Szumy uszne – Etiologia i przyczyny

Szumy uszne
Etiologia i przyczyny

Szumy uszne (tinnitus) to subiektywne odczuwanie dźwięków bez zewnętrznego źródła, stanowiące objaw wielu schorzeń, najczęściej związanych z niedosłuchem odbiorczym. Szacuje się, że problem dotyczy 10-15% populacji, z częstością wzrastającą do około 12% u osób powyżej 60. roku życia. Główne etiologie obejmują ekspozycję na hałas (70-90% przypadków), presbyacusis, zaburzenia przewodzenia dźwięku, chorobę Ménière’a (94% pacjentów z tym schorzeniem doświadcza szumów, z czego 37% ocenia je jako ciężkie) oraz otosklerozę (65-85% przypadków). Mechanizmy patofizjologiczne obejmują neuroplastyczne zmiany w centralnym układzie słuchowym (model centralnej kompensacji), teorię rezonansu stochastycznego oraz nieprawidłową komunikację między obszarami mózgu. Ponadto, ponad 260 leków, w tym NLPZ (np. kwas acetylosalicylowy), aminoglikozydy, cisplatyna i diuretyki pętlowe, mogą indukować lub nasilać szumy uszne, które często ustępują po odstawieniu leku.

Etiologia szumów usznych

Szumy uszne (tinnitus) to objaw słuchowy, który charakteryzuje się subiektywnym odczuwaniem dźwięku w uszach lub głowie przy braku zewnętrznego źródła bodźca dźwiękowego. Warto podkreślić, że szumy uszne nie są chorobą, ale objawem innych, podstawowych schorzeń lub zaburzeń zdrowotnych. Szacuje się, że problem ten dotyka około 10-15% populacji ogólnej, przy czym częstość występowania wzrasta wraz z wiekiem, dotykając około 5% osób w wieku 20-30 lat i około 12% osób powyżej 60. roku życia¹².

Uszkodzenia układu słuchowego jako główna przyczyna szumów usznych

Najczęstszą przyczyną szumów usznych są zaburzenia dotyczące układu słuchowego, szczególnie te związane z niedosłuchem odbiorczym. Badania wykazują, że aż 90% pacjentów z szumami usznymi doświadcza pewnego stopnia utraty słuchu¹². Wielu badaczy i klinicystów uważa, że szumy uszne subiektywne nie mogą istnieć bez wcześniejszej utraty słuchu, nawet jeśli taka utrata nie jest zauważalna przez pacjenta¹.

Główne przyczyny zaburzeń słuchu prowadzące do szumów usznych to:

Ekspozycja na hałas – zarówno jednorazowa (np. eksplozja, bliski strzał z broni palnej) jak i długotrwała (praca w hałaśliwym środowisku, słuchanie głośnej muzyki). Uważa się, że około 70-90% przypadków szumów usznych jest spowodowanych uszkodzeniem słuchu wywołanym hałasem¹²³.
Presbyacusis – związany z wiekiem ubytek słuchu, który postępuje wraz z procesem starzenia się. Jest to częsta przyczyna szumów usznych u osób starszych, zwykle dotykająca obu uszu i powodująca uszkodzenia w zakresie wyższych częstotliwości¹².
Zaburzenia przewodzenia dźwięku – np. obecność woskowiny w przewodzie słuchowym zewnętrznym, perforacja błony bębenkowej, otoskleroza, zapalenie ucha środkowego¹².
Choroba Ménière’a – zaburzenie ucha wewnętrznego charakteryzujące się epizodami zawrotów głowy, szumów usznych i wahającym się niedosłuchem. Około 94% pacjentów z chorobą Ménière’a doświadcza szumów usznych, a 37% klasyfikuje je jako ciężkie¹².
Otoskleroza – nieprawidłowy rozrost kości w uchu środkowym, powodujący stopniową utratę słuchu. Częstość występowania szumów usznych w otosklerozie wynosi od 65 do 85%¹².

Mechanizmy neurofizjologiczne szumów usznych

Dokładny mechanizm powstawania szumów usznych nie jest w pełni zrozumiały, jednak istnieje kilka wiodących teorii wyjaśniających to zjawisko:

Model centralna kompensacja – Według tej teorii szumy uszne są wynikiem zmian neuroplastycznych w centralnym układzie słuchowym, które powstają jako reakcja na zmniejszony dopływ bodźców z uszkodzonego ucha wewnętrznego. Gdy do mózgu dociera mniej sygnałów słuchowych, mechanizmy kompensacyjne zwiększają swoją aktywność, co może prowadzić do percepcji dźwięku, którego nie ma¹².

Teoria rezonansu stochastycznego – Gdy sygnał jest zbyt słaby, by być wykrywanym przez receptor, dodanie losowego szumu (białego szumu) może uczynić go wykrywalnym. Jeśli do mózgu przesyłane są niewystarczające sygnały, na przykład z powodu utraty słuchu, biały szum jest wzmacniany przez mózg, aby przynajmniej częściowo zrekompensować utratę słuchu. Zwiększony biały szum odpowiada zwiększonej aktywności komórek nerwowych wzdłuż drogi słuchowej w przypadku szumów usznych¹.

Nieprawidłowa komunikacja między obszarami mózgu – Inne dowody wskazują, że nieprawidłowe interakcje między korą słuchową a innymi obwodami neuronalnymi mogą odgrywać rolę w powstawaniu szumów usznych¹.

Leki ototoksyczne jako przyczyna szumów usznych

Wiele leków może wywoływać lub nasilać szumy uszne. Leki ototoksyczne to substancje, które mogą uszkadzać ucho wewnętrzne, prowadząc do niedosłuchu, zawrotów głowy lub szumów usznych. Szacuje się, że ponad 260 różnych leków może powodować szumy uszne jako działanie niepożądane¹. Do najczęściej wymienianych należą:

Niesteroidowe leki przeciwzapalne (NLPZ) – szczególnie w dużych dawkach, np. kwas acetylosalicylowy (aspiryna)¹².
Antybiotyki – zwłaszcza aminoglikozydy, erytromycyna¹².
Leki przeciwnowotworowe – m.in. cisplatyna¹².
Diuretyki pętlowe – np. bumetanid¹².
Leki przeciwmalaryczne – np. chlorochina¹.
Leki przeciwdepresyjne¹.

Szumy uszne wywołane lekami zazwyczaj ustępują po zaprzestaniu ich stosowania, choć w niektórych przypadkach efekt może być trwały¹.

Choroby i zaburzenia naczyniowe

Zaburzenia naczyniowe mogą prowadzić do szczególnego rodzaju szumów usznych – szumów pulsujących, które są zsynchronizowane z tętnem. Tego typu szumy uszne występują znacznie rzadziej niż szumy subiektywne, stanowiąc mniej niż 1% wszystkich przypadków¹. Przyczyny naczyniowe szumów pulsujących obejmują:

Nadciśnienie tętnicze – może powodować zmiany w przepływie krwi do uszu i głowy¹.
Miażdżyca – utwardzenie tętnic może wpływać na przepływ krwi w pobliżu ucha¹.
Malformacje naczyniowe – w tym przetoki tętniczo-żylne (AVMs), które mogą powodować nieprawidłowy przepływ krwi¹.
Zwężenie zatok żylnych mózgu – zwłaszcza zatoki poprzecznej i esowatej, co może zaburzać przepływ krwi i przyczyniać się do szumów pulsujących¹.
Idiopatyczne nadciśnienie śródczaszkowe (pseudotumor cerebri) – charakteryzujące się wysokim ciśnieniem płynu wokół mózgu, co może powodować bóle głowy, zawroty głowy, utratę słuchu i szumy uszne¹.
Uszypułkowane guzy naczyniowe ucha środkowego – np. glomus tympanicum, glomus jugulare¹.

Choroby neurologiczne i zaburzenia centralnego układu nerwowego

Zaburzenia neurologiczne oraz urazy głowy i szyi mogą również prowadzić do szumów usznych:

Nerwiak przedsionkowy (osłoniak nerwu VIII) – łagodny guz rozwijający się na nerwie przedsionkowo-ślimakowym, łączącym ucho wewnętrzne z mózgiem¹².
Urazy głowy i szyi – mogą powodować uszkodzenia struktur ucha, nerwu przenoszącego sygnały dźwiękowe do mózgu lub obszarów mózgu przetwarzających dźwięk¹².
Stwardnienie rozsiane – może prowadzić do uszkodzeń osłonek mielinowych w CUN, co może wpływać na przewodzenie impulsów nerwowych w drogach słuchowych¹.
Skurcze mięśni podniebiennych lub ucha środkowego (mięśnia strzemiączkowego, napinacza błony bębenkowej) – mogą powodować rytmiczne klikanie słyszalne jako obiektywne szumy uszne¹.
Malformacja Chiariego – rzadka przyczyna szumów usznych, występująca gdy nisko położone migdałki móżdżku powodują napięcie nerwu słuchowego¹.

