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ringing in the ears

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Ringing in the ears refers to a sound that usually only the affected person can hear. The sound is not coming from the environment. Instead it seems to be coming from the person's body or the ear itself. Other noises, such as buzzing or roaring, may also be heard.

What is going on in the body?
Ringing in the ears is a common problem, especially in the elderly. The ringing or other sound may be constant, or may come and go. The ringing is not usually caused by serious problems. Most of the time, it does not interfere with activities. In rare cases, ringing in the ears can be a sign of a serious condition.

What are the signs and symptoms of the condition?
The doctor will ask several questions, including:
  • the type of noise heard, such as ringing, buzzing, blowing, roaring, or another sound
  • when the ringing started
  • whether the ringing is constant or comes and goes
  • whether the ringing came on gradually or started all of a sudden
  • what medications the person takes
  • what other medical conditions the person has
  • whether the sound can be heard when there is noise in the room, or only in a quiet setting
  • whether there is any hearing loss associated with the ringing
The doctor also may ask about other symptoms, including dizziness, headaches, earaches, nausea or vomiting, and vision changes.

What are the causes and risks of the condition?
Ringing or other noises heard in the ears can have many causes, including:
  • advancing age. Up to 25% of people over age 60 have occasional high-pitched ringing in their ears. This is often related to normal age-related hearing loss, and is rarely bothersome.
  • medications, such as aspirin and caffeine. Quinidine, a heart medication, and carbamazepine, a medication used to treat seizures, can also cause ringing in the ears.
  • anxiety or depression
  • otosclerosis, a condition in which the tiny hearing bones in the middle ear cannot move properly
  • infections in the ear, such as chronic otitis media or labyrinthitis, or wax build-up in the ear
  • Meniere's disease, a condition that also causes severe vertigo, or a spinning sensation
  • damage to the hearing nerves, due to trauma, a brain tumour, or other conditions
  • abnormal blood flow around the ear, due to a cerebral aneurysm or malformed blood vessels
  • damage to the hearing area of the brain, due to a stroke, multiple sclerosis, or other conditions
  • damage to the ear from noise. Damage can occur suddenly, as when a person is exposed to the noise of an explosion. Or the damage can be from chronic exposure, such as damage from working near loud machines every day, which causes occupational hearing loss.
There are other possible causes of ringing in the ears. Sometimes, the cause cannot be found.

What can be done to prevent the condition?
Prevention is related to the cause. Avoiding loud noises and high doses of aspirin can prevent some cases. Most cases cannot be prevented.

How is the condition diagnosed?
The doctor can try to help the person figure out the cause of the ringing. Diagnosis starts with a history and physical examination. This may be all that's needed to make the diagnosis. In other cases, further testing is needed.

Various tests are ordered, depending on the suspected cause. For example, a cranial CT scan may be done if a stroke or brain tumour is suspected. Hearing tests, such as an audiogram, may be done if age-related hearing loss or noise damage are suspected.

What are the long-term effects of the condition?
Long-term effects depend on the cause. Ringing in the ears caused by Age-related hearing loss has no long-term effects besides hearing loss. The hearing loss is usually mild, and is rarely bothersome. If the cause is a brain tumour, death may occur. Strokes may cause other problems in addition to ringing in the ears, such as paralysis or numbness of an arm or leg.

What are the risks to others?
Ringing in the ears is not contagious and by itself poses no risks to others. If the cause is an ear infection, especially otitis media, the infection may be contagious.

What are the treatments for the condition?
Treatment is directed at the cause. age-related hearing loss may be treated with a hearing aid. This often covers up the ringing by amplifying normal sounds. Someone with a brain tumour may need surgery or radiation therapy. People with Meniere's disease may need medications to reduce symptoms. People with ear infections like chronic otitis media often need antibiotics. If a medication is the cause, the medication can be stopped.

What are the side effects of the treatments?
Side effects depend on the treatments used. All medications can have side effects. Antibiotics, for example, can cause allergic reactions or stomach upset. Surgery carries a risk of bleeding and infection.

What happens after treatment for the condition?
Some cases of ringing in the ears may be cured. Ringing caused by otitis media usually goes away after the infection clears up. Other cases last a long time, with or without treatment, such as ringing caused by a brain tumour or stroke.

How is the condition monitored?
People can monitor their ringing and tell their doctors about any changes or response to treatment. Other monitoring depends on the cause. For example, people with depression may need regular counselling and monitoring of their moods.

Author: Adam Brochert, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

This website and article is not a substitute for independent professional advice. Nothing contained in this website is intended to be used as medical advice and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice.  All Health and any associated parties do not accept any liability for any injury, loss or damage incurred by use of or reliance on the information.


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