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Ear Ringing or Buzzing...medical consulting

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Causes of Ear Ringing or Buzzing









Subjective tinnitus

More than 75% of ear-related disorders include tinnitus as a symptom and people who have hearing loss regardless of cause often develop tinnitus. The most common causes of subjective tinnitus include





Exposure to loud noises or explosions (acoustic trauma)




Aging (presbycusis)




Certain drugs that damage the ear (ototoxic drugs)




Meniere disease






Other causes of tinnitus include middle ear infections disorders that block the ear canal (such as an external ear infection [external otitis] excessive ear wax or foreign bodies) problems with the eustachian tube (which connects the middle ear and the back of the nose) due to allergies or other causes of obstruction otosclerosis (a disorder of excess bone growth in the middle ear) and temporomandibular disorders. An uncommon but serious cause is a vestibular schwannoma a noncancerous (benign) tumor of part of the nerve leading from the inner ear.

Objective tinnitus

Objective tinnitus usually involves noise from blood vessels near the ear. In such cases the sound comes with each beat of the pulse (pulsatile). Causes include





Turbulent flow through the carotid artery or jugular vein




Certain middle ear tumors that are rich in blood vessels




Malformed blood vessels of the membrane covering the brain






The most common noise is the sound of rapid or turbulent blood flow in major vessels of the neck. This abnormal blood flow may occur because of a reduced red blood cell count (anemia) or a blockage of the arteries (atherosclerosis) and may be worsened in people with poorly controlled high blood pressure (hypertension). Some small tumors of the middle ear called glomus tumors are rich in blood vessels. Although the tumors are small they are very near the sound-receiving structures of the ear and blood flow through them can sometimes be heard (only in one ear). Sometimes blood vessel malformations that involve abnormal connections between arteries and veins (arteriovenous malformations) develop in the membrane covering the brain (the dura). If these malformations are near the ear the person sometimes can hear blood flowing through them.



Less commonly spasms of muscles of the palate or the small muscles of the middle ear cause clicking sounds. These sounds do not follow the beat of the pulse. Such spasms often have no known cause but may be due to tumors head injury or diseases that affect the covering of nerves (for example multiple sclerosis).



Key Points about Ear Ringing or Buzzing










Most tinnitus is due to causes that are not dangerous for example exposure to loud noise aging Meniere disease and use of certain drugs.




In many cases the cause is unknown.




Findings that are of concern include tinnitus accompanied by any neurologic symptoms and tinnitus in only one ear (particularly when accompanied by hearing loss dizziness and/or balance difficulty).




Tinnitus rarely can be stopped but certain techniques help people manage their symptoms effectively.





Evaluation of Ear Ringing or Buzzing











Not all tinnitus requires evaluation by a doctor. The following information can help people decide whether a doctor's evaluation is needed and help them know what to expect during the evaluation.

Warning signs

Certain symptoms and characteristics are cause for concern. They include





Tinnitus in only one ear




Any neurologic symptoms (other than hearing loss) particularly difficulty with balance or walking but also vertigo or difficulty seeing speaking swallowing and/or talking




When to see a doctor

People with warning signs should see a doctor right away. People without warning signs in whom tinnitus recently developed should call their doctor as should people with pulsatile tinnitus. Most people with tinnitus and no warning signs have had tinnitus for a long time but should see their doctor about it if they have not already done so.

What the doctor does

In people with tinnitus doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination may suggest a cause of the tinnitus and the tests that may need to be done (see table Some Causes and Features of Tinnitus).



During the medical history doctors ask about the following:





The nature of the tinnitus including whether it is in one or both ears and whether it is constant or pulsatile




Whether the person has any neurologic symptoms




Whether the person has been exposed to loud noise or to drugs that can affect the ears






During the physical examination doctors focus on examining the ears (including hearing) and the neurologic system. They also listen with a stethoscope over and near the person's ear and on the neck for sounds of objective tinnitus.