Zaburzenia stawu skroniowo-żuchwowego i szyi

Problemy z układem mięśniowo-szkieletowym w okolicy głowy i szyi mogą przyczyniać się do powstawania szumów usznych, co jest czasami określane jako szumy somatyczne¹:

Zaburzenia stawu skroniowo-żuchwowego (TMJ) – nieprawidłowe ułożenie lub dysfunkcja stawu łączącego żuchwę z czaszką może prowadzić do szumów usznych. Ponieważ staw ten znajduje się blisko ucha, problemy z nim związane mogą wpływać na percepcję dźwięku¹².
Dysfunkcja kręgosłupa szyjnego – w tym nieprawidłowe ułożenie lub ucisk nerwów, może potencjalnie wpływać na funkcję słuchową i przyczyniać się do szumów usznych¹.
Zespół miofascjalny – zaburzenia mięśniowe mogą być przyczyną szumów usznych¹.

Zaburzenia metaboliczne i choroby ogólnoustrojowe

Różne schorzenia ogólnoustrojowe i zaburzenia metaboliczne mogą mieć związek z szumami usznymi:

Choroby tarczycy – zarówno niedoczynność jak i nadczynność tarczycy mogą przyczyniać się do szumów usznych¹².
Cukrzyca – może powodować uszkodzenia naczyń krwionośnych i nerwów w uchu wewnętrznym¹².
Niedokrwistość – niedobór żelaza i anemie mogą być związane z szumami usznymi¹.
Hiperlipidemia – podwyższony poziom lipidów we krwi¹.
Autoimmunologiczne choroby ucha wewnętrznego – rzadkie schorzenia charakteryzujące się stanem zapalnym struktur ucha wewnętrznego, w tym ślimaka i nerwu słuchowego, wynikające z odpowiedzi autoimmunologicznej¹.
Inne choroby autoimmunologiczne – np. toczeń rumieniowaty układowy, reumatoidalne zapalenie stawów¹².

Stres i czynniki psychologiczne

Czynniki psychologiczne odgrywają istotną rolę w percepcji i nasileniu szumów usznych:

Stres – może być zarówno przyczyną jak i czynnikiem nasilającym szumy uszne. Badania pokazują, że podwyższony poziom stresu może wpływać na receptory słuchowe i przetwarzanie dźwięku w mózgu¹².
Lęk i depresja – występują u około 48-78% pacjentów z ciężkimi szumami usznymi. Zaburzenia te mogą być zarówno czynnikiem przyczyniającym się do uciążliwych szumów usznych, jak i konsekwencją ich występowania¹².
Zaburzenia snu – problemy ze snem mogą nasilać szumy uszne, tworząc błędne koło: szumy uszne utrudniają zasypianie, a niewyspanie pogarsza percepcję szumów¹.

Inne czynniki ryzyka i przyczyny szumów usznych

Czynniki ryzyka rozwoju szumów usznych

Oprócz bezpośrednich przyczyn, istnieją czynniki, które zwiększają ryzyko rozwoju szumów usznych:

Wiek – ryzyko szumów usznych wzrasta wraz z wiekiem, co wiąże się głównie z postępującą utratą słuchu¹².
Płeć – szumy uszne częściej występują u mężczyzn niż u kobiet¹.
Palenie tytoniu – nikotyna może uszkadzać nerw słuchowy i zwiększać ryzyko szumów usznych¹².
Nadużywanie alkoholu – może wpływać na naczynia krwionośne i przepływ krwi w uszach¹.
Nadmierne spożycie kofeiny – może nasilać objawy szumów usznych¹.
Problemy sercowo-naczyniowe – choroby serca, nadciśnienie tętnicze i inne problemy układu krążenia mogą zwiększać ryzyko szumów usznych¹.

COVID-19 i szumy uszne

Istnieją dowody, choć być może ograniczone, że szumy uszne mogą być związane z COVID-19. Wykazano związek między długotrwałymi objawami COVID-19 (tzw. long COVID) a szumami usznymi¹². Mechanizm tego zjawiska nie jest do końca jasny, ale może być związany z wpływem wirusa na układ nerwowy i przedsionkowo-słuchowy¹.

Ponadto, istnieją dowody sugerujące, że szumy uszne mogą rozwinąć się w rzadkich przypadkach po szczepieniu przeciwko COVID-19 wektorowymi lub mRNA szczepionkami¹.

Idiopatyczne szumy uszne

W wielu przypadkach przyczyna szumów usznych pozostaje nieznana, mimo dokładnej diagnostyki. Szumy uszne bez ustalonej przyczyny nazywane są idiopatycznymi. Nawet przy zastosowaniu zaawansowanych technik diagnostycznych, u znacznego odsetka pacjentów nie udaje się zidentyfikować konkretnej przyczyny¹².

To sugeruje, że szumy uszne mogą być złożonym zjawiskiem, wynikającym z interakcji wielu czynników lub nierozpoznanych jeszcze mechanizmów neurofizjologicznych¹.

Diagnostyka przyczyn szumów usznych

Właściwa diagnostyka szumów usznych jest kluczowa dla określenia przyczyny i wdrożenia odpowiedniego leczenia. Proces diagnostyczny obejmuje:

Wywiad i badanie przedmiotowe

Pierwszym krokiem w diagnozie szumów usznych jest dokładny wywiad medyczny i badanie przedmiotowe¹:

Charakterystyka szumów – jednostronne czy obustronne, stałe czy okresowe, pulsujące czy ciągłe
Czas trwania szumów i okoliczności ich pojawienia się
Towarzyszące objawy – zawroty głowy, niedosłuch, ból, uczucie pełności w uchu
Historia ekspozycji na hałas
Przyjmowane leki
Choroby współistniejące
Badanie otoskopowe – ocena przewodu słuchowego i błony bębenkowej
Badanie układu krążenia – osłuchiwanie naczyń szyjnych pod kątem szmerów

Badania audiologiczne

Badania audiologiczne są kluczowe w diagnostyce szumów usznych¹²:

Audiometria tonalna – ocena progu słyszenia dla różnych częstotliwości
Audiometria impedancyjna – badanie funkcji ucha środkowego
Otoemisje akustyczne – badanie funkcji komórek słuchowych zewnętrznych
Słuchowe potencjały wywołane pnia mózgu – badanie funkcji drogi słuchowej

Badania obrazowe

W zależności od wyniku badania podmiotowego i przedmiotowego mogą być wskazane badania obrazowe¹:

Rezonans magnetyczny (MRI) – szczególnie wskazany w przypadku jednostronnych szumów usznych lub asymetrycznego niedosłuchu, w celu wykluczenia nerwiaków przedsionkowych i innych zmian w ośrodkowym układzie nerwowym¹
Tomografia komputerowa (CT) – przydatna w ocenie struktur kostnych i anomalii naczyniowych
Angiografia – w przypadku podejrzenia przyczyn naczyniowych

Badania laboratoryjne

W zależności od podejrzewanych przyczyn mogą być zlecone badania laboratoryjne¹:

Morfologia krwi – w celu wykluczenia niedokrwistości
Badania funkcji tarczycy – poziom TSH, fT3, fT4
Profil lipidowy – w przypadku podejrzenia hiperlipidemii
Poziom witaminy B12 i witaminy D – niedobory tych witamin mogą być związane z szumami usznymi¹
Poziom glukozy we krwi – w celu wykluczenia cukrzycy

Znaczenie właściwej diagnozy w leczeniu szumów usznych

Właściwa diagnoza przyczyny szumów usznych ma kluczowe znaczenie dla skutecznego leczenia. W przypadkach gdy szumy uszne są objawem konkretnej, rozpoznawalnej choroby, leczenie przyczyny może prowadzić do ustąpienia lub zmniejszenia szumów¹².

Niestety, w wielu przypadkach, szczególnie gdy szumy uszne wiążą się z nieodwracalnym uszkodzeniem słuchu, całkowite wyeliminowanie szumów może nie być możliwe. W takich sytuacjach celem terapii staje się złagodzenie objawów i poprawa jakości życia pacjenta¹.

Warto podkreślić, że szumy uszne jednostronne, pulsujące lub związane z innymi jednostronnymi objawami otologicznymi zazwyczaj wymagają specjalistycznych badań audiometrycznych i radiologicznych, gdyż mogą wskazywać na poważniejszą patologię¹.

Badania nad szumami usznymi są nadal prowadzone, a naukowcy poszukują nowych metod diagnostycznych i terapeutycznych dla tego powszechnego i często uciążliwego problemu¹.

