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Tinnitus 

Introduction
Tinnitus is hearing unusual sounds in the ear that are not actually occurring in the environment.  Ringing, buzzing, hissing, blowing, or other abnormal noises may be heard in one or both ears.  Tinnitus is most frequently caused by ear disorders, medical conditions, and medications.  It is a common condition that most people experience at some point in their life.  However, ongoing tinnitus can interfere with sleep and daily activities.  Treatments can help reduce or eliminate tinnitus.

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Anatomy
The ear is divided into three areas: the outer, middle, and inner ear.  Your ear not only enables you to hear, but it plays a role in balance as well.  Structures in the inner ear work with nerves to process sounds and body position.

Sensory cells for hearing line the inner ear.  Each cell is covered with microscopic hairs.  When sound waves enter the ear, the force moves the microscopic hairs.  The movement creates nerve messages that travel to the brain.  The brain interprets the messages as sound.

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Causes
Tinnitus can occur for many reasons.  If the microscopic hairs in the inner ear are broken or bent, causing false nerve signals to be sent to the brain, tinnitus can occur.  The brain interprets the inaccurate nerve signals as sound.  This explains why the sound that is heard in the ear is not actually occurring in the environment.  Loud noises and age-related hearing loss are associated with damage to the microscopic hairs.

Tinnitus is a common symptom of many ear problems, including ear wax buildup, trauma, ear infections, foreign objects in the ear, perforated eardrum, Meniere’s disease, temporomandibular joint (TMJ) disorder, and otosclerosis (hardening of the small bones in the ear).  Tinnitus can be caused by nerve disorders, such as Bell’s Palsy, neurofibromatosis, brain tumors, acoustic neuroma, traumatic brain injury, and concussion.  Changes in blood flow can cause tinnitus.  High blood pressure, preeclampsia with pregnancy, arteriovascular malformation (AVM), and aneurysm can contribute to tinnitus.  Alcohol, caffeine, cigarette smoking, aspirin, antibiotics, and other medications can cause tinnitus as well.

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Symptoms
Tinnitus causes people to hear unusual noises in one or both ears when there is actually no such sounds in the environment.  The noises may be subtle or loud and last for a short time or a long time.  Tinnitus can produce a variety of abnormal sounds, including whirling, swooshing, ringing, buzzing, chirping, roaring, whistling, blowing, or humming.  The noises may make it difficult for you to fall asleep or perform your regular activities.

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Diagnosis
You should contact your doctor if you have sustained tinnitus.  Your doctor will review your medical history and conduct an examination.  You should bring a list or the bottles of prescription and nonprescription medications that you take for your doctor to review.  You may be referred to a neurologist, audiologist, or ear, nose, and throat specialist.

Your doctor will examine the inside of your ear with an otoscope, which is a lighted device with a magnifying glass.  If pus is present, a sample may be tested to determine what type of infection it is.  Your doctor may place a stethoscope to your ear to listen for noises caused by vascular disorders.  Vascular tests or imaging scans are used to identify and confirm vascular conditions. You may receive a hearing test to measure your degree of hearing loss.

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Treatment
The treatment for tinnitus depends on its cause.  Treating ear infections, removing ear wax buildup, or removing foreign objects in the ear can stop tinnitus.  Treatment for underlying medical conditions reduces or eliminates symptoms.  If a medication is causing tinnitus, your doctor may switch your medication to one that does not cause tinnitus.  Your doctor may prescribe medication to reduce the symptoms of tinnitus.

In some cases, treatment may not make tinnitus go away.  Devices that are worn in the ear can help mask the abnormal noises.  Hearing aids may increase the volume of environmental sounds to decrease the annoyance of tinnitus.  A fan, white noise maker, or low-volume radio static can help mask tinnitus. 

Avoiding alcohol, caffeine, and cigarettes can help reduce tinnitus.  Relaxation techniques, biofeedback, regular exercise, and counseling can help to reduce stress, which may increase tinnitus.

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Prevention
You may help prevent tinnitus by reducing the risk factors that you can control.  Seek treatment for ear problems and underlying medical conditions.  Avoid alcohol, caffeine, and cigarettes.  Ask your doctor to evaluate the prescription and nonprescription medications that you take.  Participate in counseling, biofeedback, relaxation techniques, and regular exercise to reduce stress. 

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Am I at Risk

Risk factors for tinnitus:

_____ Injury from loud noises
_____ Age-related hearing loss
_____ Ear infection, earwax buildup, foreign objects in the ear
_____ Cancerous or noncancerous head and neck tumors
_____ Trauma to the ear, head, or brain
_____ Certain medical conditions including Meniere’s disease, TMJ disorder, AVM, aneurysm, anemia, allergies, otosclerosis, Bell’s Palsy, and neurofibromatosis.
_____ High blood pressure 
_____ Alcohol, cigarette smoking, and caffeine 
_____ Aspirin, antibiotics, and other medications

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.