Understanding and Treating Tinnitus, the Ringing in Your Ears

What you’ll learn:

  • Why tinnitus occurs and its relationship to other ENT health conditions

  • What strategies you can use to manage tinnitus symptoms and improve your overall ear health
  • When to seek medical help for tinnitus and an overview of the latest treatments available

Tune into the We Nose Noses podcast for more episodes on common ENT issues, from itchy ears to sinus issues, and learn more about how NJ ENT & Facial Plastic Surgery can help.

In this episode of We Nose Noses, the hosts, Doctors Nishant Reddy and Greg Smith of NJENT and Facial Plastic Surgery, dive into the fascinating and complex world of tinnitus. The phantom sound of ringing or buzzing in the ears can be an incredibly distressing experience, and the doctors are here to help shed light on the causes, symptoms, and treatments for this condition.

With their combined expertise in ear, nose, and throat health, they explore the science behind tinnitus, discussing the various factors that can lead to this condition, such as noise-induced hearing loss and age-related hearing decline and the treatments available. Whether you’re experiencing tinnitus or simply interested in learning more about this intriguing condition, this episode is a must-listen for anyone interested in ENT health.

Listen to the audio version below.

Audio Transcript:

Nishant Reddy:

Some of the more common causes of pulsatile tinnitus is high blood pressure. If your blood pressure’s too high, you can actually hear your blood close to your ear. And excessive caffeine use can also cause it. So if you’re drinking a lot of coffee, energy drinks, things like that can also cause pulsatile tinnitus.

Hello everyone. Welcome to the NJENT podcast, the We Nose Noses podcast. Dr. Reddy and Dr. Smith.

Dr. Smith. Good to see you.

Nishant Reddy:

Just a little bit of quick news about our practice, some exciting news. We have a new location in South Jersey, in Marlton, New Jersey, and we’re serving the greater Philadelphia area as well as South Jersey area close to Mount Laurel. And we’re excited about our new space. So come see us if you ever need an ENT care. But today the first topic we’re talking about is something very common. It’s called tinnitus. The medical term is tinnitus. And that’s basically any noise that you potentially are hearing in your ear that’s not supposed to be there. So yes, I’ll give it to Dr. Smith to get started on.

Greg Smith:

Perfect. So yeah, as Dr. Reddy said, tinnitus, which is tener, which is from the Greek word, which means ringing. Tinnitus can come in all forms. It could be hissing, ringing, buzzing, clicking, ticking. It’s some noise that you’re hearing in the ear. Now, most times that is something that only you are hearing, so that is not something that we, the physicians, are hearing or somebody, a loved one, sitting next to you. And so we try to classify tinnitus as whether you’re the only one hearing it subjective, or if it’s subjective, it can be heard out. And so of those, most commonly we have subjective tinnitus and of the subjective tinnitus, there are two major types and there’s what we call pulsatile and non-pulsatile. Pulsatile is pretty simple. It sounds like your heartbeat. And usually patients are pretty easy and quick to describe that. Dr. Reddy can maybe talk about a few quick causes that might cause some pulsatile tinnitus, and we’ll delve kind of mainly into the non-pulsatile subjective tinnitus.

Nishant Reddy:

Yeah, so some causes of pulsatile tinnitus is if a blood vessel is too close to the inner part of your ear, and there’s different kinds of blood vessels that can do that. Sometimes your carotid artery can be close to your inner part of the ear or some type of vascular malformation. And sometimes your internal jugular vein, which is one of your big jugular veins that drains your head can also be close to the inner part of the ear, maybe because of some bony erosion or something like that. Those are quite rare. Some of the more common causes of pulsatile tinnitus is high blood pressure. If your blood pressure’s too high, you can actually hear your blood close to your ear. And excessive caffeine use can also cause it so if you’re drinking a lot of coffee, energy drinks, things like that can also cause pulsatile tinnitus.

Greg Smith:

Ringing, buzzing, clicking, ticking, those sounds are typically generated by the brain. And so a lot of times patients come in and say to us like, “Hey, I have this ringing in my ear. I heard there’s nothing I can do for it.” And there’s some truth to that, but it’s not entirely true. There is something that can be done for it. And that’s kind of like what you need to see an ENT or one of us about is to try to figure out what you can do about it, because not everybody’s tinnitus is due to the same. So tinnitus, as I said, is kind of generated from the hearing center of the brain, and it’s there because of a lack of sound getting to that hearing center. So hearing loss is what typically causes tinnitus. And so that is somewhat true that some hearing losses, there’s not much you can do about it acutely, but there’s plenty that can be.