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Materiały źródłowe

#1 Tinnitus – Ear, Nose, and Throat Disorders – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/ear-nose-and-throat-disorders/approach-to-the-patient-with-ear-problems/tinnitus
Tinnitus is a noise in the ears. It is experienced by 10 to 15% of the population. […] Subjective tinnitus is thought to be caused by abnormal neuronal activity in the auditory cortex. This activity results when input from the auditory pathway (cochlea, auditory nerve, brain stem nuclei, auditory cortex) is disrupted or altered in some manner. […] Causes may be considered by whether they cause subjective or objective tinnitus. […] Subjective tinnitus may occur with almost any disorder affecting the auditory pathways. […] The most common disorders are those that involve sensorineural hearing loss, particularly Acoustic trauma (noise-induced sensorineural hearing loss), Presbycusis (with aging), Ototoxic medications, Meniere disease, and Migraines. […] Infections and central nervous system lesions (eg, caused by tumor, stroke, multiple sclerosis) that affect auditory pathways also may be responsible.
#1 Other Hearing Conditions Associated with Tinnitus | American Tinnitus Association
https://www.ata.org/about-tinnitus/why-are-my-ears-ringing/other-hearing-conditions/
Tinnitus can be associated with a range of comorbid (existence of two or more) health conditions, including vestibular disorders, audiological problems, and behavioral health issues. […] The causal relationship between tinnitus and each comorbid condition is variable and complex. In some cases, the comorbid condition is itself the primary cause of tinnitus. This is certainly true with hearing loss and MÃ©niÃ¨re’s disease, in which tinnitus is one of several symptoms caused by the primary disorder. […] Hearing loss is the primary catalyst for tinnitus symptoms; it is common for patients to experience both conditions simultaneously. The prevalence of comorbid hearing loss and tinnitus fluctuate. Recent research suggests that approximately 90% of tinnitus patients have some degree of hearing loss. Many researchers and clinicians believe that subjective tinnitus cannot exist without some prior loss of hearing â even if such hearing loss is not discernable by the patient.
#1 Tinnitus (Ringing in the Ears) Causes and Definition
https://www.webmd.com/a-to-z-guides/understanding-tinnitus-basics
Tinnitus is especially common in older people. Cells inside your inner ear and the nerve fibers that help you hear break down as part of the natural aging process. That can lead to both hearing loss and tinnitus. […] Usually, when you develop tinnitus, it’s your brain’s response to a problem with the nerves or other parts of your ear that control your hearing. Ear damage from loud sounds is the most common cause. Up to 90% of people with tinnitus have some level of noise-induced hearing loss. Long-term exposure to noise causes permanent damage to the sound-sensitive cells of the cochlea, a spiral-shaped organ in the inner ear. […] There are many other potential causes of tinnitus: Aging, Ear Blockage, Medications, Head or neck injury, Other medical conditions. […] More than 200 prescription and nonprescription drugs can cause tinnitus, especially when you start or stop taking them.
#1 Diagnostic Approach to Tinnitus | AAFP
https://www.aafp.org/pubs/afp/issues/2004/0101/p120.html
Tinnitus has many possible causes. A thorough history and physical examination should be directed at ruling out serious disorders. In general, pulsatile tinnitus, unilateral tinnitus, and tinnitus associated with other unilateral otologic symptoms represent potentially more serious underlying disease than bilateral tinnitus. […] Otologic disorders are the most common cause of subjective tinnitus. Most cases of tinnitus result from the same conditions that cause hearing loss. There are two types of hearing loss: conductive and sensorineural. Conductive hearing loss is caused by the inhibition of sound transmission to the inner ear. This inhibition may be caused by cerumen impaction, swelling of the external auditory canal from otitis externa, tympanic membrane perforation, middle ear fluid, or abnormalities of the ossicular bone chain, such as otosclerosis. Sensorineural hearing loss indicates a disease or abnormality of the inner ear or cochlear portion of the eighth cranial nerve. The most common etiologic factors are noise-induced hearing loss (NIHL), or the progressive loss of acuity that occurs with advancing age (presbycusis).
#1 What Causes Tinnitus? A Comprehensive Review | NeuroMed Tinnitus Clinic
https://neuromedcare.com/what-causes-tinnitus/
Meniere’s disease is a disorder of the inner ear characterized by episodes of vertigo, fluctuating hearing loss, tinnitus, and a feeling of fullness or pressure in the ear. […] According to research on Meniere’s disease, 94% experience tinnitus and 37% would classify tinnitus as severe. […] Otosclerosis is a condition marked by abnormal bone growth in the middle ear, particularly affecting the stapes bone, leading to conductive hearing loss. […] The prevalence of tinnitus in otosclerosis ranges from 65-85%. […] Sudden hearing loss is a common underlying condition in people with tinnitus. […] Sudden hearing loss is sometimes what causes tinnitus. […] Autoimmune inner ear disease (AIED) is a rare inner ear disorder characterized by inflammation of the inner ear structures, including the cochlea and auditory nerve, resulting from an autoimmune response.
#1 What Is Tinnitus? â Causes and Treatment | NIDCD
https://www.nidcd.nih.gov/health/tinnitus
While there are many possible causes of tinnitus, some people develop it for no known reason. […] One leading theory is that tinnitus can occur when damage to the inner ear changes the signal carried by nerves to the parts of your brain that process sound. […] Other evidence shows that abnormal interactions between the auditory cortex and other neural circuits may play a role in tinnitus. […] Evidence suggests that tinnitus is caused by changes in neural networks in the brain, so many research efforts are aimed at testing the benefit of magnetic or electrical stimulation of the brain.
#1 Causes of tinnitus | FAU Erlangen-NÃ¼rnberg
https://www.fau.eu/2020/04/news/research/causes-of-tinnitus/
Approximately three million people in Germany suffer from chronic tinnitus. There are various theories of what causes the chronic ringing in the ears. FAU researchers led by Dr. Patrick Krauss, Professorship for Experimental Ear, Nose and Throat Medicine, have developed a model which explains tinnitus better than previous models. The model is based on stochastic resonance: When a signal is too weak to be measured by a sensor, a random signal, white noise, can be added to make it detectable, explains Krauss. If insufficient signals are transferred to the brain, for example due to a loss of hearing, the white noise is amplified by the brain to at least partially compensate for the hearing loss. The increased white noise corresponds to the increased nerve cell activity along the auditory pathway in the case of tinnitus.
#1 Tinnitus – Wikipedia
https://en.wikipedia.org/wiki/Tinnitus
Ototoxic drugs also may cause subjective tinnitus, as they may cause hearing loss, or increase the damage done by exposure to loud noise. […] More than 260 medications have been reported to cause tinnitus as a side effect. […] Factors associated with tinnitus include ear problems and hearing loss, neurologic disorders, temporomandibular joint dysfunction, metabolic disorders, psychiatric disorders, and other factors. […] A specific type of tinnitus, objective tinnitus, is characterized by hearing the sounds of one’s own muscle contractions or pulse, typically a result of sounds that have been created by the movement of jaw muscles or sounds related to blood flow in the neck or face. […] Some tinnitus may be caused by neuroplastic changes in the central auditory pathway. In this theory, the disturbance of sensory input caused by hearing loss results in such changes as a homeostatic response of neurons in the central auditory system, causing tinnitus.
#1 Tinnitus (Ringing in Ears): Types, Causes, Treatment, Prevention
https://www.healthline.com/health/tinnitus
Medication use can also cause tinnitus and hearing damage. This is known as ototoxicity (ear poisoning). […] These medications include: very large doses of aspirin, loop diuretic medications, such as bumetanide (Bumex), antimalarial drugs, such as chloroquine, certain antibiotics, such as erythromycin (Eryc, Ery-Tab) and gentamicin, certain anticancer drugs, such as vincristine.
#1 Tinnitus (Ringing in Ears): Causes & Treatment
https://my.clevelandclinic.org/health/symptoms/14164-tinnitus
Ear injuries and trauma. These injuries may affect nerves or areas of your brain that help you hear. People who get tinnitus after an injury usually only have ringing in one ear. […] Ear conditions. Earwax blockages or ear infections can cause temporary hearing loss, resulting in ear ringing. […] Medications. Certain drugs can cause tinnitus, including some antibiotics, antidepressants, cancer drugs and nonsteroidal anti-inflammatory drugs (NSAIDs). […] Less common tinnitus risk factors include: Eustachian tube dysfunction. […] Mnires disease. […] Temporomandibular joint (TMJ) disorders. […] Vestibular schwannoma (a noncancerous tumor that forms on the vestibular nerve). […] Otosclerosis (abnormal bone growth inside your ears). […] Blood vessel disorders, which can cause pulsatile tinnitus a rare form of ear ringing that happens in time with your heartbeat. […] Autoimmune diseases like lupus or rheumatoid arthritis.
