Tinnitus

One of my patients recently asked if the ringing in her ears was anything to worry about. Since nothing medical is ever as simple as it should be, I said “It depends”.

Ringing, or tinnitus, is the perception of sound that is obviously NOT coming from outside of the head (this excludes voices—that’s a psychiatric problem). Also described as “crickets”, “buzzing”, “humming”, etc., it usually is a more or less constant sound heard at the same pitch or frequency. It almost always accompanies the high frequency hearing loss we commonly see in older people and those exposed to loud noises without hearing protection. Somehow the brain “hears” the very frequencies lost by age or damage. Tinnitus is usually not a worrisome sign ONLY if it meets ALL the following criteria: IF it is not of recent onset, not severe (only noticed in quiet), if the ringing is the same loudness and pitch in both ears, if the hearing is stable and is the same in both ears, AND there is no dizziness; then it is ALMOST certain that it is not a sign of something serious. Any exceptions to these conditions require evaluation. Common causes of tinnitus include stress, elevated blood pressure, medical drugs, MANY different diseases, and most kinds of hearing loss.

Tinnitus that is (1) significantly worse on one side than the other, (2) is associated with a worse hearing ear, (3) loud, or (4) especially if associated with dizziness, needs to be evaluated by an ear, nose and throat specialist. Causes of one-sided tinnitus range from brain tumors and neurologic conditions, to both simple and complicated diseases of the ear.

Another particular kind of tinnitus called pulsitile tinnitus is caused when one hears blood flow pulsing through blood vessels around the ears. This occurs when the sounds from abnormal blood flow in the neck or head are transmitted to the inner ear. Serious vascular tumors, life threatening blood vessel blockage, heart conditions, and certain brain conditions need to be looked for with pulsitile tinnitus.

Lastly, loud tinnitus caused by loud noise and gunfire is usually a sign of permanent hearing damage. Each time this happens, you lose a little more hearing that will never come back. Do not allow yourself or anyone you love to hunt without hearing protection (ear plugs or muffs). Call or see your local ENT doc if you can’t find some you are happy with.

Dr. Chuck Guice