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Tinnitus: 101 Causes

This one is a fun one in that there are a plethora of underlying causes for #tinnitus, and sadly, most of what I hear from clients is that they've always had it and very few, if any, have ever had anyone try to figure out the underlying cause. Like many complaints in primary care though, this is a symptom, not a disease in itself, so identifying why is imperative to future health. When we simply ignore or mask these symptoms, this sort of warning sign will accompany additional symptoms as the issue beneath grows more significant.


The ringing you hear in your ear isn't from an external sound. This is from within and about 20 percent of people suffer this burden. Broken or damaged hair cells in the cochlea may be to blame or how the blood vessels move through the carotid artery, but so might also be to blame is the temporomandibular joint or how the brain processes sound.


Clients often describe this as a ringing in their ear, but also buzzing, roaring, clicking, hissing, humming, in both low roars and high squeals, one or both ears. For some the sound is loud enough that it interferes with their ability to concentrate and hear other external sounds. It may be present all the time, or it may come and go. In rare causes, tinnitus may be a rhythmic pulsing or whooshing sound, often in time with your heartbeat. In this case, your clinician may even be able to hear your tinnitus on examination.



As a functional medicine provider, we can't help but dig deeper. Not all cases can be resolved, but methods can be offered that reduce the distraction. Tinnitus can cause fatigue, stress, sleep problems, trouble concentrating, memory problems, depression, headaches, anxiety and irritability. Other times though, when the underlying cause is identified, this truly can be eliminated.


Referral to an audiologist for examination should be part of this work-up if hearing changes are identified and imaging isn't often necessary unless tinnitus is unilateral, pulsatile, or associated with asymmetric hearing loss or with some level of neurologic findings (Dalrymple, Lewis, & Philman, 2021).


Hearing Loss


There are tiny, delicate hair cells in your inner ear (cochlea) that move when your ear receives sound waves. This movement triggers electrical signals along the nerve from your ear to your brain (auditory nerve). Your brain interprets these signals as sounds. If the hairs inside your inner ear are bent or broken, which can happen with age or when regularly exposed to loud sounds, this can lead random electrical impulses to your brain, causing tinnitus. We don't tend to think of noise as pollution or a toxic exposure at work, but certainly this can play a role in our vitality. Evaluate your environment for possible causes.


Ear Infection or Ear Canal Blockage


Your ear canals can become blocked with a buildup of ear wax or fluid, or dirt or any other foreign material. This can change the pressure in your ear, causing tinnitus. Frequent use of Q-tips can push the wax up against the membrane making it harder to loosen and fall from your ear. If you're a client of mine, schedule a time to come in to have your ears evaluated. We can then talk strategies for eliminating impaction, or peek at the blog post listed just above. Other causes may include a tympanic membrane perforation, vestibular schwannoma, otosclerosis or cholesteatoma.


Neurological & Head or Neck Injuries


Head or neck trauma can affect the inner ear, hearing nerves or brain function linked to hearing. Such injuries usually cause tinnitus in only one ear. Read more about concussions in a previous blog post. However, the cause may be idiopathic intracranial hypertension, idiopathic stapedial or tensor tympani muscle spasm, multiple sclerosis, palatal myoclonus, spontaneous intracranial hypotension, or type 1 Chiari malformation, or even a vestibular migraine.


Underlying Infections


Bacterial infections such as Lyme disease or syphilis may contribute to tinnitus, but so can fungal infections and a variety of viral infections.


Various Medications


A number of medications may cause or worsen tinnitus. Generally, the higher the dose of these medications, the worse tinnitus becomes. Often unwanted noise disappears when you stop using these drugs. Nonsteroidal anti-inflammatory drugs, such as NSAIDs are common, as well as certain antibiotics, anesthetics, antiepileptics, antivirals, immunosuppressants, cancer drugs, Viagra and Cialis, water pills, antimalarial drugs, and even some antidepressants.