#1 Understanding Tinnitus: Causes, Diagnosis, and Treatment
https://treblehealth.com/tinnitus-causes-diagnosis-treatment/
For other medical maladies that may result in tinnitus, there are at least 200 linked to the condition â from common diseases such as diabetes and cardiovascular diseases to auto-immune disorders such as rheumatoid arthritis or lupus that cause inflammation. […] Significant stress is a risk factor for developing tinnitus. […] Many medications are considered âototoxic,â meaning they can cause damage to the inner ear at certain dosages, and if you look at the side effect list of most medications, tinnitus is commonly listed as a potential side effect. […] Tinnitus usually resolves when stopping NSAIDs or non-ototoxic medications, but in some cases, the symptoms may be more long-term even after ceasing use.
#1 Tinnitus: Diagnosis and Management | AAFP
https://www.aafp.org/pubs/afp/issues/2021/0601/p663.html
Tinnitus is the sensation of hearing a sound in the absence of an internal or external source and is a common problem encountered in primary care. Most cases of tinnitus are benign and idiopathic and are strongly associated with sensorineural hearing loss. […] The etiology of primary tinnitus is often unclear, but most cases are associated with sensorineural hearing loss (SNHL). Secondary tinnitus results from sound generated by a source near the ear or referred to the ear, and is rare, accounting for less than 1% of tinnitus cases. Vascular and neuromuscular etiologies are the more common causes of secondary tinnitus. Guidelines recommend a standard approach to history and physical examination that can begin the process of determining the etiology of the tinnitus, followed by audiometric testing and imaging, laboratory studies, and other testing as appropriate.
#1 Pulsatile Tinnitus Causes and Treatments | UCSF Radiology
https://radiology.ucsf.edu/pulsatile-tinnitus
That depends on what is causing the pulsatile tinnitus. If the pulsatile tinnitus is caused by a dangerous problem with the blood vessels in the head or neck, and it is untreated, blindness or stroke (causing problems with walking, talking, or death) can result. A doctor should help you determine whether your pulsatile tinnitus is dangerous or not, and then you can decide whether to leave it untreated or not.
#1 Is tinnitus dangerous? Causes, outlook, and seeking help
https://www.medicalnewstoday.com/articles/is-tinnitus-dangerous
Tinnitus is not usually dangerous. However, in some cases, it may be a sign of a serious underlying condition that requires treatment. […] In rare cases, tinnitus may indicate a serious underlying health condition that may be dangerous without treatment. […] Sometimes, tinnitus may occur due to serious conditions, which could be dangerous without treatment. These can include: […] An injury to the head or neck may cause damage to nerves, ear structures, or parts of the brain involved in processing sound, resulting in tinnitus. […] A head, neck, or brain tumor may cause tinnitus. An acoustic neuroma is a noncancerous tumor that develops on the nerve linking the inner ear and brain and can cause tinnitus. […] High blood pressure, hardening of the arteries, or malformations in blood vessels can affect blood flow to the ear and cause tinnitus.
#1 What Causes Pulsatile Tinnitus? | Neurological Surgery
https://neurosurgery.weillcornell.org/condition/pulsatile-tinnitus/what-causes-pulsatile-tinnitus
Other conditions that can lead to changes in blood flow and result in pulsatile tinnitus include: Vascular malformations (including AVM and dural arteriovenous fistula): Pulsatile tinnitus is the result of abnormal connections between arteries and veins. […] Idiopathic intracranial hypertension (pseudotumor cerebri): This is a condition that consists of high pressure in the fluid around the brain and is characterized by headaches, dizziness, hearing loss, and visual disturbances. […] Venous sinus diverticulum: A small abnormal pouch on the wall of the vein transmits sound to the ear. […] Atherosclerosis (hardening of the arteries): When major blood vessels close to the middle and inner ear lose some of their elasticity, blood flow becomes more forceful and easier to hear. […] Head and neck tumors: A vascular neoplasm that presses on blood vessels in the head or neck can cause tinnitus and other symptoms.
#1 Pulsatile Tinnitus Causes & Treatments
https://www.neurosurgeonsofnewjersey.com/blog/pulsatile-tinnitus-causes-treatments/
In some cases of pulsatile tinnitus is caused by a narrowing of one of the large veins in the head and neck. The narrowing, or stenosis, disrupts the flow of blood and can lead to the whooshing sound or other noises of pulsatile tinnitus. […] Pulsatile tinnitus can be caused by problems in the arteries or veins of the head, neck, or both. […] A 2013 review of the current literature indicated that about 28 percent of pulsatile tinnitus cases were due to venous causes, 23 percent were arterial, 18 percent were arteriovenous (affecting both artery and vein), and 31 percent were due to other or unknown causes. […] More than half of the venous cases of pulsatile tinnitus were due to idiopathic intracranial hypertension which has recently been associated with venous stenosis. […] Many cases of pulsatile tinnitus can be traced to stenosis in one of the large veins in the brain, most commonly the transverse and sigmoid sinuses, or large veins in the neck, such as the jugular vein. The narrowing of the veins causes a disturbance in the blood flow, contributing to the whooshing sounds of pulsatile tinnitus. […] Other conditions that can lead to changes in blood flow and result in pulsatile tinnitus include (amongst others): […] It is critically important to identify the underlying condition causing the pulsatile tinnitus; treating and resolving that condition is the key to ending the noise.
#1 Table: Some Causes of Tinnitus-Merck Manual Professional Edition
https://www.merckmanuals.com/professional/multimedia/table/some-causes-of-tinnitus
Some Causes of Tinnitus […] Acoustic trauma (eg, noise-induced hearing loss) […] Barotrauma […] Central nervous system tumors (eg, vestibular schwannoma, meningioma) and lesions (eg, caused by multiple sclerosis or stroke) […] Eustachian tube dysfunction […] Infections (eg, otitis media, labyrinthitis, meningitis, neurosyphilis) […] Medications (eg, salicylates; aminoglycosides; loop diuretics; some chemotherapeutic agents, including cisplatin) […] Meniere disease […] Obstruction of ear canal (eg, caused by cerumen, foreign body, or otitis externa) […] Presbycusis (with aging) […] Dural arteriovenous malformations […] Myoclonus (palatal muscles, tensor tympani, stapedius) […] Turbulent flow in carotid artery or jugular vein […] Vascular middle ear tumors (eg, glomus tympanicum, glomus jugulare)
#1 Tinnitus – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/tinnitus/diagnosis-treatment/drc-20350162
Your doctor will typically diagnose you with tinnitus based on your symptoms alone. But in order to treat your symptoms, your doctor will also try to identify whether your tinnitus is caused by another, underlying condition. Sometimes a cause can’t be found. […] To help identify the cause of your tinnitus, your doctor will likely ask you about your medical history and examine your ears, head and neck. Common tests include: […] This type of sound suggests that muscle contractions in and around your ear might be the cause of your tinnitus. […] These sounds usually stem from blood vessel (vascular) causes, such as high blood pressure, and you may notice them when you exercise or change positions, such as when you lie down or stand up. […] This type of sound may point to ear canal blockages, Meniere’s disease or stiff inner ear bones (otosclerosis).
#1 What Is Tinnitus? â Causes and Treatment | NIDCD
https://www.nidcd.nih.gov/health/tinnitus
A head/neck injury can damage structures of the ear, the nerve that carries sound signals to the brain, or areas of the brain that process sound, causing tinnitus. […] Tinnitus can be a symptom of Mnires disease, an inner ear disorder that can also cause balance problems and hearing loss. […] The joint that connects the lower jaw to the skull is close to the ear. […] A vestibular schwannoma (acoustic neuroma) is a benign tumor on a nerve that leads from the inner ear to the brain. […] High blood pressure, atherosclerosis, or malformations in blood vessels, especially if they are in or close to the ear, can alter blood flow and cause tinnitus. […] Diabetes, migraines, thyroid disorders, anemia, and certain autoimmune disorders such as lupus and multiple sclerosis are among the chronic conditions that have been linked to tinnitus.
#1 Bilateral Tinnitus: Symptoms, Causes, Treatment
https://www.healthline.com/health/bilateral-tinnitus
Noise-induced hearing loss. Loud noise exposure over time can reduce hearing and increase the risk for bilateral tinnitus. Just one severe exposure to extremely loud noises can also have this effect. […] Other forms of hearing loss. Age and noise-related hearing loss are the most common causes of tinnitus, but other types of hearing loss, like irregular bone growths or a ruptured eardrum, can also cause tinnitus. […] Ototoxic medications can damage the ear and cause hearing loss. There are over 200 prescription and over-the-counter drugs that can have this effect. […] Disorders of the blood vessels or muscular system. Certain blood or muscular system disorders are associated with objective tinnitus. […] Amyotrophic lateral sclerosis (ALS). ALS can cause muscular tinnitus. […] Multiple sclerosis. MS is a cause of muscular tinnitus.