Table










Some Causes and Features of Tinnitus






Cause




Common Features*




Diagnosis†








Subjective tinnitus (typically a constant tone and sometimes accompanied by some degree of hearing loss)






Acoustic trauma (noise-induced hearing loss)




History of occupational or recreational exposure to noise



Hearing loss




Doctor’s examination alone‡






Aging (presbycusis)




Progressive hearing loss often with family history




Doctor’s examination alone‡






Barotrauma (ear damage due to sudden pressure change)




Clear history of ear damage




Doctor’s examination alone‡






Brain tumors (such as vestibular schwannoma or meningioma) or disorders such as multiple sclerosis or stroke




Tinnitus and often hearing loss in only one ear



Sometimes other neurologic abnormalities




Audiometry



Gadolinium-enhanced MRI






Drugs (particularly aspirin aminoglycoside antibiotics certain diuretics and some chemotherapy drugs including cisplatin)




Tinnitus beginning in both ears shortly after starting use of drug



Except with aspirin hearing loss also possible



With aminoglycoside antibiotics possible dizziness and problems with balance




Doctor’s examination alone‡






Eustachian tube dysfunction




Often a long history of decreased hearing and frequent colds and problems clearing ears with air travel or other pressure change



May be in one or both ears (often one ear more of a problem than the other)




Tympanometry






Infections (such as otitis media labyrinthitis meningitis or syphilis)




History of such infection




Sometimes doctor’s examination alone‡



Sometimes other tests (for example a lumbar puncture if meningitis is suspected)






Meniere disease




Repeated episodes of hearing loss tinnitus and/or fullness in one ear and severe vertigo




Vestibular testing



Gadolinium-enhanced MRI to rule out vestibular schwannoma






Obstruction of ear canal (due to wax foreign object or external otitis)




Only one ear affected



Visible abnormalities seen during ear examination including discharge with external otitis




Doctor’s examination alone‡






Objective tinnitus (typically pulsatile or intermittent)






Artery and vein (arteriovenous) malformations of the dura




Constant pulsatile tinnitus in only one ear



Usually no other symptoms



Possible humming or pulsing noise over the skull heard during examination




Magnetic resonance angiography (MRA) CT angiography CTA) or conventional angiography






Spasm of muscles of the palate or of the middle ear




Irregular clicking or mechanical-sounding noise



Possibly other neurologic symptoms (when the cause of the spasm is a neurologic disease such as multiple sclerosis)



Possible movement of the palate and/or eardrum when symptoms occur




Sometimes MRI



Tympanometry






Turbulent blood flow in carotid artery or jugular vein




Possible humming or pulsing noise heard over the neck during examination



The noise may stop when the doctor pushes on the jugular vein and/or has people turn their head to the side




Sometimes doctor’s examination alone



Sometimes CT venogram and CT angiography






Vascular middle ear tumors (such as glomus tumors)




Constant pulsatile tinnitus in only one ear



Possible pulsing noise heard over the affected ear during examination



Sometimes doctors can see the tumor behind the eardrum when they look in the ear canal with a light




CT



MRI



Angiography (usually done before surgery)








* Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present.






† Although a doctor's examination is always done it is mentioned in this column only if the diagnosis can sometimes be made by the doctor's examination alone without any testing.






‡ Most people should have a full hearing test (audiometry).






CT = computed tomography; MRI = magnetic resonance imaging.















Testing

Possible tests for people with tinnitus include





Formal hearing test (including tympanometry)






Most people should have a formal hearing test done by either the doctor or a hearing specialist (audiologist). People with tinnitus in only one ear and hearing loss should have gadolinium-enhanced magnetic resonance imaging (MRI). People with pulsatile tinnitus often require magnetic resonance angiography (MRA) computerized tomography angiography (CTA) or conventional angiography.



Treatment of Ear Ringing or Buzzing











Attempts to identify and treat the disorder causing tinnitus are often unsuccessful. However correcting any hearing loss (for example with a hearing aid) relieves tinnitus in about half of people.



Treatment of stress and other mental conditions (such as depression) may help. Many people are reassured if they learn that their tinnitus is not caused by a serious disorder. Caffeine and other stimulants can worsen tinnitus so people should try to avoid these.



Various techniques can help make tinnitus tolerable although the ability to tolerate it varies from person to person. Many people find that background sound helps mask the tinnitus and helps them fall asleep. Some people play background music. Other people use a tinnitus masker which is a device worn like a hearing aid that produces a constant level of neutral sounds. For the profoundly deaf an implant in the cochlea (the organ of hearing) may reduce tinnitus but is only done for people with severe to profound hearing loss in both ears. If these standard techniques are not helpful people may want to seek treatment in clinics that specialize in the treatment of tinnitus.


simple explanation



Ringing in the ears (tinnitus) is noise originating in the ear rather than in the environment. It is a symptom and not a specific disease. Tinnitus is very common—10 to 15% of people experience it to some degree.


