Tinnitus: Causes, Types & Management

Tinnitus is the perception of sound in the absence of external acoustic stimulation—hearing a ringing, buzzing, roaring, or clicking sound in one or both ears. The sound originates internally, most commonly from the cochlea (inner ear) and auditory pathway, though the neural mechanisms remain incompletely understood. Tinnitus affects millions of people worldwide and can significantly impact quality of life.

Tinnitus is a symptom, not a disease, usually caused by underlying auditory or neurological conditions.

Common causes:

• Age-related hearing loss
• Noise exposure
• Ear infections or wax impaction
• Ototoxic medications
• Head or neck trauma
• Temporomandibular joint disorder
• Vascular abnormalities
• Neurological conditions

Objective tinnitus (audible to examiner):

• Vascular abnormalities
• Muscle spasms
• Eustachian tube dysfunction

Patients report:

• Ringing in ears (most common)
• Buzzing or humming
• Roaring or hissing
• Clicking or pulsing
• Fluctuating or constant
• Unilateral or bilateral

Associated symptoms:

• Hearing loss
• Dizziness
• Sleep disturbance
• Difficulty concentrating
• Anxiety or depression

Evaluation includes:

• Otoscopic examination
• Audiometry (hearing tests)
• Tinnitus pitch and loudness matching
• Imaging (MRI for unilateral tinnitus)
• Special tests (otoacoustic emissions, auditory brainstem response)

Conservative approaches:

• Hearing aids (if hearing loss present)
• Sound masking therapy
• Cognitive behavioral therapy (CBT)
• Counseling and patient education
• Relaxation and stress reduction

Medical interventions:

• Tinnitus retraining therapy (TRT)
• Transcranial magnetic stimulation (experimental)
• Medications (limited evidence)

Treatment varies based on underlying cause and patient response.

Prevention strategies include:

• Hearing protection (earplugs in loud environments)
• Limiting ototoxic medication exposure
• Treatment of hearing loss
• Management of hypertension and atherosclerosis
• Adequate sleep and stress management

See an audiologist if tinnitus persists, impairs function, or causes psychological distress. Seek urgent evaluation for sudden-onset tinnitus. Regular follow-up helps monitor for progression.