#1 Tinnitus – Ear, Nose, and Throat Disorders – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/ear-nose-and-throat-disorders/approach-to-the-patient-with-ear-problems/tinnitus
Disorders causing conductive hearing loss also may cause tinnitus. […] Objective tinnitus usually involves noise from vascular flow, which causes an audible pulsating sound synchronous with the pulse. […] Causes include Turbulent flow through the carotid artery or jugular vein, Highly vascular middle ear tumors, Dural arteriovenous malformations (AVMs), Cerebral venous sinus stenosis or thrombosis, especially transverse sinus stenosis, Idiopathic intracranial hypertension, Bony dehiscence over the sigmoid sinus or jugular bulb in the middle ear, and Superior semicircular canal dehiscence. […] Muscle spasms or myoclonus of palatal muscles or those of the middle ear (stapedius, tensor tympani) may cause perceptible noise, typically a rhythmic clicking. […] Tinnitus with asymmetric hearing loss may indicate retrocochlear pathology, such as a vestibular schwannoma.
#1 Tinnitus – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK430809/
Tinnitus is classically described as high-pitched ringing or buzzing that is usually only audible to the affected individual. Most tinnitus is subjective, meaning the examiner cannot hear it. However, objective tinnitus can arise from an aneurysm and can be heard by the examiner. […] There are many causes of tinnitus: […] The most common cause of subjective tinnitus is noise trauma. For example, an employee in a noisy industry loses hearing at the 4000 Hz tone. Now, the employee hears a sound similar to the 4000 tone. […] Metabolic diseases such as heart disease, hypertension, and diabetes are associated with an onset of tinnitus. Various drugs are ototoxic to some individuals or at sufficient doses. For example, high doses of aspirin cause tinnitus, and the issue resolves when aspirin is stopped. […] Ear diseases cause tinnitus, including Meniere disease, and lesions affecting the eighth cranial nerve. […] A rare cause of tinnitus is the Chiari malformation. Tinnitus occurs when low-lying cerebellar tonsils cause auditory nerve tension and can be unilateral or bilateral.
#1 Causes | American Tinnitus Association
https://www.ata.org/about-tinnitus/why-are-my-ears-ringing/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. […] 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. […] Tinnitus related to head, neck, or dental issues is sometimes referred to as somatic tinnitus. […] Another example of somatic tinnitus is that caused by temporomandibular joint disorder.
#1 Tinnitus Causes: What is the main Cause of Tinnitus? | US
https://www.earpros.com/ear-diseases/tinnitus/causes
Abnormal bone growth can cause the bones in the middle ear to stiffen which can affect your hearing, and as a result, cause tinnitus. […] Some medications cause tinnitus or can worsen symptoms, particularly when taken at a high dose. […] Cervical spine dysfunction, including misalignment or nerve compression, can potentially impact auditory function and contribute to tinnitus. […] Unusual ear sounds such as tinnitus can often be worsened by stress and anxiety.
#1 Tinnitus – Causes of ear noises at a glance | KIND
https://www.kind.com/en-sg/magazine/tinnitus/tinnitus-causes/
Public plague tinnitus: The causes can be varied, a common trigger is noise. […] Sometimes tinnitus develops after a single, exceptionally high noise exposure such as an explosion or loud bang near the ear. This is known as a blast trauma. […] The causes of tinnitus can also be diseases of the ear or the auditory pathway. […] Possible triggers of subjective tinnitus: Sound trauma (noise trauma, blast trauma), Stress, Hearing loss (hypoacusis), Inflammation of the ear (e.g. inflammation of the middle ear), Otosclerosis of the middle ear, Meniere’s disease (disease of the inner ear), Viral and bacterial infections (e.g. borreliosis), Autoimmune diseases of the inner ear, Foreign bodies in the ear canal (e.g. earwax plugs), Acoustic neuroma (tumour of the auditory nerve), Craniomandibular dysfunction (muscular dysfunction of the jaw joints, often as a result of stress), Functional disorders of the cervical spine, Decompression sickness in divers, Variations in the amount of inner ear fluid (endolymph) due to congestion, Muscular causes (Myofascial syndrome), Cardiovascular diseases, Metabolic and kidney diseases, diseases of the central nervous system, medicines, for example high doses of acetylsalicylic acid, but also certain antibiotics, dehydration tablets and other, Toxins, for example certain solvents and heavy metals, but also arsenic and carbon monoxide, Blows to the head and skull injuries.
#1 Diagnostic Approach to Tinnitus | AAFP
https://www.aafp.org/pubs/afp/issues/2004/0101/p120.html
Ototoxic medications or substances are another common cause of bilateral tinnitus. Currently, almost every major group of medication includes one or more compounds with ototoxic properties. Ototoxicity may affect hair cells, the eighth cranial nerve, or their central nervous connections. The damage can be exhibited as hearing loss, vertigo, or tinnitus. The presence of tinnitus often heralds a cochlear hearing loss. […] Neurologic disorders or head trauma are implicated in 5 to 10 percent of patients reporting tinnitus. These conditions include skull fracture, closed head injury, whiplash injury, and multiple sclerosis. […] Various metabolic abnormalities may be associated with tinnitus. These abnormalities include hypothyroidism, hyperthyroidism, hyperlipidemia, anemia, and vitamin B12 or zinc deficiency.
#1 What Causes Tinnitus? A Comprehensive Review | NeuroMed Tinnitus Clinic
https://neuromedcare.com/what-causes-tinnitus/
The estimated prevalence of tinnitus in AIED is 25-50%. […] Vestibular migraine can be an underlying cause of tinnitus. […] According to a meta-analysis, around 40% of patients with vestibular migraine experience tinnitus as well. […] High blood pressure can also lead to pulsatile tinnitus. […] Diabetes may be associated with tinnitus due to its potential to damage blood vessels and nerves in the inner ear, leading to changes in auditory function and the perception of ringing in the ears. […] Low thyroid problems (hypothyroidism) can make tinnitus worse because the thyroid hormone imbalances can affect blood flow to the inner ear. […] There is a strong link between long COVID and tinnitus. […] Middle ear infection (otitis media) is associated as the initiating cause of tinnitus in around 61% of patients. […] Rare severe injuries to the head (e.g. skull fracture) can be associated with tinnitus. […] Ototoxic medications are drugs that can harm the inner ear, potentially causing hearing loss, balance issues, and tinnitus. […] Genetics are sometimes what causes tinnitus.
#1 Tinnitus – Causes of ear noises at a glance | KIND
https://www.kind.com/en-sg/magazine/tinnitus/tinnitus-causes/
For a long time it was assumed that subjective tinnitus develops in the inner ear. But this theory is contradicted by the fact that tinnitus usually persists even after the auditory nerve has been severed. […] The psyche also plays an important role in the causes of tinnitus: what we hear triggers feelings – and conversely, our mood influences how we perceive sounds and noises. […] In this respect, stress is one of the causes of tinnitus. […] Stress also massively increases the subjective burden of the tinnitus during the course of the illness.
#1 Other Hearing Conditions Associated with Tinnitus | American Tinnitus Association
https://www.ata.org/about-tinnitus/why-are-my-ears-ringing/other-hearing-conditions/
Mental health issues can be both a contributing factor to burdensome tinnitus and a consequence of burdensome tinnitus. Tinnitus symptoms can generate feelings of despair and anxiety in many patients. Current estimates suggest that 48-78% of patients with severe tinnitus also experience depression, anxiety, or some other behavioral disorder. […] The vestibular system, which manages balance and spatial orientation, is closely connected with the auditory system, which controls hearing functions. Several structures in the inner ear play key roles in both sensory systems. As such, damage to one system (as evidenced by tinnitus) is often mirrored by a correlated vestibular condition.
#1 What Can You Do About Tinnitus? – The New York Times
https://www.nytimes.com/2025/04/29/well/live/tinnitus-treatment-options.html
People who are regularly exposed to loud noises are also more likely to develop tinnitus, Dr. Schwam said. […] Stress, anxiety and lack of sleep can make tinnitus worse, Dr. Schwam said. âI often tell people that those things are not necessarily causing your tinnitus, but theyâre certainly not helping,â he said. […] If tinnitus is caused by a bone, nerve or circulatory issue, then treating the underlying problem may cure it, Dr. Schwam said. But if hearing loss is the cause, then treatments can improve symptoms but may not eliminate them, he said.
#1 What causes ringing in the ears?
https://www.healthyhearing.com/help/tinnitus/causes
If your tinnitus resembles a pumping, beating or pulsating sound, it could be caused by damage to your blood vessels. […] The most common drugs known to cause tinnitus are non-steroidal anti-inflammatory drugs (like aspirin and other OTC pain relievers), diuretics, certain antibiotics and cancer drugs, and the malaria drug quinine. […] Aging, loud noise exposure, and certain habits are all strongly linked to tinnitus. […] Hearing loss due to aging is called presbycusis, and it often starts around the age of 60. […] Being exposed to loud noise on a regular basis from heavy equipment, chain saws, or firearms are common causes of hearing loss and tinnitus. […] Researchers are not entirely certain why, but drinking alcohol excessively, smoking cigarettes, eating certain foods and consuming caffeinated beverages can play a role in tinnitus.
