What are the most common causes of ringing in the ear in an otherwise healthy individual, and what are possible tests and treatments for it?

Doctor's Answers (1)

Tinnitus refers to a ringing sound heard in the ear. It is quite common and most people would have experienced it at some point in their lives. The sound may have an actual source (objective tinnitus) or no actual source (subjective tinnitus - ie only the person suffering from it can hear it).  Causes of tinnitus depends on whether it is subjective vs objective (are as follows):

Subjective tinnitus:

  • Idiopathic (unknown cause) but may be worsened by stress or sleep deprivation
  • Hearing loss
  • Ear infections
  • Ear wax
  • Side effects from medications
  • Meniere's disease 

Objective tinnitus:

  • Clicking sounds from jaw joints or muscles nearby
  • Noise from nearby blood vessels
  • Vascular tumours

Fortunately, over 95% of the tinnitus that I see in my clinical practice (and I believe for most other ENT Specialists or GPs too) are subjective tinnitus. In an otherwise healthy individual with no other ear, nose or throat symptoms, most subjective tinnitus are idiopathic (unknown cause) or related to hearing loss. We do not know exactly why such tinnitus exist but one of the hypothesis suggests that the sound originates from the hearing nerve, hearing organ or the hearing centre of the brain. These structures may have "misfired", resulting in sound generated in the head without an actual source (stimulus). 

Assessment of a patient with tinnitus include a thorough clinical history and physical examination of the ear, as well as the head and neck region. A hearing test is also usually required to determine if there is any hearing loss associated with the tinnitus (which sometimes the patient may not be aware of). 

Some of the red flags of tinnitus which require further assessment (e.g. CT scan or MRI) include:

  • Pulsatile tinnitus (sound of the tinnitus feels like or coincides with your heartbeat)
  • One sided tinnitus
  • One sided hearing loss
  • Associated neurological symptoms (e.g. giddiness, facial numbness, headaches etc)

Treatment of tinnitus depends on the underlying cause. For idiopathic subjective tinnitus, majority of the time, reassurance of the patient is all that is required. For patients who are bothered by the tinnitus, treatment options include:

  • Tinnitus advice and counselling (coping mechanisms can be taught to the patient)
  • Tinnitus retraining therapy (a specialised habituation programme to allow patient to better understand the cause tinnitus and to eliminate or reduce the morbidity associated with it)
  • Medications (unfortunately, most have effectiveness of approximately 30-40%) 
  • Tinnitus masker (this involves wearing a device to emit soothing sounds to "mask" or "cover up" the tinnitus)
  • Hearing aids - for patients with associated hearing loss

If you have tinnitus that is persistent, troubling or has the red flags mentioned above, you should visit an ENT Specialist for an assessment.

Hope this helps and all the best!

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All content posted is for general informational purposes only and is not a substitute for professional medical advice. This Q&A is not a patient consultation and any information provided herein is not intended to replace consultation with a qualified medical professional. If you think you may have a medical emergency, call your doctor immediately. Always seek the advice of your doctor before starting or changing treatment.

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