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Causes

Tinnitus is a symptom associated with an array of other health conditions.

Tinnitus is not a disease, but rather a symptom of some other underlying health condition. In most cases, tinnitus is a sensorineural reaction in the brain to damage in the auditory system. While tinnitus is often associated with hearing loss, there are roughly 200 different health disorders that can generate tinnitus as a symptom. Below is a list of some of the most commonly reported catalysts for tinnitus.

Note: Tinnitus, by itself, does not necessarily indicate any one of the items listed below. Patients experiencing tinnitus should see their physician or a hearing health professional for a full examination to diagnose the underlying cause of symptoms. In some cases, resolving the root cause will alleviate the perception of tinnitus.

Hearing Loss

Sensorineural hearing loss is commonly accompanied by tinnitus. Some researchers believe that subjective tinnitus cannot exist without some prior damage to the auditory system. The underlying hearing loss can be the result of:

  • Age-related hearing loss (presbycusis) - Hearing often deteriorates as people get older, typically starting around the age of 60. This form of hearing loss tends to be bilateral (in both ears) and involves the sensory loss of high-frequency sounds. Age-related hearing loss explains, in part, why tinnitus is so prevalent among elderly people.
  • Noise-induced hearing loss - Exposure to loud noise, either a single traumatic experience or over time, can damage the auditory system and result in hearing loss and sometimes tinnitus as well. Traumatic noise exposure can happen at work (e.g. loud machinery), at play (e.g. loud sporting events, concerts, other recreational activities), and/or by accident (e.g. a backfiring engine.) Noise-induced hearing loss is sometimes unilateral (one ear only) and typically causes patients to lose hearing around the frequency of the triggering sound trauma.

It is important to note that existing hearing loss is sometimes not directly observable by the patient, who may not perceive the inability to hear lost frequencies. But that does not mean that hearing damage has not occurred. An audiologist or other hearing health professional can perform audiometric tests to precisely measure the true extent of hearing loss.

The exact biological process by which hearing loss is associated with tinnitus is still being investigated by researchers. However, we do know that the loss of certain sound frequencies leads to specific changes in how the brain processes sound. In short, as the brain receives less external stimuli around a specific frequency, it begins to adapt and change. Tinnitus may be the brain’s way of filling in the missing sound frequencies it no longer receives from the auditory system.

Obstructions in the Middle Ear

Blockages in the ear canal can cause pressure to build up in the inner ear, affecting the operation of the eardrum. Moreover, objects directly touching the eardrum can irritate the organ and cause the perception of tinnitus symptoms. Common obstructions include:

  • Excessive earwax (ceruminosis)
  • Head congestion
  • Loose hair from the ear canal
  • Dirt or foreign objects

In many cases, the removal of the blockage will alleviate tinnitus symptoms. However, in some situations, the blockage may have caused permanent damage that leads to chronic tinnitus.

Head and Neck Trauma

Injury to the head or neck can cause nerve, blood flow, and muscle issues that result in the perception of tinnitus. Patients who ascribe their condition to head and neck trauma often report higher tinnitus volume and perceived burden, as well as greater variability in sound/s, frequency, and location of their tinnitus.

Tinnitus related to head, neck, or dental issues is sometimes referred to as somatic tinnitus. (“Somatic” derives from the Greek somatikos, meaning “of the body.”)

Temporomandibular Joint Disorder

Another example of somatic tinnitus is that caused by temporomandibular joint disorder. The temporomandibular joint (TMJ) is where the lower jaw connects to the skull, which is located in front of the ears. Damage to the muscles, ligaments, or cartilage in the TMJ can lead to tinnitus symptoms. The TMJ is adjacent to the auditory system and shares some ligaments and nerve connections with structures in the middle ear.

Tinnitus patients with a TMJ disorder may experience pain in the face and/or jaw, limited ability to move the jaw, and regular popping sounds while chewing or talking.  A dentist, craniofacial surgeon, or other oral health professional can appropriately diagnose and often fix TMJ issues. In many scenarios, fixing the TMJ disorder will alleviate/reduce tinnitus symptoms.

Sinus Pressure and Barometric Trauma

Nasal congestion from a severe cold, flu, or sinus infection can create abnormal pressure in the middle ear, impacting normal hearing and causing tinnitus symptoms.

Acute barotrauma, caused by extreme or rapid changes in air or water pressure, can also damage the middle and inner ear. Potential sources of barotrauma include:

  • Diving / Snorkeling / Scuba Diving
  • Flying (only during extreme, abnormal elevation changes; normal commercial air travel is generally safe)
  • Concussive explosive blasts

Traumatic Brain Injury (TBI)

Traumatic brain injury, caused by concussive shock, can damage the brain’s auditory processing areas and generate tinnitus symptoms. TBI is one of the major catalysts for tinnitus in military and veteran populations. Nearly 60% of tinnitus cases diagnosed by the U.S. Department of Veterans Affairs are attributable to mild-to-severe traumatic brain injuries.

Ototoxic Drugs

Tinnitus is a potential side effect of many prescription medications. However, in most cases and for most drugs, tinnitus is an acute, short-lived side effect, meaning if the patient stops taking the medication, the tinnitus symptoms typically subside. However, there are some ototoxic drugs that cause permanent tinnitus symptoms. These include:

  • Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
  • Certain antibiotics
  • Certain cancer medications
  • Water pills and diuretics
  • Quinine-based medications

If you are worried about tinnitus as a side effect of your medications, please consult your prescribing physician or pharmacist. You should never stop taking a medication without first consulting your healthcare provider. The risk of stopping a medication may far exceed any potential benefit in the reduction of the tinnitus sound.

Other Diseases & Medical Conditions

Tinnitus is a reported symptom of the following medical conditions:

  • Metabolic Disorders: Hypothyroidism, Hyperthyroidism, Anemia
  • Autoimmune Disorders: Lyme Disease, Fibromyalgia
  • Blood Vessel Disorders: High Blood Pressure, Atherosclerosis
  • Psychiatric Disorders: Depression, Anxiety, Stress
  • Vestibular Disorders: Ménière's Disease,Thoracic Outlet Syndrome, Otosclerosis
  • Tumor-Related Disorders (very rare): Acoustic Neuroma, Vestibular Schwannoma, other tumorous growths

Again, a person experiencing tinnitus should not assume that he/she has one of the medical conditions listed above. Only a trained healthcare provider can appropriately diagnose the underlying cause of tinnitus.