#1 What Causes Tinnitus (Ringing in the Ears)? | HearCANADA
https://www.hearcanada.com/tinnitus/causes/
High blood pressure, heart disease, and other cardiovascular issues are risk factors for tinnitus. This can include obesity and diabetes, both which may impact on your cardiovascular health. […] Smoking and drinking alcohol regularly can increase the risk of tinnitus. Nicotine damages the auditory nerve, while alcohol affects blood vessels and blood flow in the ears. […] You are increasingly likely to develop tinnitus as you get older. This is due to the increased chance of your hearing mechanisms becoming damaged. […] Having a history of injuries or trauma in your head or neck will increase the risk of developing tinnitus with each new injury. […] Tinnitus is more common in men than women. While there is no helping this, men should be more careful in avoiding the other common risk factors.
#1 Tinnitus – Causes, Treatments, and Definition
https://hifla.org/tinnitus-causes-treatments-and-definition/
Many people think of subjective tinnitus as a condition, but it is actually a symptom of another underlying medical problem. It may be caused by hearing loss, aging, noise exposure, infection, allergies, earwax, drugs, foreign objects in the ears, and more. […] Tinnitus is generated in the brain, not in the ear. It is located near the limbic system, the brains emotional center. Severe tinnitus has often been linked to depression and anxiety disorders. […] These substances, especially when used excessively, can affect blood flow and contribute to tinnitus.
#1 Tinnitus: Practice Essentials, Philosophy, Classification, Pathophysiology, and Quantification, Evaluation: History, Physical, and Laboratory
https://emedicine.medscape.com/article/856916-overview
Clinically, subjective tinnitus is the perception of sound in the absence of auditory stimulation. In terms of neurophysiology, tinnitus is the consequence of the brains response to input deprivation from the auditory periphery. […] Additional data from animal and human studies have suggested that tinnitus may be associated with neuronal hyperactivity at different levels of the central auditory pathways, including the dorsal cochlear nucleus, the inferior colliculus, auditory cortex, and the striatum. […] There is evidence, albeit perhaps limited, that tinnitus may be associated with coronavirus disease 2019 (COVID-19). […] Evidence also exists that tinnitus may develop in rare cases following immunization with vector-based or mRNA COVID-19 vaccines. […] Tinnitus is organic to Mnire syndrome. Thus, treatment of the syndrome may help resolve tinnitus. […] The problem with the therapy of tinnitus is its unpredictability. Although the successful ablation of the identifiable problem in many of these cases should eliminate the problem, often only 50% of patients describe complete relief from the difficulty.
#1 Ringing in ears after COVID-19? 5 tinnitus causes, what it sounds like and how to get some relief | Nebraska Medicine Omaha, NE
https://www.nebraskamed.com/ear-nose-throat/tinnitus/ringing-in-the-ears-tinnitus-symptoms-can-covid-19-cause-it-and-what-you-can-do-about-it
Anything that causes hearing loss can cause tinnitus,” says Geoffrey Casazza, MD, Nebraska Medicine otolaryngologist and head and neck surgeon. „Many patients think it will lead to deafness, which is extremely unlikely. They may worry it could be due to a tumor, which is possible but also unlikely. They may wonder it is due to an inner ear infection, which is possible, but not likely without other additional symptoms.” […] While we’re not certain what is going on physically to cause tinnitus, much of the time (about 99%), certain types of stress are at play. […] Five types of stress can have a significant impact, including: […] „Chloroquine and hydroxychloroquine, azithromycin, interferon and ivermectin, are known to be ototoxic and could cause someone to develop hearing loss, which may lead to tinnitus,” adds Dr. Casazza. […] „While there may be some evidence that those who have persistent COVID symptoms, such as loss of taste or smell, fatigue and the like may also develop tinnitus,” says Dr. Casazza. „But if this is a true development of the tinnitus or an exacerbation of a prior symptom is unclear.”
#1 Tinnitus – Hearing Loss Association of America
https://www.hearingloss.org/understanding-hearing-loss/types-causes-and-treatments/tinnitus/
The precise causes of tinnitus are unknown, but may include excessive noise exposure, ototoxic medications, ear infections, earwax blockage, head or neck injuries and certain medical diseases or chronic conditions. […] Some experts believe that tinnitus is caused by neural circuits in the brain adapting to inner ear damage (the loss of sensory hair cells). More recently, scientists are researching the impact of abnormal communications between the auditory cortex and other neural circuits. […] Exciting research is being conducted around the country to investigate the causes of tinnitus and develop more advanced, effective approaches. Among the current research topics are different ways to stimulate the brain and targeting treatments to individuals based on personalized profiles via brain imaging data.
#1 Diagnostic Approach to Tinnitus | AAFP
https://www.aafp.org/pubs/afp/issues/2004/0101/p120.html
Tinnitus is a common disorder with many possible causes. Most cases of tinnitus are subjective, but occasionally the tinnitus can be heard by an examiner. Otologic problems, especially hearing loss, are the most common causes of subjective tinnitus. Common causes of conductive hearing loss include external ear infection, cerumen impaction, and middle ear effusion. Sensorineural hearing loss may be caused by exposure to excessive loud noise, presbycusis, ototoxic medications, or Meniere’s disease. Unilateral hearing loss plus tinnitus should increase suspicion for acoustic neuroma. Subjective tinnitus also may be caused by neurologic, metabolic, or psychogenic disorders. Objective tinnitus usually is caused by vascular abnormalities of the carotid artery or jugular venous systems. Initial evaluation of tinnitus should include a thorough history, head and neck examination, and audiometric testing to identify an underlying etiology. Unilateral or pulsatile tinnitus may be caused by more serious pathology and typically merits specialized audiometric testing and radiologic studies.
#1 Tinnitus – Ear, Nose, and Throat Disorders – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/ear-nose-and-throat-disorders/approach-to-the-patient-with-ear-problems/tinnitus
It is important to note whether the tinnitus is unilateral because vestibular schwannomas may manifest only with unilateral tinnitus. […] Specific causes can often be suspected by findings on examination. […] Loud noise, aging, Meniere disease, migraines, and medications are the most common causes of subjective tinnitus.
#1 Tinnitus Causes, Symptoms, Sound, Treatment, Test, Cure, Drugs
https://www.medicinenet.com/tinnitus_ringing_in_the_ears/article.htm
Meniere’s disease, which is associated with hearing loss and vertigo also may cause tinnitus. […] Aging: As people age, their hearing may decrease and there can be associated tinnitus. […] Otosclerosis, which is caused by abnormal bone growth in the middle ear, can sometimes cause tinnitus. […] Trauma may also be a cause of tinnitus and hearing loss. […] Tinnitus has been linked to vitamin B12 and vitamin D deficiencies. […] Repeated loud noise exposure can be a cause of tinnitus as well as hearing loss. […] A variety of medications may be ototoxic (damage the ear) and cause tinnitus.
#1 Tinnitus – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/tinnitus/diagnosis-treatment/drc-20350162
This is the most commonly heard tinnitus sound. Likely causes include loud noise exposure, hearing loss or medications. Acoustic neuroma can cause continuous, high-pitched ringing in one ear. […] Treatment for tinnitus depends on whether your tinnitus is caused by an underlying health condition. If so, your doctor may be able to reduce your symptoms by treating the underlying cause. […] Removing an earwax blockage can decrease tinnitus symptoms. […] Underlying blood vessel conditions may require medication, surgery or another treatment to address the problem. […] If your tinnitus is caused by noise-induced or age-related hearing loss, using hearing aids may help improve your symptoms. […] If a medication you’re taking appears to be the cause of tinnitus, your doctor may recommend stopping or reducing the drug, or switching to a different medication.
#1 Tinnitus – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/tinnitus/diagnosis-treatment/drc-20350162
Many times, tinnitus can’t be cured. But there are treatments that can help make your symptoms less noticeable. […] Drugs can’t cure tinnitus, but in some cases they may help reduce the severity of symptoms or complications. […] Researchers are investigating whether magnetic or electrical stimulation of the brain can help relieve symptoms of tinnitus.
#2 Tinnitus: Causes, Symptoms, and Treatment | Doctor
https://patient.info/doctor/tinnitus-pro
