Health Information

Summary/Definition

Tinnitus or ringing in the ears is a symptom characterized by the presence of acoustic sensations in the absence of a sound source. Often patients describe tinnitus as a buzzing, hissing or wind noise, with some claiming to hear mixed sound manifestations. Tinnitus can be divided into two types: objective tinnitus and subjective tinnitus. Objective tinnitus is associated with pathological processes in the vessels and muscles of the ear and is heard not only by the patients themselves, but also by specialists during audiometry. Subjective tinnitus, on the other hand, is perceived exclusively by the patient. It is important to distinguish subjective tinnitus from auditory hallucinations, which are characterized by the perception of voices or music inside the head and are often observed in patients with mental disorders such as schizophrenia.

Tinnitus itself is not an independent disease, but rather a symptom of various ear pathologies. Tinnitus can be divided into two categories: auditory and non-auditory. The former occurs within the auditory apparatus, while the latter is related to processes occurring in surrounding structures, such as muscles and blood vessels. Auditory tinnitus is mainly caused by damage to the auditory apparatus itself. It is assumed that abnormal signals are generated due to damage to the auditory apparatus and are perceived as ringing in the ears by the central nervous system, but this phenomenon still needs to be studied in more detail.

The main causes of hearing damage are age-related changes, exposure to high noise levels, Meniere’s disease and chronic otitis media. Causes of nonauditory tinnitus include high blood pressure, atherosclerosis, vascular anomalies, vascular tumors, anaemia, thyroid disease, diabetes and muscle spasms.

Symptoms

Tinnitus is mainly associated with high-frequency metallic sounds. There is little or no correlation between the sound symptomatology and the source of the condition. Approximately 75% of tinnitus cases manifest themselves as a variety of sounds, such as tinkling mechanisms, vapor sounds, buzzing insects, squeaks, wind or water noises. Sometimes there is also a mixture of different sounds. Tinnitus symptoms are often aggravated by physical exertion and may increase in silence or when a person is nervous. Depending on the underlying cause of the condition, tinnitus may be accompanied by hearing loss or dizziness.

Diagnostics

Diagnosis of hearing disorders is essential to identify the causes of tinnitus. In some cases, the physical examination will include questioning the patient about their complaints and completing a questionnaire to assess the symptoms accurately and thoroughly. The nature of the symptoms, the duration of the tinnitus and the presence or absence of pathologies that may cause the tinnitus are assessed. In addition, audiological tests, ear ringing analysis and other diagnostic procedures are carried out, which provide important information about the origin of the ear ringing. Once the results of these tests have been interpreted together, auditory brainstem response tests, CT and MRI scans of the temporal region and, if necessary, blood tests, blood pressure monitoring and thyroid function tests are carried out.

Treatment and course of the disease

The treatment of tinnitus depends on the cause of the condition. There is no universal method to directly alleviate or treat tinnitus, so the first priority is to identify the cause of tinnitus and then prescribe the appropriate treatment. If the underlying cause of tinnitus is a condition such as ear inflammation, sudden hearing loss or Meniere’s disease, appropriate medication is used. An effective treatment for ear ringing is tinnitus habituation therapy. It is based on the principles of habituation therapy and includes directive counselling to reframe tinnitus as a neutral signal, sometimes in combination with hearing aids. In addition, depending on the patient’s specific symptoms, long-term or short-term medication may be required. Pulsatile ear noise caused by varicose vessels or arteriovenous malformations (AVMs) in the ear region can be treated surgically.

Tinnitus is most commonly associated with impaired hearing function, and despite the correlation with the degree of hearing loss, many patients are unaware that their hearing is impaired. Therefore, even with hearing loss, the progression of the condition is not usually life-threatening. However, it is important to seek professional help, not only for medical treatment, but also for psychological support and to address any anxiety that may be present.

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