Tinnitus Part One: A Symptom

Buzzing, ringing, whooshing, roaring, clicking, cicadas…it sounds different to everyone—tinnitus. Tinnitus is defined as the perception of sound within the human ear in the absence of an external sound. It is not considered a disease on its own, but can be a symptom of an underlying condition. This “symptom” affects 10-15% of adults on a regular basis; it can range clinically from an occasional temporary sound to something that is constant and extremely bothersome to the individual perceiving it.

Tinnitus can be split into two basic categories: objective and subjective. Objective tinnitus is an actual sound, which can be perceived, originating from the patient’s ears. This type can be observed by both the patient and the examiner. It can be caused by crackling or spasming of the middle ear muscles—this may cause a click type tinnitus that seems fairly regular. Objective tinnitus can also have a pulsatile quality that keeps time with the patient’s heartbeat. Pulsatile, or vascular, tinnitus can result from increased or more turbulent blood flow in or around the ear. The most common vascular cause cited is a dural arteriovenous malformation (AVM)—an abnormal connection between veins and arteries in the brain. Other vascular causes include: head/neck tumors pressing on the blood vessels, atherosclerosis, and hypertension. Objective tinnitus can also be caused by TMJ disorders, or a swollen Eustachian tube. Otologic literature suggests that objective tinnitus is very rare.

Subjective tinnitus is a sensation of noise that can only be perceived by the person affected. This is most common type of tinnitus. It can have many possible causes, usually coinciding with some other otologic disorder. Some causes include: age-related hearing loss (presbycusis), exposure to loud noise, earwax blockage, stiffening or abnormal growth of the middle ear bones (otosclerosis), Meniere’s disease, use of ototoxic (toxic to the ear) medications, systemic diseases and acoustic tumors. The exact cause is not always known, but tinnitus should never be considered imaginary.

You are at greater risk for developing tinnitus if you are exposed to excessive noise, as you increase in age, if you are male, if you smoke, or if you have cardiovascular problems. If you have any of these risk factors you should have your hearing checked on a regular basis (annually or sooner if you notice a change).

Common complications of tinnitus include: fatigue, stress, sleep problems, trouble concentrating, memory problems, depression, anxiety, and irritability. Many of these complications can also compound your perception of the tinnitus, making it seem even worse.

You should see an audiologist if you experience tinnitus that becomes bothersome to you, or if you feel you are experiencing any of the above complications due to tinnitus. The audiologist may recommend evaluation and follow-up with an Otolaryngologist, or ear-nose-throat specialist (ENTs).

Be on the lookout for the next segment: Tinnitus Part Two: What to Expect at the Audiologist/ENT

Sarah Nordberg, AuD is an audiologist at Affinity Hearing in Plymouth.  She may be reached at 763-744-1190 for any questions.  Affinity Hearing provides free hearing screenings and hearing protection consults to the general public.