Tinnitus can be divided into two main types: […] Common causes are: Otological: any cause of hearing loss; particularly presbyacusis. Also, noise-induced hearing loss, otosclerosis, impacted cerumen, otitis media, Mnire’s disease. […] Psychological: anxiety, depression and experience of psychological trauma have been linked to tinnitus. Although it is not always clear whether these factors specifically cause the onset of tinnitus, or if they are contributing factors, tinnitus often arises during or after periods of intense stress. […] Many cases of tinnitus have no identifiable cause. […] The presence of tinnitus has been reported to increase progressively with age, affecting 5% of people aged 20-30 years and 12% of people over 60 years of age. […] The link between depression and tinnitus has been queried in the past but a large comprehensive systematic review reported a prevalence of 33% in people who had tinnitus. […] Surgical treatment is almost never used, unless a surgically treatable underlying cause has been identified (eg, an acoustic neuroma).
#2 What Causes Tinnitus? – Sound Relief Tinnitus & Hearing Center
https://www.soundrelief.com/what-causes-tinnitus/
Tinnitus a sound in the head with no external source is not a disease; it is a symptom that can be triggered by a variety of different health conditions. So what causes tinnitus? Common sources include trauma, hearing loss, loud noise exposure, ear wax buildup, ototoxic medications, and ear bone changes. […] Most causes of tinnitus alter neurological activity within the auditory cortex, the portion of the brain responsible for hearing. […] According to the American Tinnitus Association, there are approximately 200 health disorders that can produce tinnitus as a symptom. […] Most people who suffer from tinnitus also experience hearing loss to some degree. […] In fact, some researchers believe that subjective tinnitus can only occur if the auditory system has been previously damaged.
#2 What Causes Tinnitus? Everything Made Simple in This Comprehensive Guide
https://www.joinoto.com/articles/what-causes-tinnitus
Otosclerosis is a condition which results in the abnormal growth of bones inside the ear. […] Approximately 70% of tinnitus is caused by loud noises. […] Old age is linked to many conditions, such as worsening eyesight and hearing. […] 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. […] Menieres disease is thought to be linked to the inappropriate amount of fluid found in the inner ear, but the exact cause is uncertain. […] 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. […] These traumas may lead to tinnitus. […] These blood vessel-related causes of tinnitus are much rarer.
#2 Ringing In Your Ears? – Tinnitus Symptoms – Happy Ears
https://www.happyearshearing.com/tinnitus/causes-of-tinnitus/
In this article, we will outline some of the most typical causes of tinnitus. Tinnitus, in most cases, is a symptom of some other underlying health condition. […] In most cases, tinnitus is the brains reaction to damage in the inner ear and the auditory system. […] Even though tinnitus is often associated with hearing loss, there are hundreds of different health disorders that can cause tinnitus as a symptom. […] A Sensorineural hearing loss is most commonly associated with tinnitus. […] Noise-induced hearing loss can be caused by one single traumatic event or various amounts of noise exposure over time. […] Age-related hearing loss almost always occurs in both ears and involves damage to the higher frequencies. […] Tinnitus can be an early indication of Menieres disease. […] Problems with the temporomandibular joint can cause tinnitus.
#2 What Is Tinnitus? â Causes and Treatment | NIDCD
https://www.nidcd.nih.gov/health/tinnitus
Tinnitus is commonly described as a ringing sound, but some people hear other types of sounds, such as roaring or buzzing. […] The causes of tinnitus are unclear, but most people who have it have some degree of hearing loss. […] While the exact causes of tinnitus are not fully understood, it has been linked to the following: Noise exposure. Many people experience tinnitus after being exposed to loud noise in a workplace setting or at a sporting event or concert. […] Hearing loss, which can be caused by factors such as aging or exposure to loud noise, is strongly associated with tinnitus. […] Tinnitus can be a side effect of taking certain medications, especially if they are taken at high doses. […] Blockage of the ear canal by earwax or by fluid from an ear infection can trigger tinnitus.
#2 Causes | American Tinnitus Association
https://www.ata.org/about-tinnitus/why-are-my-ears-ringing/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. […] 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. […] Tinnitus related to head, neck, or dental issues is sometimes referred to as somatic tinnitus. […] Another example of somatic tinnitus is that caused by temporomandibular joint disorder.
#2 Tinnitus (Ringing in the Ears) Causes and Definition
https://www.webmd.com/a-to-z-guides/understanding-tinnitus-basics
Tinnitus can be a symptom of many different illnesses and conditions, among them: Meniere’s disease, which affects the inner part of the ear; Otosclerosis, a disease that causes stiffening of the small bones in the middle ear; Neck or jaw problems, such as temporomandibular joint (TMJ) syndrome; Tumor on the nerve that sends sound signals to your brain; Migraine; Traumatic brain injury; High blood pressure; Cardiovascular disease; Circulatory problems; Anemia; Allergies; Under- or overactive thyroid gland; Autoimmune disorders such as lupus and rheumatoid arthritis; Diabetes; Fibromyalgia; Low vitamin levels; Hormonal changes; Depression or anxiety. […] It’s rare, but there’s a type of tinnitus called pulsatile tinnitus in which the sound beats in sync with your heart. This could mean you have a blood vessel problem, and you should tell your doctor about it right away.
#2 Causes of tinnitus | FAU Erlangen-NÃ¼rnberg
https://www.fau.eu/2020/04/news/research/causes-of-tinnitus/
Approximately three million people in Germany suffer from chronic tinnitus. There are various theories of what causes the chronic ringing in the ears. FAU researchers led by Dr. Patrick Krauss, Professorship for Experimental Ear, Nose and Throat Medicine, have developed a model which explains tinnitus better than previous models. The model is based on stochastic resonance: When a signal is too weak to be measured by a sensor, a random signal, white noise, can be added to make it detectable, explains Krauss. If insufficient signals are transferred to the brain, for example due to a loss of hearing, the white noise is amplified by the brain to at least partially compensate for the hearing loss. The increased white noise corresponds to the increased nerve cell activity along the auditory pathway in the case of tinnitus.
#2 What causes ringing in the ears?
https://www.healthyhearing.com/help/tinnitus/causes
If your tinnitus resembles a pumping, beating or pulsating sound, it could be caused by damage to your blood vessels. […] The most common drugs known to cause tinnitus are non-steroidal anti-inflammatory drugs (like aspirin and other OTC pain relievers), diuretics, certain antibiotics and cancer drugs, and the malaria drug quinine. […] Aging, loud noise exposure, and certain habits are all strongly linked to tinnitus. […] Hearing loss due to aging is called presbycusis, and it often starts around the age of 60. […] Being exposed to loud noise on a regular basis from heavy equipment, chain saws, or firearms are common causes of hearing loss and tinnitus. […] Researchers are not entirely certain why, but drinking alcohol excessively, smoking cigarettes, eating certain foods and consuming caffeinated beverages can play a role in tinnitus.
#2 Table: Some Causes of Tinnitus-Merck Manual Professional Edition
https://www.merckmanuals.com/professional/multimedia/table/some-causes-of-tinnitus
Some Causes of Tinnitus […] Acoustic trauma (eg, noise-induced hearing loss) […] Barotrauma […] Central nervous system tumors (eg, vestibular schwannoma, meningioma) and lesions (eg, caused by multiple sclerosis or stroke) […] Eustachian tube dysfunction […] Infections (eg, otitis media, labyrinthitis, meningitis, neurosyphilis) […] Medications (eg, salicylates; aminoglycosides; loop diuretics; some chemotherapeutic agents, including cisplatin) […] Meniere disease […] Obstruction of ear canal (eg, caused by cerumen, foreign body, or otitis externa) […] Presbycusis (with aging) […] Dural arteriovenous malformations […] Myoclonus (palatal muscles, tensor tympani, stapedius) […] Turbulent flow in carotid artery or jugular vein […] Vascular middle ear tumors (eg, glomus tympanicum, glomus jugulare)
#2 What Is Tinnitus? â Causes and Treatment | NIDCD
https://www.nidcd.nih.gov/health/tinnitus
A head/neck injury can damage structures of the ear, the nerve that carries sound signals to the brain, or areas of the brain that process sound, causing tinnitus. […] Tinnitus can be a symptom of Mnires disease, an inner ear disorder that can also cause balance problems and hearing loss. […] The joint that connects the lower jaw to the skull is close to the ear. […] A vestibular schwannoma (acoustic neuroma) is a benign tumor on a nerve that leads from the inner ear to the brain. […] High blood pressure, atherosclerosis, or malformations in blood vessels, especially if they are in or close to the ear, can alter blood flow and cause tinnitus. […] Diabetes, migraines, thyroid disorders, anemia, and certain autoimmune disorders such as lupus and multiple sclerosis are among the chronic conditions that have been linked to tinnitus.
#2 Tinnitus – Wikipedia
https://en.wikipedia.org/wiki/Tinnitus
