Tinnitus is the medical term for ringing or other sounds in the ears that occur when there is no external source of these sounds. It is a very common condition, affecting an estimated 35 million people in the United States each year. It is estimated that 1 to 5 percent of these people have tinnitus so severe that it affects their ability to lead a normal life. Symptoms include ringing, hissing, buzzing, or whistling in one or both ears. The symptoms may be constant or come and go, the pitch can vary from high to low, and the sound can pulsate in time with the heartbeat. One type of tinnitus causes clicking or crackling sounds. These annoying sounds can be a major source of distraction and irritation, affecting performance at work and other daily activities. Tinnitus can make it difficult for the person to fall asleep.

Tinnitus is caused by hearing loss or by spasms (involuntary muscle contractions) in the muscles of the neck or jaw. The hearing loss, which may not be noticeable, may result from a variety of diseases and conditions, including stiffening of the bones in the middle ear, allergies, high blood pressure, diabetes, a tumor, a thyroid condition, or head or neck injury. Certain medications—such as anti-inflammatory drugs, antidepressants, aspirin, or antibiotics—can trigger tinnitus. However, most cases of tinnitus result from damage to the sensory hair cells and the microscopic endings of the auditory nerve, which are in the inner ear. This damage is common in older people. In younger people the damage



Concerns usually results from continual exposure to loud noise. Hearing loss typically accompanies tinnitus, but one often becomes apparent before the other.

If you hear ringing in your ears or other unusual or unwanted sounds, see your doctor. He or she will probably refer you to an otolaryngologist, who will first administer a hearing test. Additional tests, such as a computed tomography (CT) scanning or magnetic resonance imaging (MRI), a test for balance, and blood tests, may be performed to determine the cause of your tinnitus. Possible causes may include infection, obstruction, or Meniere's disease (see below). If the tinnitus is caused by an infection, your doctor will probably prescribe antibiotics. If there is an obstruction, such as a buildup of earwax or dirt, your doctor will remove it. In many cases, however, a cause cannot be identified.

There are a number of steps you can take to reduce the severity of your tinnitus, depending on its cause. The most important thing you can do is to avoid loud noises. Some people also find that relaxation exercises (see page 119) help to relax their muscles, improve circulation, and reduce the ringing in their ears. If your tinnitus is caused by high blood pressure or poor circulation, you should have your blood pressure checked regularly and work with your doctor to control it. Reduce your intake of stimulants such as coffee, tea, colas, and tobacco products. Exercise regularly to promote good circulation.

Some doctors recommend using a technique called masking to relieve the effects of tinnitus. Because the condition is more noticeable in quiet surroundings, you can try to mask the unwanted sounds in your ears by listening to a competing sound, such as a radio or television, an air conditioner, a ticking clock, or radio static. Tapes that play "white noise" can also distract you from the annoying sounds of tinnitus. Your doctor may recommend a tinnitus masker, which is worn like a hearing aid and gives off a more pleasant sound that masks the tinnitus. A hearing aid sometimes helps mask tinnitus, even if your hearing seems adequate. Before trying any of these techniques, however, talk to your doctor about which methods are best for you. Most people will learn to tolerate their tinnitus. Some people benefit by joining a support group where they can share experiences and information with other people who have tinnitus. Others may find that counseling helps them to cope with the condition. Ask your doctor for a referral.

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