The HPV vaccine has also been associated with tinnitus, including Bivalent (HPV-16, HPV-18), quadrivalent (HPV-6, HPV-11, HPV-16, HPV-18) and the vaccine, pneumococcal polysaccharide (Pneumovax). Lipitor, Wellbutrin, risedronate, and Chantix are others which have been associated with tinnitus.


Meniere's Disease


A less common cause of tinnitus is Meniere's disease, which is an inner ear disorder that may cause inner ear fluid pressure resulting in ringing in the ears.


Eustachian Tube Dysfunction


When the tube connecting your middle ear to your upper throat remains expanded all the time, your ear can feel really full and tinnitus may result.


Ear Bone Changes


Stiffening of the bones in your middle ear, otosclerosis, may affect your hearing and cause tinnitus. This condition, caused by abnormal bone growth, tends to run in families.


Muscles Spasms in the Inner Ear


Muscles in the inner ear can tense up and spasm, which can result in tinnitus, or even hearing loss. This sometimes happens for no explainable reason, but it can also be caused by neurologic diseases, including multiple sclerosis.


Temporomandibular Joint Disorders


As discussed previously, issues with the joint on each side of your head or jaw bone in front of your ears, can certainly cause tinnitus.


Acoustic Neuroma or other Head & Neck Tumors


Acoustic neuroma is a noncancerous tumor that develops on the cranial nerve that runs from your brain to your inner ear and controls balance and hearing. Other head, neck or brain tumors can also cause tinnitus.


Blood Vessel Disorders


Conditions that affect your blood vessels, such as atherosclerosis, high blood pressure, or kinked or malformed blood vessels - can cause blood to move through your veins and arteries with more force. These blood flow changes can cause tinnitus or make tinnitus more noticeable. Paget disease is another potential cause of tinnitus.


Chronic Disease


Conditions such as diabetes, thyroid problems, migraines, anemia, hyperlipidemia, and autoimmune disorders such as rheumatoid arthritis and lupus have all been associated with tinnitus. Vitamin B12 is another cause, and easily corrected. Depression has also been strongly associated with tinnitus, and the presence of tinnitus alongside #depression can contribute to #suicidal ideation.


Treatment Options


Treating any one of these issues is the key to resolving tinnitus, which should not be ignored but there are other options as well, such as behavioral treatment. Tinnitus retraining therapy (TRT) is an individualized program that is usually administered by an audiologist or a tinnitus treatment center. TRT combines sound masking and counseling from a trained professional. Typically, you wear a device in your ear that helps mask your tinnitus symptoms while you also receive directive counseling. Over time, TRT may help you notice tinnitus less and feel less distressed by your symptoms.


Cognitive behavioral therapy (CBT) or other forms of counseling can also be helpful. A licensed mental health professional or psychologist can help you learn coping techniques to make tinnitus symptoms less bothersome. Counseling can also help with other problems often linked to tinnitus, including anxiety and depression. Many mental health professionals offer CBT for tinnitus in individual or group sessions, and CBT programs are also available online.


Medications


Drugs can't cure tinnitus, but in some cases they may help reduce the severity of symptoms or complications. To help relieve your symptoms, your doctor may prescribe medication to treat an underlying condition or to help treat the anxiety and depression that often accompany tinnitus.


Thinking Outside the Box


Researchers are investigating whether magnetic or electrical stimulation of the brain can help relieve symptoms of tinnitus. Examples include transcranial magnetic stimulation (TMS) and deep brain stimulation.


If your ears are ringing, there might also be a spiritual reason. A few clients of mine have shared that they recognized their own tinnitus initiated when they began to explore or connect more with the spiritual world, a shift in their vibrational state. This is a bit outside my expertise of course, but I share because this has been important to a few of my clients. Certainly, if you have new onset tinnitus, let's explore or rule out an underlying medical cause, but if it resonates with you that this might be spiritual or development of clairaudience, know that many times this may only happen during meditation or it may only happen at night, although some do hear it all day long.


References

Dalrymple, S. N., Lews, S. H., & Philman, S. (2021). Tinnitus: Diagnosis and management. American Family Physician, 103(11), 663-671.

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