Tinnitus is described as a ringing, buzzing or other strange or unusual sounds in the ear/ears, not associated with an external or internal source. The sound produced by tinnitus is usually only heard by the sufferer, but in in some cases may be heard by the doctor in examination.

Tinnitus is not a disease itself but a symptom of any one or more disorders. It is a sign your auditory system (ear, auditory nerve which connects your inner ear to your brain and sound processing parts of the brain) is not functioning correctly. It can be a symptom of ear injury, hearing loss from aging, or disorders of circulation, amongst other things. Even though it is not in itself considered a serious disorder, it can be annoying for the sufferer with the condition.

Symptom relief may be obtained if the cause can be identified, otherwise masking of the noise can help make it less noticeable.

How do you get tinnitus?

Tinnitus is thought to begin when hearing loss is experienced and usually induced from loud noise. Chronic tinnitus is generated by the brain, not the ear and is considered the perception of sound in the absence of physical sound from an external or internal source. Not unlike phantom pain experienced by someone who has lost a limb. The brain tries to compensate from the lack of hearing.

Common culprits associated with tinnitus

Age-related hearing loss, known as presbycusis can occur usually after the age of 60 years. Age related tinnitus can occur as we age due to a lack of input from the cochlea which triggers neural plastic changes (the capacity of our brain to change in response to external or/ and internal demands) resulting in overactivityin the affected regions of the auditory system. Unfortunately, tinnitus can worsen with age.

Exposure to loud noises. These might include work related industrial noises, or from listening to loud music, especially if exposed for long periods of time. 

Blocked ears. Wax in the ear is used to trap debris and bacteria in the ear canal, but sometimes too much can accumulate and will harden, making it harder to remove. The ear drum can become irritated, limit hearing and lead to noises in the ear.

Otosclerosis is a stiffening of the bones in the middle ear which can affect hearing and cause tinnitus. This is an abnormal bone growth and can be a hereditary condition.

Other less common conditions associated with tinnitus include:

Meniere’s disease. This is a condition caused by abnormal inner ear fluid pressure.
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Acoustic neuroma/vestibular schwannoma. This is a benign tumour which can grow on the nerve that runs from your brain to your inner ear. Known as the cranial nerve it controls hearing and balance.

Eustachian tube dysfunction. The eustachian tube connects your upper throat to your ear and can expand and contract. In this condition the tube can remain expanded giving the ear a feeling of fullness. This condition will sometimes occur in pregnancy, or those people having radiation therapy or people who have experienced substantial weight loss.

Head or neck injuries can affect the hearing nerves of the inner ear and brain function linked to hearing resulting in tinnitus.

Muscle spasm. Muscles of the inner ear can spasm which can cause in hearing loss, as well as a feeling of fullness and tinnitus. It can be associated with multiple sclerosis, other neurological diseases, or have no known explanation of occurrence.

Medications. Some medication can also be the blame for tinnitus. Often the higher the dose, the worse the condition. These may include:

• Antibiotics
• Diuretics
• Antidepressants

Other culprits are caffeine and nicotine.

Different kinds of tinnitus

There are different kinds of tinnitus.These include subjective, objective and pulsatile tinnitus.

Subjective tinnitus

In this condition only you can hear the noises. This is the more common condition and is usually caused by inner, middle or outer ear problems, or problems with the nerves of the brain which interpret sound.

Objective tinnitus

In this condition the doctor can also hear the noise under examination. This less common condition can be associated with problems of circulation, bone conditions of the middle ear or muscle contractions.

Pulsatile tinnitus 

Conditions which involve blood circulation are called pulsatile tinnitus, ie relating to pulse.

These can include:

• High blood pressure – or any thing that increases blood pressure can cause tinnitus to worsen. These can include: caffeine, alcohol, excess weight and stress.
   
• Atherosclerosis – Just like other blood vessels, the blood vessels in the middle and inner ear can also be affected by cholesterol and other deposit, causing them to lose their flexibility with each heartbeat. The blood flows more forcefully and this can be heard – usually in both ears.
   
• Irregular or turbulent blood flow – kinks or constrictions can impede blood flow in the neck.
   
• Head or neck tumour – these can press on blood vessels in the head or neck and are called vascular neoplasms.
   
• Arteriovenous malformation (AVM) – this condition is a malformation of the connections between arteries and veins and usually will only affect one ear.

What can help

Reduce high blood pressure –  by losing weight, reducing stress, avoiding alcohol and caffeine. Magnesium is a mineral supplement that can help with stress reduction and blood pressure regulation.
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Quit smoking – smoking causes blood vessels to narrow, reducing oxygen rich blood to the sensory cells of your ears.
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Sound therapy - also referred to as masking devices, is using sound similar to that described as “white noise”, like listening  to an out-of-tune radio. The idea being to either distract from the noise experienced, mask with loud noise to cover the noise of the tinnitus, habituation – the idea the brain will reclassify the sound as unimportant and should be ignored, and neuromodulation – the use of specific sound to lower the neural activity thought to cause the noise in tinnitus.

Clear your ears of wax build-up – start with a softening agent over-night in the ears and then use a syringe or ear cleansing spray to remove wax from the ears.

Gingko biloba extract EGb 761® in studies has been found to alleviate tinnitus and dizziness in elderly patients.

Mindfulness-based cognitive therapy (MBCT) was found to be effective in reducing the severity of tinnitus in chronic conditions. Treatment focused on mindful meditation and was found to alleviate psychological distress, depression and anxiety with the reduction of severity and loudness of noise.

Getting a good night sleep. If tinnitus is interfering with sleep causing you to be tired during the day and making your tinnitus worse, you may like to try some sleep hygiene practices. These include going to bed at a reasonable time, remove electronic devices from room (accept your masking device if it helps), try a warm bath using magnesium salts or supplement with magnesium. Magnesium is known as the great relaxer. Herbal medicines such as valerian, passionflower, chamomile, lemon balm, kava or skull cap can help support a good night sleep without the morning drowsiness. 
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Protect your hearing by using sound reducing earplugs when around loud noise.

Managing tinnitus will usually involve a number of strategies to get effective results.

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References 

Maladaptive Neural Synchrony in Tinnitus: Origin and Restoration https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4330892/ 

http://www.mind.ilstu.edu/curriculum/modOverview.php?modGUI=233

https://www.mayoclinic.org/diseases-conditions/tinnitus/symptoms-causes/syc-20350156 https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/tinnitus

Ginkgo biloba extract EGb 761® alleviates neurosensory symptoms in patients with dementia: a meta-analysis of treatment effects on tinnitus and dizziness in randomized, placebo-controlled trials. https://www.ncbi.nlm.nih.gov/pubmed/29942120

Mindfulness-Based Cognitive Therapy as a Treatment for Chronic Tinnitus: A Randomized Controlled Trial. https://www.ncbi.nlm.nih.gov/pubmed/29131084

Maladaptive plasticity in tinnitus--triggers, mechanisms and treatment. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4895692/

Neural Plastic Effects of Cognitive Training on Aging Brain https://www.hindawi.com/journals/np/2015/535618/

https://www.cochrane.org/CD006371/ENT_sound-therapy-masking-in-the-management-of-tinnitus-in-adults

https://www.ata.org/managing-your-tinnitus/treatment-options/sound-therapies