Ototoxic drugs also may cause subjective tinnitus, as they may cause hearing loss, or increase the damage done by exposure to loud noise. […] More than 260 medications have been reported to cause tinnitus as a side effect. […] Factors associated with tinnitus include ear problems and hearing loss, neurologic disorders, temporomandibular joint dysfunction, metabolic disorders, psychiatric disorders, and other factors. […] A specific type of tinnitus, objective tinnitus, is characterized by hearing the sounds of one’s own muscle contractions or pulse, typically a result of sounds that have been created by the movement of jaw muscles or sounds related to blood flow in the neck or face. […] Some tinnitus may be caused by neuroplastic changes in the central auditory pathway. In this theory, the disturbance of sensory input caused by hearing loss results in such changes as a homeostatic response of neurons in the central auditory system, causing tinnitus.
#2 Bilateral Tinnitus: Symptoms, Causes, Treatment
https://www.healthline.com/health/bilateral-tinnitus
Menieres disease. This disorder of the inner ear can cause tinnitus. […] Ear and sinus infections. Infections of the inner ear may cause tinnitus. […] Hormone changes. Hormonal changes in people assigned female at birth during times like perimenopause, menopause, and pregnancy may cause tinnitus. […] Impacted earwax buildup. A buildup of earwax may cause tinnitus. […] Temporomandibular joint disorders (TMJ). Disorders of the TMJ joint have been associated with tinnitus. […] Hyperthyroidism is a cause of pulsatile tinnitus. […] Brain tumor. Brain tumors can cause tinnitus depending on their size and location. […] Tinnitus may result from many health conditions and other underlying causes. Age-related hearing loss and noise-related hearing loss are two of the most common causes of bilateral tinnitus.
#2 What Causes Tinnitus? – Sound Relief Tinnitus & Hearing Center
https://www.soundrelief.com/what-causes-tinnitus/
Loss of certain sound frequencies due to hearing loss may change how the brain processes sound, causing it to adapt and fill in the gaps with tinnitus. […] Exposure to loud or excessive noise can damage or destroy hair cells (cilia) in the inner ear. […] Age-related hearing loss results from the cumulative effect of aging on hearing. […] When ear wax accumulates, it can diminish your ability to hear. […] A disorder of the inner ear, Mnires disease typically affects hearing and balance and may cause debilitating vertigo, hearing loss, and tinnitus. […] When a medication is ototoxic, it has a toxic effect on the ear or its nerve supply. […] Numerous disorders and diseases can cause or worsen the condition, including all of the following: Hypothyroidism, Hyperthyroidism, Fibromyalgia, Thoracic Outlet Syndrome, Temporomandibular Joint Disorder (TMJ), Diabetes, Lyme Disease, Thyroid Disorders, Depression, Anxiety.
#2 Ringing in ears after COVID-19? 5 tinnitus causes, what it sounds like and how to get some relief | Nebraska Medicine Omaha, NE
https://www.nebraskamed.com/ear-nose-throat/tinnitus/ringing-in-the-ears-tinnitus-symptoms-can-covid-19-cause-it-and-what-you-can-do-about-it
Anything that causes hearing loss can cause tinnitus,” says Geoffrey Casazza, MD, Nebraska Medicine otolaryngologist and head and neck surgeon. „Many patients think it will lead to deafness, which is extremely unlikely. They may worry it could be due to a tumor, which is possible but also unlikely. They may wonder it is due to an inner ear infection, which is possible, but not likely without other additional symptoms.” […] While we’re not certain what is going on physically to cause tinnitus, much of the time (about 99%), certain types of stress are at play. […] Five types of stress can have a significant impact, including: […] „Chloroquine and hydroxychloroquine, azithromycin, interferon and ivermectin, are known to be ototoxic and could cause someone to develop hearing loss, which may lead to tinnitus,” adds Dr. Casazza. […] „While there may be some evidence that those who have persistent COVID symptoms, such as loss of taste or smell, fatigue and the like may also develop tinnitus,” says Dr. Casazza. „But if this is a true development of the tinnitus or an exacerbation of a prior symptom is unclear.”
#2 What Causes Tinnitus (Ringing in the Ears)? | HearCANADA
https://www.hearcanada.com/tinnitus/causes/
High blood pressure, heart disease, and other cardiovascular issues are risk factors for tinnitus. This can include obesity and diabetes, both which may impact on your cardiovascular health. […] Smoking and drinking alcohol regularly can increase the risk of tinnitus. Nicotine damages the auditory nerve, while alcohol affects blood vessels and blood flow in the ears. […] You are increasingly likely to develop tinnitus as you get older. This is due to the increased chance of your hearing mechanisms becoming damaged. […] Having a history of injuries or trauma in your head or neck will increase the risk of developing tinnitus with each new injury. […] Tinnitus is more common in men than women. While there is no helping this, men should be more careful in avoiding the other common risk factors.
#2 Tinnitus (Ringing in the Ears) â Causes and Triggers
https://www.webmd.com/a-to-z-guides/tinnitus-triggers
Tinnitus can be triggered by many things, including loud noises, earwax buildup, ear infections, head injuries, certain medications, stress, and aging. […] Loud, traumatic noises can damage your ears and lead to tinnitus. […] Lifestyle factors and habits can cause or worsen tinnitus. […] Smoking increases your risk of hearing loss and tinnitus because it disrupts nerve signals that carry sound from the ears to the brain. […] High blood pressure changes the way that blood flows throughout your body, including to your ears. […] Injuries, illness, infection, and other physical causes can trigger tinnitus. […] About 1 in 3 adults over 65 have tinnitus. […] Allergic reactions, such as to tree or grass pollen, can cause mucus to build up in your ears. […] High blood pressure (hypertension) could trigger bleeding (hemorrhage) in your cochlea.
#2 Common tinnitus causes and how to address them
https://www.hiddenhearing.ie/hearing-loss/types/tinnitus/causes
There are some medications that can affect your ears and your hearing health; these are referred to as being ototoxic. […] Studies have shown a link between COVID-19 and hearing loss, tinnitus, and dizziness due to the effect that the virus has on the nervous system and the auditory-vestibular system.
#2 What Is Tinnitus? – Symptoms – Diagnosis & Tests | familydoctor.org
https://familydoctor.org/condition/tinnitus/
Certain medicines can damage the inner workings of the ear (for example, taking high doses of aspirin every day). […] Allergies, high blood pressure, low blood pressure, diabetes, tumors, and head injuries can also cause tinnitus. If you have a foreign object in your ear or a build-up of ear wax, you may also experience tinnitus. […] In many cases, the cause of tinnitus canât be identified.
#2 Diagnostic Approach to Tinnitus | AAFP
https://www.aafp.org/pubs/afp/issues/2004/0101/p120.html
Tinnitus is a common disorder with many possible causes. Most cases of tinnitus are subjective, but occasionally the tinnitus can be heard by an examiner. Otologic problems, especially hearing loss, are the most common causes of subjective tinnitus. Common causes of conductive hearing loss include external ear infection, cerumen impaction, and middle ear effusion. Sensorineural hearing loss may be caused by exposure to excessive loud noise, presbycusis, ototoxic medications, or Meniere’s disease. Unilateral hearing loss plus tinnitus should increase suspicion for acoustic neuroma. Subjective tinnitus also may be caused by neurologic, metabolic, or psychogenic disorders. Objective tinnitus usually is caused by vascular abnormalities of the carotid artery or jugular venous systems. Initial evaluation of tinnitus should include a thorough history, head and neck examination, and audiometric testing to identify an underlying etiology. Unilateral or pulsatile tinnitus may be caused by more serious pathology and typically merits specialized audiometric testing and radiologic studies.
#2 A review of tinnitus
https://www1.racgp.org.au/ajgp/2018/april/tinnitus
Tinnitus may be categorised as subjective, objective, primary or secondary. […] Almost any insult to the auditory pathway can result in tinnitus. Several non-auditory conditions can also lead to tinnitus. Therefore, many organic states can lead to the experience of tinnitus. The most common and potentially reversible causes are outlined in Table 2. […] Tinnitus associated with a specific underlying cause (other than symmetrical SNHL) is classified as secondary tinnitus. […] Management of secondary tinnitus is centred on identification of the underlying cause and, where possible, reversal of the underlying condition. […] Tinnitus is common and has many varied causes. After careful history-taking and examination, tinnitus can be classified as either primary or secondary.
#3 Tinnitus: One Possible Reason Your Ears Won’t Stop Ringing | University Hospitals
https://www.uhhospitals.org/blog/articles/2021/03/tinnitus-one-possible-reason-your-ears-wont-stop-ringing
Tinnitus is the perception of sound in the human ear in the absence of any external sound. […] The exact physiological cause of tinnitus is unknown, says UH otolaryngologist Sarah Mowry, MD. Several sources are known, however, to trigger or worsen tinnitus, she says, such as: […] Noise-induced hearing loss. This is the most common cause of tinnitus. Either a single intense event or long-term noise exposure such as factory or construction work, can damage hearing. […] Up to 90 percent of all tinnitus patients have some level of hearing loss. […] Certain medications. Some medicines are toxic to the ears and can produce tinnitus as a side effect. […] Ear or sinus infections. Many people, including children, experience tinnitus along with an ear or sinus infection. […] Jaw misalignment. Temporomandibular jaw misalignment, or TMJ, can induce tinnitus.