Tinnitus FAQ
	www.bixby.org/faq/tinnitus.html a resource for understanding tinnitus, not a substitute for a health care provider

What is tinnitus?

What does it sound like?

What causes tinnitus?

• Allergic Reactions
• Diseases
• Growths/Tumors
• Health Care
• Injuries and Medical Treatments
• Medication
• Noise Exposure
• Syndromes

Tinnitus can be described as "ringing" ears and other head noises that are perceived in the absence of any external noise source. It is estimated that 1 out of every 5 people experience some degree of tinnitus. Tinnitus is classified into two forms: objective and subjective.

Objective Tinnitus

Tthe rarer form, consists of head noises audible to other people in addition to the sufferer. The noises are usually caused by vascular anomalies, repetitive muscle contractions, or inner ear structural defects. The sounds are heard by the sufferer and are generally external to the auditory system. This form of tinnitus means that an examiner can hear the sound heard by the sufferer by using a stethoscope. Benign causes, such as noise from TMJ, openings of the eustachian tubes, or repetitive muscle contractions may be the cause of objective tinnitus. The sufferer might hear the pulsatile flow of the carotid artery or the continuous hum of normal venous outflow through the jugular vein when in a quiet setting. It can also be an early sign of increased intracranial pressure and is often overshadowed by other neurologic abnormalities. The sounds may arise from a turbulant flow through compressed venous structures at the base of the brain.

Subjective Tinnitus

This form of tinnitus may occur anywhere in the auditory system and is much less understood, with the causes being many and open to debate. Anything from the ear canal to the brain may be involved. The sounds can range from a metallic ringing, buzzing, blowing, roaring, or sometimes similar to a claanging, popping, or nonrhythmic beating. It can be accompanied by audiometric evidence of deafness which occurs in association with both conductive and sensorineural hearing loss. Other conditions and syndromes which may have tinnitus in conjunction with the condition or syndrom, are otosclerosis, Menier's syndrome, and cochlear or auditory neve lesions.

Hearing loss, hyperacusis, recruitment, FMS, and balance problems may or may not be present in conjunction with tinnitus.

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Many sufferers in the online community report that their tinnitus sounds like the high-pitched background squeal emitted by some computer monitors or television sets. Others report noises like hissing steam, rushing water, chirping crickets, bells, breaking glass, or even chainsaws. Some report that their tinnitus temporarily spikes in volume with sudden head motions during aerobic exercise, or with each footfall while jogging.

Objective tinnitus sufferers may hear a rhythmic rushing noise caused by their own pulse. This form is known as pulsatile tinnitus.

In a database of 1544 tinnitus patients, 79% characterized the sound as "tonal" with an average loudness of 7.5 (on a subjective scale of 1-10). The other 21% characterized the sound as "noise" with an average loudness of 5.5. When compared to an externally generated noise source, the average loudness was 7.5dB above threshold. 68% of patients were able to have their tinnitus masked by sounds 14dB or less above threshold. The internal origination of the tinnitus sounds was perceived by 56% of the patients to be in both ears, 24% from somewhere inside the head, 11% from the left ear, and 9% from the right ear.

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In a database of 1687 tinnitus patients, no known cause was identified for 43% of the cases, and noise exposure was the cause for 24% of the cases.

Allergic Reactions

Food:

Specific foods may trigger tinnitus. Problem foods include red wine, grain-based spirits, cheese, and chocolate. One contributor reported hearing tones after consuming honey. Another contributor notes that these same foods are on the list known to trigger migraine headaches; additional migraine foods include soy and anything including soy, MSG, very ripe bananas, avocados, and citrus fruits.

Foods Rich in Salicylates:

There is a long list of foods that are supposed to be "rich" in salicylates. See the Shulman book listed below for details. [Ed. note: I'm not listing the foods here since no data is given on exactly how rich the foods are, i.e. "13 mangoes = 1000mg aspirin" as a hypothetical example.]

Aspartame:

Some people allege (quite controversially) that the artificial sugar substitute aspartame is linked to tinnitus, vertigo, and many other serious problems (I agree). To retrieve further information about the allegations against aspartame, send e-mail to freeinfo@servint.com and include the lowercase command "info mp" in the body (not the Subject:) of the message.

Marijuana:

Marijuana usage may worsen pre-existing cases of tinnitus.

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Diseases

Lyme Disease:

Lyme is a parasitic, tick-borne disease, which in the United States is most commonly seen in eastern states. In some cases, tinnitus has been a side-effect of Lyme.

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Growths/Tumors

Acoustic Neuromas:

Acoustic neuromas are small, slow growing benign tumors that press against or invade the auditory nerves. If your tinnitus is only in one ear, you should see your physician to rule this one out. An MRI will probably be required for a definitive diagnosis, but one contributor's ENT felt that an MRI wasn't warranted unless frequent dizziness was present. Acoustic neuromas are removable by surgery but involve a risk of hearing loss. Doing nothing should be considered an option by elderly patients since these tumors grow so slowly.