The noise heard by people with tinnitus may be a buzzing ringing roaring whistling or hissing sound and is often associated with hearing loss. Some people hear more complex sounds that may be different at different times. These sounds are more noticeable in a quiet environment and when people are not concentrating on something else. Thus tinnitus tends to be most disturbing to people when they are trying to sleep. However the experience of tinnitus is highly individual. Some people are very disturbed by their symptoms whereas others find them quite bearable.


Subjective tinnitus is by far the most common type. It is caused by abnormal activity in the part of the brain responsible for processing sound (auditory cortex). Doctors do not fully understand how this abnormal activity develops.


Objective tinnitus is much less common. It represents actual noise created by structures near the ear. Other people can sometimes hear the sounds of objective tinnitus if they listen closely.


More than 75% of ear-related disorders include tinnitus as a symptom and people who have hearing loss regardless of cause often develop tinnitus. The most common causes of subjective tinnitus include


Exposure to loud noises or explosions (acoustic trauma)


Aging (presbycusis)


Certain drugs that damage the ear (ototoxic drugs)


Meniere disease


Other causes of tinnitus include middle ear infections disorders that block the ear canal (such as an external ear infection [external otitis] excessive ear wax or foreign bodies) problems with the eustachian tube (which connects the middle ear and the back of the nose) due to allergies or other causes of obstruction otosclerosis (a disorder of excess bone growth in the middle ear) and temporomandibular disorders. An uncommon but serious cause is a vestibular schwannoma a noncancerous (benign) tumor of part of the nerve leading from the inner ear.


Objective tinnitus usually involves noise from blood vessels near the ear. In such cases the sound comes with each beat of the pulse (pulsatile). Causes include


Turbulent flow through the carotid artery or jugular vein


Certain middle ear tumors that are rich in blood vessels


Malformed blood vessels of the membrane covering the brain


The most common noise is the sound of rapid or turbulent blood flow in major vessels of the neck. This abnormal blood flow may occur because of a reduced red blood cell count (anemia) or a blockage of the arteries (atherosclerosis) and may be worsened in people with poorly controlled high blood pressure (hypertension). Some small tumors of the middle ear called glomus tumors are rich in blood vessels. Although the tumors are small they are very near the sound-receiving structures of the ear and blood flow through them can sometimes be heard (only in one ear). Sometimes blood vessel malformations that involve abnormal connections between arteries and veins (arteriovenous malformations) develop in the membrane covering the brain (the dura). If these malformations are near the ear the person sometimes can hear blood flowing through them.


Less commonly spasms of muscles of the palate or the small muscles of the middle ear cause clicking sounds. These sounds do not follow the beat of the pulse. Such spasms often have no known cause but may be due to tumors head injury or diseases that affect the covering of nerves (for example multiple sclerosis).


Not all tinnitus requires evaluation by a doctor. The following information can help people decide whether a doctor's evaluation is needed and help them know what to expect during the evaluation.


Certain symptoms and characteristics are cause for concern. They include


Tinnitus in only one ear


Any neurologic symptoms (other than hearing loss) particularly difficulty with balance or walking but also vertigo or difficulty seeing speaking swallowing and/or talking


People with warning signs should see a doctor right away. People without warning signs in whom tinnitus recently developed should call their doctor as should people with pulsatile tinnitus. Most people with tinnitus and no warning signs have had tinnitus for a long time but should see their doctor about it if they have not already done so.


In people with tinnitus doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination may suggest a cause of the tinnitus and the tests that may need to be done (see table Some Causes and Features of Tinnitus).


During the medical history doctors ask about the following:


The nature of the tinnitus including whether it is in one or both ears and whether it is constant or pulsatile


Whether the person has any neurologic symptoms


Whether the person has been exposed to loud noise or to drugs that can affect the ears


During the physical examination doctors focus on examining the ears (including hearing) and the neurologic system. They also listen with a stethoscope over and near the person's ear and on the neck for sounds of objective tinnitus.


