also have muscles in our inner ear and the exact same can happen to those muscles. The muscles tense up and spasms resulting in either tinnitus, or usually worsening of existing tinnitus.
Eustachian tube dysfunction
The eustachian tube is a small pipe that connects the middle ear to the upper part of the throat.
This tube is in charge of regulating the pressure within the middle ear, equalising the pressure inside and outside the ear. When a person has Eustachian tube dysfunction, this tube remains expanded all the time resulting in full sensation in the ear.
One of the symptoms of the condition can be tinnitus and problems with hearing.
Blood vessel disorders
These blood vessel-related causes of tinnitus are much rarer.
They usually result in a specific type of tinnitus called pulsatile tinnitus. Pulsatile tinnitus occurs as a result of turbulent blood flow in or near your ears.
Instead of hearing a steady ringing or buzzing, you would tend to hear a rhythmic sound that follows the same rate of the heart.
What medications cause tinnitus?
There are known medications that have been linked to the cause or worsening of tinnitus.
It is generally thought that in higher doses, the higher the risk of tinnitus. But when the medications are stopped, it tends to subside and usually will stop. The medications include:
- Antibiotics: polymyxin B, erythromycin, vancomycin and neomycin
- Cancer medications: methotrexate and cisplatin
- Diuretics (water medications): bumetanide, ethacrynic acid or furosemide
- Quinine medications used in the treatment of malaria or other conditions
- Certain antidepressants
- High doses of aspirin.
If you happen to be taking any of these, your doctor will have probably advised you to look out for any symptoms.
If you do think your tinnitus is linked to one of these medications, make an appointment with your GP to discuss it further.
Does stress cause tinnitus?
It is unlikely that stress would be a direct cause of tinnitus.
However, the two are closely linked and we do know that increased stress can make tinnitus worse. Stress can also trigger a tinnitus flare up in those that have habituated to the condition.
In many people hearing the sound of their tinnitus will activate the fight or flight response. This may in turn make the tinnitus feel more intrusive.
The British Tinnitus Association provides tips about how to interrupt this cycle.
Finding the Cause
How can you find out which one of these conditions is causing your tinnitus?
After some tests, your doctor should be able to tell you which condition is causing your tinnitus. Although it is worth noting that this is not always possible.
In rarer cases, sometimes the cause is never found.
If you live in the UK, there is a specific pathway for tinnitus diagnosis and treatment in the NHS.
You can read more about which tinnitus treatments may be more appropriate for you in our next article.