Glomous Tumors:

These benign tumors of the glomus body can cause pulsatile tinnitus. They are confirmed with a CAT scan or other imaging, and may be surgically removable by a delicate procedure.

Otosclerosis:

Otosclerosis is a bony growth around the footplate of the stapes (one of the 3 middle ear bones). This footplate forms the seal that separates the middle ear space from the inner ear. When the footplate moves normally, the sound vibrations are passed from the middle ear "chain" of bones into the fluid of the inner ear. If the footplate is fixated, the vibrations cannot pass into the inner ear as well and hence a resulting hearing loss. Tinnitus may also be involved.

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Health Care

Wax/Dirt Build-up in the Ear Canal:

If you're experiencing tinnitus, this is one of the first things you should check for. NEVER try digging or suctioning the ear canal yourself or allow a physician to do it as SERIOUS damage may result. Numerous over-the-counter chemical washes are available from your drugstore which will clean the ear canal in a safe and gentle manner.

Severe Ear Infections:

Many tinnitus cases onset after severe ear infections. But this may also be related to the use of ototoxic antibiotics.

High Blood Cholesterol:

High blood cholesterol clogs arteries that supply oxygen to the nerves of the inner ear. Reducing your cholesterol level may reduce your tinnitus.

Vascular Abnormalities:

Arteries may press too closely against the inner ear machinery or nerves. This is sometimes correctable by delicate surgery.

Stress:

Stress is not a direct cause of tinnitus, but it will generally make an already existing case worse.

Diet and Other Lifestyle Choices:

Like stress above, a poor diet can worsen an existing case of tinnitus. Alcohol, tobacco, caffeine, quinine/tonic water, high fat, high sodium can all make tinnitus worse in some people.

Intracranial Hypertension:

Intracranial hypertension can cause pulsatile tinnitus. If you can stop your tinnitus by slight pressure to the neck on the affected side, that is an indication. The definite way to find out is if you get a spinal tap and your Opening Pressure is higher than 200.

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Injuries and Medical Treatments

Traumatic Head Injuries:

Some automobile crash victims have reported a sudden onset of tinnitus.

Dental Procedures:

Certain dental procedures such as difficult tooth extractions and ultrasonic cleaning can cause hearing damage via bone conduction of loud sounds directly to the ear. Wearing ear plugs will not guard against bone conduction.

Mercury Amalgam Tooth Fillings:

Researchers, June Rogers and Jacyntha Crawley (P.O. Box 413, London SW7 2PT, U.K.), have found a possible connection between mercury tooth fillings and tinnitus. They publish a booklet on the subject available for 6 International Reply Coupons, and they also have a questionnaire that interested people can fill out. Their research suggests following a vegetarian diet, plus eating 2 raw African green chillies one day, followed by 1 chilli the next day for temporary relief. A prominent American tinnitus specialist says that no such link has been established.

Cochlear Implant or Other Skull Surgeries:

Sometimes poking around inside the skull will accidentally damage the hearing system. Tinnitus can result, or even profound deafness caused by severe inner ear infections.

Arnold Chiari Malformation (ACM):

An *unscientific* response of 30 ACM patients revealed that 14 had ringing in the ears (significant) and 9 had a whooshing sound in their ears (also significant).

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Medication

Ototoxic Drugs:

Many prescription and over-the-counter drugs may cause tinnitus and/or hearing loss that may be permanent or may disappear when the dosage is reduced or eliminated. Before starting treatment with any prescription drug, tinnitus sufferers should always ask their physician and/or pharmacist about the potential for ototoxic side effects. These drugs include; salicylate analgesics (higher doses of aspirin), naproxen sodium (Naprosyn, Aleve), ibuprofen, many other non-steroidal anti-inflammatories, aminoglycoside antibiotics, anti-depressants, loop-inhibiting diuretics, quinine/anti-malarials, oral contraceptives, and chemotherapy.

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Noise Exposure

Overexposure to Loud Noises:

Repeated exposure to loud noises such as guns, artillery, aircraft, lawn mowers, movie theaters, amplified music, heavy construction, etc, can cause permanent hearing damage. Some people report auditory fatigue from driving automobiles long distances with the windows down. Anybody regularly exposed to these conditions should consider wearing ear plugs or other hearing protection.

MRI, CAT, and Other Non-invasive Scanning Machines:

These high-tech machines may take great images, but they are very, very LOUD. Do not attempt this type of imaging without wearing approved earplugs; any competent imaging facility should be able to supply the earplugs. [Note: Mark Bixby reports that he had knee MRIs done, and even with earplugs and his head outside the bulk of the machine it was very loud.]

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Syndromes

Temporo-Mandibular Joint (TMJ) Syndrome:

This jaw disorder may cause tinnitus and is characterized by many symptoms, including headaches, earaches, tenderness of the jaw muscles, dull facial pain, jaw noises, the jaw locking open, and pain while chewing. For a good online document on TMJ, see: http://www.uiuc.edu/departments/mckinley/health-info/dis-cond/misc/tmj-diso.html

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Remember, the t-faq is a resource. For medical care, visit your health care professional.