Millions of people experience tinnitus, more commonly referred to as ringing in the ears, or "head noise". Approximately 2 million Americans are disabled by the condition.

Tinnitus is really more a symptom than a disease or ailment, and in most cases the exact cause is obscure. There are essentially two types of tinnitus:

Objective tinnitus is a result of sounds that are generated in the body. This type of tinnitus is rare and can be auscultated, or heard by a physician, because it is actually, physically there (it is usually a symptom of vascular abnormality).

Subjective tinnitus and is characterized by the absence of an identifiable, physical sound that can be heard by an observer.

Whereas objective tinnitus can usually be treated successfully by correcting the causative medical condition, the much more common subjective tinnitus is often very resistant to treatment.

What causes tinnitus?

There are many hypotheses explaining the actual physiological mechanism of subjective tinnitus, but none proven. The most commonly accepted hypothesis is that the tiny hearing receptors (hair cells) in the inner ear spontaneously "fire" and send signals to the brain which are interpreted as a ringing sound. Because there is no proven mechanism, tinnitus is often the most frustrating symptom for the patient and the most difficult or stubborn symptom for the physician to treat.

Some persons with tinnitus simply ignore it, whereas others are severely bothered by it. This factor of tolerance is apparently more important than the loudness of the tinnitus. Tinnitus loudness measurements indicate that some persons with very loud tinnitus tolerate it very well, while others with a mild tinnitus claim to be on the verge of suicide if the tinnitus can’t be controlled.

There are many factors that are known to cause or aggravate tinnitus: Noise exposure (the most common cause), bruxism (jaw clenching), ear disease, infection, or injury, certain medications, excessive salt intake, alcohol, coffee, stress, etc. Tinnitus is commonly correlated with hearing loss and most people can identify a pattern between the cause (situation or incident) and effect (symptom). However, when tinnitus becomes enough of a problem to seek medical attention, a doctor must carefully investigate a possible cause and rule-out a treatable medical condition.

How is tinnitus treated?

Treatment of tinnitus can be directed at either: 1) Decreasing the intensity of the tinnitus, 2) Masking the tinnitus, or 3) Increasing the tolerance.

The ideal treatment begins with #1, but often involves all three methods.

Decreasing the Intensity of Tinnitus

The first step is to determine if there is any correctable condition or behavior that is causing the tinnitus. Common correctable conditions causing or aggravating tinnitus are:

1) Any blockage of the conductive apparatus, such as wax in the ear canal, fluid in the middle ear or fixation of the middle ear ossicles (Ex. Otosclerosis).

2) Certain diseases: Meniere’s disease, acoustic neuroma, hypertension, increased intracranial pressure, arterial anomalies, etc.

3) Common behaviors, including: noise exposure, jaw clenching, intake of certain foods (caffeine, wines) or drugs (aspirin, aminoglycosides).

The strategy with these conditions consists of treating the medical condition or correcting the behavior. When any of these factors can be identified, the chance of success is much greater. Otherwise, most efforts to find effective treatments to reduce and/or eliminate tinnitus have met with limited success. Some of the more widespread treatment options available include local anesthetics, antihistamine drugs, vasodilators, minor tranquilizers and vitamin/mineral supplements.

Masking the Tinnitus

Masking is often a viable option for people where other routes of palliation have failed. Masking refers to exposing the patient to other sounds in an effort to block out, or take their mind off their tinnitus. Modern electronic devices called maskers are worn like a hearing aid and serve to provide constant background noises, thereby reducing perceived tinnitus. A hearing aid will often serve as a good masker because of its background noise. Some people create their own masking by wearing headphones, having a fountain, fish tank or an electric fan to detract their conscious involvement with tinnitus.

Maskers do not help the tinnitus long term, because the tinnitus will return in a few minutes after the masking noise is removed.

Increasing the Tolerance to Tinnitus

After correctable factors have been ruled out, or corrected, the tinnitus can be labeled as "intractable", whereupon efforts can be directed toward increasing the tolerance to the tinnitus. Drugs can be helpful, but are best used only short term, since long term use can quickly result in addiction.

Where medical treatment or masking has failed, some patients may benefit from psychotherapeutic biofeedback training (counseling). This therapy primarily affects the patient’s perception of their tinnitus rather than the actual symptom.

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