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Tinnitus (Ringing in the Ears)

  • What is tinnitus?


    Tinnitus refers to a noise in one or both ears that is not caused by an external sound source. Often described as ringing, buzzing, roaring or hissing, it can be rather disturbing. Tinnitus is a common condition affecting around 20% of adults. Although mostly innocuous, it is occasionally a symptom of a serious underlying condition, such as an acoustic neuroma (tumour of the hearing nerve) or even a cancer at the back of the nose (nasopharyngeal carcinoma).

    There are essentially 2 types of tinnitus: subjective and objective.

    Subjective tinnitus

    Subjective tinnitus is the common type and is heard only by the patient.

    Objective tinnitus

    Objective tinnitus can be heard by both the patient and others, such as the doctor who uses a stethoscope.

  • In general, the causes of tinnitus are similar to those of hearing loss. These include:

    • Old age
    • Exposure to excessively loud noise
    • Medications such as certain antibiotics and diuretics
    • Certain medical conditions which can compromise blood circulation to the ear

    It is believed that damaged hearing cells and nerves result in the cessation of normal impulses to the brain, which then creates its own noise to make up for the lack of sound.

    The cause of subjective tinnitus is largely unknown, while objective tinnitus can be caused by lesions such as a vascular tumour in the ear or myoclonus of muscles related to the ear. Patients commonly describe objective tinnitus as “pulsatile” (ie. in sync with heartbeat).

    Tinnitus is often aggravated by stress, tiredness, anxiety and worrying. Pains and aches in the head and neck region can also contribute to the worsening of tinnitus.

    Preventing tinnitus

    While tinnitus can be treated, it is always better to prevent it while you can. Certain precautions can be made to help prevent different types of tinnitus:

    • Use of hearing protection – Constant exposure to noises louder than 85 decibels can potentially damage the hearing cells. Such situations can occur during leisure activities or at work. If turning down the volume of sound is not possible, proper ear protection, such as the wearing of well-fitting earplugs, is advised.
    • Stay healthy – Stress, anxiety and even cardiovascular disorders can contribute to tinnitus. Maintaining a healthy lifestyle is helpful, such as getting enough rest, exercise and nutritious food and effective management of stress.
  • A person suffering from tinnitus sometimes experiences associated ear symptoms, such as:

    • Dizziness
    • Hearing loss
    • Ear discharge
    • Itch, pain and blockage

    Other individuals may experience other ENT symptoms, such as a bleeding nose or blood in the phlegm.

    While tinnitus is rarely a serious medical condition, it is advisable to seek advice from a doctor particularly if it is one-sided or pulsatile. It may also be of concern if it is is associated with other ear or ENT symptoms.

    You may also want to seek medical attention if it is persistently disturbing, and disrupting your sleep, work, and lifestyle. Your family doctor may choose to refer you to an audiologist and an ear, nose and throat (ENT) specialist for more expert advice.

    Urgent consultations are warranted for patients who also develop facial paralysis and sudden hearing loss.

  • To assess tinnitus, your doctor may conduct the following procedures:

    Physical examination

    The doctor asks for the relevant history and examines the ear, nose, throat and other related areas in the head and neck. Signs pointing to the causes of tinnitus may be detected.

    Hearing test

    This procedure is done by applying sounds at different intensities and frequencies (pitches) through a set of headphones to the ears. You then indicate the softest sound that you are able to hear at each frequency. This documents your hearing level in each ear.

    Imaging tests

    These may be indicated in some patients after a physical examination and hearing test. In particular, magnetic resonance imaging (MRI) may be ordered to assess the hearing nerve and computerised tomography (CT) scans may be useful to assess the middle fear structures.

  • There are different treatments available for tinnitus. If an underlying medical cause of tinnitus (eg. outer/middle ear infection) is found, the appropriate treatment for this cause will be prescribed. Successful treatment of the underlying cause can lead to resolution of tinnitus. General treatment for tinnitus includes:


    Your doctor may give you medications to improve blood circulation to the cochlea, and medications to reduce stress, depression, insomnia and anxiety.

    Hearing aids

    Use of hearing aids can help to relieve tinnitus in people also found to have hearing loss.

    Modulated-sound therapy

    There are devices that produce modulated sounds which are music based. Such sounds help the auditory neural elements to adapt and adjust, which may bring about tinnitus relief with time. There are also devices that produce white noise which serves to mask the irritating sounds of tinnitus.

    For tinnitus, there is no one treatment that fits all. A comprehensive assessment leading to an accurate diagnosis is crucial, so that the most appropriate treatment can be recommended for each patient by the ENT specialist.

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  • If not addressed and treated early, tinnitus can bring some complications to your physical and mental well-being including:

    Anxiety and depression

    Some patients are so disturbed by their tinnitus that they are unable to focus on their daily activities. They may develop anxiety and depression as a result. Furthermore, if hearing loss is also present, it can result in further additional emotional and mental stress. Some patients may even develop suicidal thoughts as a result of their tinnitus.

    Fatigue and difficulty in sleeping

    People with disturbing tinnitus may have trouble sleeping, resulting in much fatigue the next day. Their daytime activities may then be affected, which can add to their mental stress.

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