Cause


Common Features*


Diagnosis†


Subjective tinnitus (typically a constant tone and sometimes accompanied by some degree of hearing loss)


Acoustic trauma (noise-induced hearing loss)


History of occupational or recreational exposure to noise


Hearing loss


Doctor’s examination alone‡


Aging (presbycusis)


Progressive hearing loss often with family history


Doctor’s examination alone‡


Barotrauma (ear damage due to sudden pressure change)


Clear history of ear damage


Doctor’s examination alone‡


Brain tumors (such as vestibular schwannoma or meningioma) or disorders such as multiple sclerosis or stroke


Tinnitus and often hearing loss in only one ear


Sometimes other neurologic abnormalities


Audiometry


Gadolinium-enhanced MRI


Drugs (particularly aspirin aminoglycoside antibiotics certain diuretics and some chemotherapy drugs including cisplatin)


Tinnitus beginning in both ears shortly after starting use of drug


Except with aspirin hearing loss also possible


With aminoglycoside antibiotics possible dizziness and problems with balance


Doctor’s examination alone‡


Eustachian tube dysfunction


Often a long history of decreased hearing and frequent colds and problems clearing ears with air travel or other pressure change


May be in one or both ears (often one ear more of a problem than the other)


Tympanometry


Infections (such as otitis media labyrinthitis meningitis or syphilis)


History of such infection


Sometimes doctor’s examination alone‡


Sometimes other tests (for example a lumbar puncture if meningitis is suspected)


Meniere disease


Repeated episodes of hearing loss tinnitus and/or fullness in one ear and severe vertigo


Vestibular testing


Gadolinium-enhanced MRI to rule out vestibular schwannoma


Obstruction of ear canal (due to wax foreign object or external otitis)


Only one ear affected


Visible abnormalities seen during ear examination including discharge with external otitis


Doctor’s examination alone‡


Objective tinnitus (typically pulsatile or intermittent)


Artery and vein (arteriovenous) malformations of the dura


Constant pulsatile tinnitus in only one ear


Usually no other symptoms


Possible humming or pulsing noise over the skull heard during examination


Magnetic resonance angiography (MRA) CT angiography CTA) or conventional angiography


Spasm of muscles of the palate or of the middle ear


Irregular clicking or mechanical-sounding noise


Possibly other neurologic symptoms (when the cause of the spasm is a neurologic disease such as multiple sclerosis)


Possible movement of the palate and/or eardrum when symptoms occur


Sometimes MRI


Tympanometry


Turbulent blood flow in carotid artery or jugular vein


Possible humming or pulsing noise heard over the neck during examination


The noise may stop when the doctor pushes on the jugular vein and/or has people turn their head to the side


Sometimes doctor’s examination alone


Sometimes CT venogram and CT angiography


Vascular middle ear tumors (such as glomus tumors)


Constant pulsatile tinnitus in only one ear


Possible pulsing noise heard over the affected ear during examination


Sometimes doctors can see the tumor behind the eardrum when they look in the ear canal with a light


CT


MRI


Angiography (usually done before surgery)


* Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present.


† Although a doctor's examination is always done it is mentioned in this column only if the diagnosis can sometimes be made by the doctor's examination alone without any testing.


‡ Most people should have a full hearing test (audiometry).


CT = computed tomography; MRI = magnetic resonance imaging.


Possible tests for people with tinnitus include


Formal hearing test (including tympanometry)


Most people should have a formal hearing test done by either the doctor or a hearing specialist (audiologist). People with tinnitus in only one ear and hearing loss should have gadolinium-enhanced magnetic resonance imaging (MRI). People with pulsatile tinnitus often require magnetic resonance angiography (MRA) computerized tomography angiography (CTA) or conventional angiography.


Attempts to identify and treat the disorder causing tinnitus are often unsuccessful. However correcting any hearing loss (for example with a hearing aid) relieves tinnitus in about half of people.


Treatment of stress and other mental conditions (such as depression) may help. Many people are reassured if they learn that their tinnitus is not caused by a serious disorder. Caffeine and other stimulants can worsen tinnitus so people should try to avoid these.


Various techniques can help make tinnitus tolerable although the ability to tolerate it varies from person to person. Many people find that background sound helps mask the tinnitus and helps them fall asleep. Some people play background music. Other people use a tinnitus masker which is a device worn like a hearing aid that produces a constant level of neutral sounds. For the profoundly deaf an implant in the cochlea (the organ of hearing) may reduce tinnitus but is only done for people with severe to profound hearing loss in both ears. If these standard techniques are not helpful people may want to seek treatment in clinics that specialize in the treatment of tinnitus.


Most tinnitus is due to causes that are not dangerous for example exposure to loud noise aging Meniere disease and use of certain drugs.


In many cases the cause is unknown.


Findings that are of concern include tinnitus accompanied by any neurologic symptoms and tinnitus in only one ear (particularly when accompanied by hearing loss dizziness and/or balance difficulty).


Tinnitus rarely can be stopped but certain techniques help people manage their symptoms effectively.
  • The Author: wikbe
 
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