Ringing in the Ears (Tinnitus)

What is Tinnitus?

Tinnitus represents one of the most elusive mysteries facing audiologists and other hearing health care professionals. It refers to an auditory perception not directly produced by an external sound. Tinnitus is commonly described as a “hissing, roaring or ringing.” It can range from high pitch to low pitch, consist of multiple tones or sound like noises (having no tonal quality at all). Tinnitus may be constant, pulsed or intermittent. It may begin suddenly, or may come on gradually. It can be perceived in one ear, both ears, or in the head. Tinnitus can be very mild, noticeable only in a quiet room, or it can become so loud and annoying the victim hears nothing else. While Tinnitus does not cause hearing disorders, it may accompany decreased hearing and other ear symptoms such as pressure, unsteadiness, or dizziness.

Who has Tinnitus?

As many as 50 million adults experience tinnitus, with more than 10 million seeking help for the condition. Because tinnitus, like pain, is subjective, two individuals may report similar tinnitus characteristics yet be affected in significantly different ways. The severity of tinnitus and how it affects one’s life is largely influenced by the individual’s reaction to the tinnitus. Many tinnitus sufferers report interference with sleep, concentration, and attention to detail. Some are depressed and anxious and may report additional problems at work or at home that compound the distress caused by tinnitus. Many people with tinnitus also suffer from hyperacusis, an inability to tolerate even moderate level sounds. Most tinnitus patients report a relationship between tinnitus perception and stress. The onset of tinnitus often coincides with a change (emotional, physical or social) in one’s life situation. Tinnitus has both a physiological and psychological component.

There are many potential causes, including:

  • wax buildup or obstructions in the outer ear canal.
  • trauma to the head or neck as in a concussion or whiplash injury
  • perforation in the eardrum or fluid accumulation behind
  • systemic disorders such as high or low blood pressure, anemia, diabetes, thyroid dysfunction, glucose metabolism abnormalities, vascular disorders, acoustic tumors, head or neck aneurisms, hormonal changes;
  • Otosclerosis – the stapes bone becomes fixed
  • Otitis media (ear infections)
  • exposure to a sudden loud noise or repeated exposure to noise without adequate protection
  • temporary effects of high dosages of medications such as anti-inflammatories (including aspirin, ibuprofen, and quinine), and certain sedatives and antidepressants; possible permanent effects from certain antibiotics and chemotherapeutic agents;
  • some medications induce head noises
  • high or low blood pressure or anemia
  • disorders in the outer ear such as: ear wax (cerumen), hair or a foreign body touching the eardrum;
  • disorders in the middle ear such as: vascular abnormalities, infection, otosclerosis, muscle spasms, Eustachian tube dysfunction, benign tumors;
  • disorders in the inner ear such as: sensorineural (nerve) damage due to noise exposure, presbycusis (hearing loss from aging), labyrinthitis (inner ear infection), Meniere’s disease (associated with hearing loss and dizziness);
  • trauma to the head or neck, cervical (neck) problems, temporomandibular (jaw joint) misalignment.

While some tinnitus sufferers also have hearing loss, the presence of tinnitus does NOT necessarily mean that one is losing hearing.

Treatment of Tinnitus

Correcting treatable causes of Tinnitus (i.e., ear wax build-up, allergy, infection, syphilis) often will improve the condition. However, when the cause is unknown, or when head noises arise from within the cochlea, auditory nerve, or brain, treatment becomes more difficult. Most medications and surgical procedures have not been successful in relieving Tinnitus. When hearing loss exists, utilizing hearing aids will generally mask the head noises by stimulating the auditory nerve with environmental sound. Because of the direct association between the hearing mechanism and the nervous system, Tinnitus sufferers have been advised to avoid nervous tension, fatigue, and stimulants. Some anti-depressants and anti-anxiety medications address the problems associated with tinnitus and have proven helpful for certain patients. Always consult your physician and pharmacist concerning any drug or combination of medications you may be considering. Sedatives, biofeedback, and other relaxation techniques may offer some people temporary relief.

Amplification is among the most effective tool for providing relief form tinnitus. Hearing aids may help by amplifying background sounds that reduce the loudness of the tinnitus or even mask it. In addition they may help by relieving stress associated with the adverse impact of hearing loss on communication abilities. The only other approach that so far has achieved any success has been Tinnitus Maskers to mask the ringing sound with other sounds as a means of distracting the individual’s concentration on Tinnitus. There are several methods of providing masking, including tinnitus maskers (ear level electronic sound-producing devices housed in a hearing aid case), tinnitus instruments (combination hearing aids and tinnitus maskers), tabletop bedside sound generators or hearing aids. CD’S and tapes that provide various sounds also may help mask tinnitus. These can be used with either speakers or headphones. Other worthwhile treatments to explore are cognitive therapy and Tinnitus Retraining Therapy (TRT). Tinnitus Re-Training Therapy is based on the principals of neural plasticity (brain re-wiring). The two components of this method are directive counseling (education) and sound therapy. Eventually, the brain may relearn a pattern that will-de-emphasize the importance of the tinnitus.

Alternate Approaches
Data is limited on benefit from alternative approaches such as hypnosis, acupuncture, essential oils, or chiropractic manipulation. Anecdotal reports however indicate benefit for some patients. This is likely due to lack of appropriate studies as well as the multitude of causative findings and other ongoing health conditions that can cause/exacerbate the condition.

What Can You Do to Minimize Tinnitus?

  • Avoid loud noises
  • Wear proper ear protection in high noise areas
  • Control stress
  • Avoid fatigue
  • Learn to relax
  • Maintain good nutrition; certain disorders may be helped by lower salt intake
  • Reduce or eliminate alcohol and stimulants such as caffeine
  • Exercise
  • Educate yourself about tinnitus
  • Consult your Audiologist about Tinnitus Therapy which generally included counseling strategies and sound stimulation with tinnitus generators or hearing aid devices equipped with sound generators.

See Functional Audiology, Functional Tinnitus For More Information on Tinnitus!

What Should You Do If You Have Tinnitus?

Consult an audiologist who is knowledgeable about tinnitus to help develop your management program. Audiologists are trained professionals who can help diagnose and treat may of the problems associated with tinnitus. Audiologist Dr. Brandy Vowell may refer you to your primary care physician or otolarynologist if she feels your tinnitus may be due to a medical condition.

Educate yourself about the nature of tinnitus and methods for managing and relieving your associated problems (anxiety, depression, sleep deprivation; etc.). Taking charge of your overall health may also aid in your tinnitus awareness.


Because Tinnitus may be symptomatic of a more serious disorder, it is important to have a thorough diagnostic hearing evaluation by Dr. Vowell, your Tulsa Audiologist in Oklahoma, to determine if an underlying cause exists for your tinnitus.