Tinnitus: what it is, symptoms, causes and treatment

By Cristiano Antonino On Jan 24, 2023

Rather than an actual disease, tinnitus is a symptom of potential ear or central auditory pathology involving neurological diseases

A severe form of tinnitus that is accompanied by reduced hearing can significantly affect the patient’s quality of life.

According to a recent study–conducted by the Mario Negri Institute in collaboration with experts from the British University of Nottingham, the University of Regensburg in Germany, and Watt University in Malaysia–one in seven Europeans, about 65 million people, suffer from tinnitus, and the prediction for the next decade is for a substantial increase.

What is tinnitus

Tinnitus or tinnitus is a hearing disorder that manifests itself in the form of buzzing, whistling, buzzing, and rustling sounds that are not generated by an actual external acoustic source.

Basically, it is a “phantom” noise, weak or loud, continuous or intermittent, which can be perceived

by one ear only (unilateral tinnitus)
from both ears (bilateral tinnitus)
or be localized in the center of the head.

This acoustic phenomenon, which each patient can perceive at different volumes and pitches, can occur transiently, with wave-like frequencies, or constantly without ever disappearing completely.

From a strictly medical point of view, tinnitus is not a harmful disorder.

However, the constant annoying strain can over time have psychological repercussions on the sufferer.

Some individuals, for example, experience their tinnitus as severely disabling, as it disrupts concentration during daylight hours and impairs sleeping hours at night.

If the noise in the ear is perceived by the patient as overwhelming or substantial, mechanisms are triggered in the limbic system (a complex of encephalic areas with a key role in emotional reactions and behavioral responses) that are capable of intensifying emotional perception, thus producing a vicious cycle whereby tinnitus is in essence permanent at the conscious level.

In any case, people affected by tinnitus do not always suffer from the noises they detect in the ear.

For this reason, one can speak of:

compensated tinnitus, when the noise is not perceived as particularly annoying
decompensated tinnitus, when, on the other hand, noise is ubiquitous and generates quite a lot of suffering. In this case it has negative consequences on the quality of life, causing stress, up to and including anxiety and depression.

In relation to severity, experts distinguish tinnitus into four grades that identify the degree of perceived distress:

Severity I, the person does not experience any suffering
severity II, the buzzing occurs mainly in absolutely silent environments and mainly in situations of high tension or stress
Severity III, in this case significant effects on private and working life are perceived. In addition, noise often causes disturbances in concentration, sleep, and impaired balance
severity IV, noise is perceived as disabling and seriously impairs the peaceful conduct of daily life. Headache and profound sadness may also occur.

Based on intensity and duration, however, tinnitus can be:

acute, occurring for less than three months and disappearing spontaneously. In these cases, the administration of medication may help
sub-acute, reappearing within three to 12 months. Drug treatment and/or relaxation exercises can generate improvement
chronic, persists for more than a year and only rarely disappears without pharmacological or therapeutic intervention.

The main symptomatology with which tinnitus or tinnitus manifests is typically ringing in one or both ears

Depending on the degree of noise in the patient’s environment, the perception of the disturbance may vary significantly, due to an effect called “masking” such that the tinnitus may appear:

mild in noisier places (such as crowded squares or large commercial centers)
more intense in quiet places (especially during the night).

Since diminished hearing or hearing loss-rising after age 60-is the main accelerator for tinnitus, it is not surprising that the latter occurs more frequently with increasing age: about one in three cases, in fact, occurs in patients between the ages of 60 and 69.

Some associated symptoms of tinnitus may be:

difficulty concentrating
nervousness and irritability
feeling of pressure in the ear or head
dizziness and impaired balance
muscle tension, in the cervical spine or jaw area
headache, migraine
pain in the ears
sleep disorders
forms of anxiety and altered moods
hyperacusis, meaning hypersensitivity to loud noises
Dysacusis, meaning a distorted perception of sounds

Based on whether the noise is perceived only by the patient, or conversely, is an actual sound from the ear canal (generated by structures bordering the ear), tinnitus is distinguished respectively into:

subjective tinnitus, which is more widely spread and generally associated with hearing loss (either sensorineural or transmissive), is generated due to impaired hearing; a subcategory is somatic tinnitus (also called somatosensory tinnitus) in which the frequency and intensity of the noise changes depending on movements made, such as rolling the eyes, clenching the jaw, or applying pressure to the head and neck
Objective tinnitus, which is rarer than subjective tinnitus presents with an actual noise coming from the ear canal. The sound may be so loud that even the hearing care professional can hear it during the test; this occurs because the noise, originating from an area adjacent to the middle ear, typically involves the presence of blood vascular flow that produces a distinctly audible, often pulsating sound.

Causes and treatment

Most often, tinnitus can be traced to severe emotional stress, rather than problems related to the inner ear.

Various studies have shown that patients exposed to stress before the onset of the disorder experience sudden hearing loss and tinnitus at a higher incidence than other patients who are not subjected to sources of stress.

In many cases, tinnitus can be traced to chronic stress due to family or work-related concerns, or to traumatic events, such as the death of a family member.

The main causes of tinnitus can be classified into 4 categories: otological (afferent to the ear), neurological, infectious, and drug-related.

Otological causes include:

earwax accumulation
dysfunction of the Eustachian tube (duct connecting the back of the nose to the middle ear)
presbyacusis, or ossi a form of age-related hearing loss
hypoacusis
otosclerosis (abnormal growth of the stapes, or middle ear ossicle)
Ménière’s syndrome
auricular barotrauma (tissue damage generated by pressure changes), common in divers and people who routinely take airplanes
sensorineural hearing loss, acoustic trauma generated by exposure to noise.

Prolonged exposure to noise can cause damage to the hair cells in the cochlea, as a result of which certain tones are transmitted very faintly to the brain, or may not even be transmitted at all; by a kind of compensatory effect, the hearing center in the brain increases the volume of the missing frequencies.

This is the reason why the tinnitus sound often and ironically corresponds to those frequencies that the patient mishears or is no longer able to perceive.

Occasional exposure to significant acoustic disturbances (e.g., a music concert) can cause temporary tinnitus that usually passes within 16 to 48 hours, after a period called acoustic rest.

Tinnitus appears to be the most common symptom of noise-induced hearing loss among professional musicians

Great music stars who suffer or have suffered from tinnitus include, for example, Eric Clapton and Neil Young.

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The most relevant neurological causes are:

whiplash or other cervical spine problems
head trauma
multiple sclerosis
neurinoma of the auditory nerve
vascular tumors of the middle ear

Infectious causes include:

inflammations of the ear, such as otitis media
meningitis
Lyme disease
Meniere’s syndrome (inner ear disease that causes dizziness, nausea and hearing loss)
syphilis

There are over 200 medications (both over-the-counter and prescription) that can generate hearing loss or tinnitus (transient or permanent).

These are typically medications to treat pain, serious infections, heart and kidney disease, and cancers.

Tinnitus, as can be deduced from what has been said so far, is a rather complex disorder whose causes can vary considerably from subject to subject; for this reason to date there is no unambiguous effective and resolving therapy.

The valid treatments available aim, on the one hand, to alleviate the discomfort caused by this disorder and, on the other hand, to act on the causes that caused it.

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