” Is that your phone buzzing?”
” I don’t hear any buzzing…”
Have you ever heard a phantom clicking, ringing, or buzzing in your ears that no one else seems to be able to hear? You may be experiencing tinnitus. Perhaps you are also hallucinating and delusional but for the purposes of this article we’ll focus on tinnitus.
In the US, as much as a quarter of the population has experienced tinnitus. Though not a disease, tinnitus is often considered a symptom of an underlying disorder, and is characterized by the sensation of noise without the presence of any external sounds. People with tinnitus often describe this sound as a clicking, ringing, buzzing, hissing, roaring, or humming, and it may be either at a high or low pitch, in just one ear or both. In addition to making you check your phone unnecessarily often, tinnitus can be a source of great annoyance as the incessant or recurrent phantom noise can interfere with concentration and sleep, and cause stress, anxiety, and even depression.
What causes tinnitus?
In general terms, tinnitus is caused by a disruption at some point along the auditory pathway – this includes the ear itself, the cochlear (auditory) nerve carrying signals from the inner ear to the brain, and the areas of the brain involved in sound processing. For some people no underlying cause can be found.
A common cause of tinnitus relates to damage to the sensory hair cells of the inner ear and subsequent hearing loss. With a loss of the ability to detect external sounds, these hair cells may spark spontaneous neural signals to the brain which are then interpreted as noise. Another hypothesis explains tinnitus as being a result of the brain overcompensating to the loss of natural hearing and tuning in to even noises internal to the cranium. The causes of hearing loss are varied but the most common include:
- Presbycusis – another name for “you’re getting old.” Age-related hearing loss affects approximately 35% of those aged over 65 and about 50% of those over 75 years old. This type of hearing loss typically affects both ears equally.
- Noise-related – exposure to excessive noise can cause damage to the hair cells of the ear. Though usually the resultant tinnitus is temporary, even short-term exposure to loud sounds has the potential to cause permanent damage. Working with heavy machinery, firearms, and loud music can contribute to noise-related hearing loss. In the case of individuals exposed to active war zones, hearing loss may even be a result of shockwaves from armaments damaging areas of the brain involved in sound processing.
- Earwax – an example of too much of a good thing. Though earwax usually has the most honorable intentions, an excessive accumulation of it can end up plugging the ear canal or causing irritation to the eardrum.
- Otosclerosis – though this condition is not considered particularly common it can cause hearing loss-related tinnitus. Abnormal bone tissue remodeling in the middle ear can restrict the ability of some of these bones, usually the one called the stapes, to vibrate in response to sound. As this vibration brings sound from the middle ear to the inner ear, otosclerosis can cause hearing loss and subsequent tinnitus.
Rarer causes of tinnitus can include those that are not a direct result of hearing loss, such as head and neck trauma, Meniere’s disease, acoustic neuromas, and ear infections.
A specific subtype of tinnitus known as pulsatile tinnitus is caused by cardiovascular disease. Hypertension, abnormal formation of capillaries, tumors around the vessels of the head and neck, or other vascular disorders that cause turbulent or irregular blood flow can become noticeable in the ears as a rhythmic whooshing, such as with the heartbeat. Almost 5 million Americans experience pulsatile tinnitus. Because this type of tinnitus may be a symptom of a potentially life-threatening condition, it is important to have it checked out sooner rather than later.
Certain medications are associated with the development or exacerbation of tinnitus, usually in a dose-dependent manner. Antibiotics, antidepressants, high-dose aspirin, chemotherapy drugs, diuretics, and non-steroidal anti-inflammatory drugs (NSAIDS) are known to be linked with tinnitus. Usually, cessation of these medications can resolve the tinnitus symptoms.
What to do if you have tinnitus?
When managing tinnitus, the priority lies in identifying and addressing the underlying cause. This may involve treatment of an ear infection, reassessing the necessity or dosage of current medications, or management of cardiovascular disease.
As with many things, prevention is better than cure. As many cases of tinnitus are a result of damaged hearing, protecting your hearing by means of adequate ear protection when in noisy environments, turning down the volume in your headphones, slowing down aging (because, you know, you can easily just dial that one down a bit) will be a better option than trying to deal with the effects of tinnitus when it starts happening. If you do already hear an intermittent or constant high-pitched whining but can’t find any mosquitos nearby, certain modern hearing aids are available with a tinnitus management feature. These typically work by producing a background white noise or soothing sound to direct the brain’s attention away from the tinnitus and can be customized to the user’s preferences. The use of a hearing aid also serves to combat the effects of hearing loss in general by amplifying external sound stimuli. A survey conducted in 2007 by the American Tinnitus Association reported that up to 60% of those with tinnitus found some degree of relief from hearing aids, with 22% identifying this relief as significant.
For a minority of people, tinnitus can be the source of substantial distress and lead to a decreased quality of life. Sleep disturbance, anxiety, depression, and mental stress have all been associated with intolerable tinnitus. Despite this, many people do not seek attention or treatment from a healthcare professional.
If you think you often hear the clicking of footsteps behind you only to turn around and find no one there, it may be time to seek a hearing assessment by an audiologist or ENT doctor. It probably wouldn’t hurt to carry a little can of pepper spray around too, just in case.
Tinnitus epidemiology: prevalence, severity, exposures and treatment patterns in the United States. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5812683/
Fact sheet: what is tinnitus? https://www.deafnessforum.org.au/fact-sheet-what-is-tinnitus/
What is otosclerosis? https://www.webmd.com/cold-and-flu/ear-infection/otosclerosis-facts#1
Pulsatile tinnitus clinic. https://radiology.ucsf.edu/pulsatile-tinnitus
What you need to know about tinnitus. https://www.medicalnewstoday.com/articles/156286.php
Hearing aids. https://www.ata.org/managing-your-tinnitus/treatment-options/hearing-aids