So if it’s wax in the ear or a hole in the eardrum, fluid in the middle ear or some fusion of the bone, sometimes it’s a conductive hearing loss causing lack of sound getting to the brain. And sometimes it’s a problem with, what we call, the sensory neural or the nerve pathway to the brain. So the cochlea can start to show some aging or some noise damage. The nerve can have some damage, and even the brain can have some damage leading to this tinnitus sound. So there is something that can be done. We talk to patients. Typically, we like to get a hearing test, get a good exam of the ear canal, make sure there’s nothing that looks easily apparent that could cause some hearing loss. And because a lot of those things can be correctable. So if any of you have ever had wax or fluid in the ear, often you may hear some tinnitus.

Another common thing that may give you some tinnitus would be noise exposure. So you may go to a loud concert or have some loud bang go near your ear and you may experience tinnitus for the next couple hours, next couple days and that’s just a temporary hearing loss that occurs from a little concussion inside the inner ear called the cochlea. So as far as workup, I’ll let Dr. Reddy talk to you a little bit about some of the workup that we normally would do during tinnitus, and then we can delve more into some treatments.

Nishant Reddy:

Yeah. So for the workup, we typically just start with a ear, nose, and throat physical examination. We look at your ears. We look in your nose. We look at your throat. Make sure there isn’t anything that might be contributing to some outer ear or middle ear problems. And if there is something, we address it. Some of the common things like Dr. Smith was mentioning is earwax. And just a simple removal of earwax can oftentimes just make the tinnitus sound not as bad as it was before. After that, we do the audiologic testing, and sometimes, depending on the hearing testing, we sometimes order some type of imaging studies too. It may be a CAT scan of the ear. It may be an MRI, but it just depends on what the workup kind of shows.

Greg Smith:

Right. Yeah, I agree. And most normal tinnitus doesn’t need imaging, but there are certain cases, and that’s why you need to see an ENT and an audiologist that it might require or might necessitate some sort of imaging. As far as the treatment goes, the number one thing that is for first and foremost is protecting the hearing that you have. So knowing that you have a hearing loss is one thing, but then it may make protection even more important. So if you have some high frequency or age related hearing loss or noise-induced hearing loss, we may recommend certain things to protect the hearing. So the most common way that we and deal with ringing from hearing loss is our brain habituates, which means it gets used to and accustomed to that loss of input and actually we’ll start to get used to it and get rid of that tinnitus.

And the vast majority of patients will habituate to the tinnitus that they experience as long as their hearing loss stays stable. So there are plenty of studies that help as far as hearing and whitening out tinnitus that show that amplification of hearing can help with that habituation process. So sometimes it’s something as simple as a hearing aid or improving noise cancellation so that when patients are exposed to significant noise exposure, and it might be something as simple as, “Hey, you know, have noise exposure and hearing loss. You may need to, when you’re doing yard work or something else that has a lot of noise, you may need to think about using protection more frequently and more often.” And so there’s a lot of counseling that goes with tinnitus treatments.

There are all sorts of over-the-counter treatments for tinnitus. Now, most of these haven’t been shown to have any major statistical significance, and these are what we call the ringing vitamins. A lot of these are B complex vitamins, lipo-flavonoids and things that have antioxidants to help increase the blood flow into the cochlea. And for the vast majority of patients, those may not work. However, certainly patients have tried them anecdotally and have shown some improvement with their ringing. But if you look at what we tend to look at, which is evidence-based medicine, not a whole lot that we can say, “Okay, everybody should be on these tinnitus vitamins or ringing supplements.”

Of all the things that do help, as with most things, these are kind of stress related as well. So in the brain, that hearing center has a real big connection to the stress and anxiety center. And in that brain, some people will get a real big input from the stress center and that hearing center. And so the big problem that a lot of people have with tinnitus is that they’re just not able to habituate. And that’s where most of the studies and most of the treatments are aimed at helping that habituation process. And so there’s classes of antidepressant, antianxiety medications that can help. There’s something called tinnitus retraining therapy, which is a type of cognitive behavioral therapy, which can help the patients habituate to tinnitus. And those things have had some statistical significance in certain studies. So there are certainly things that can be done for tinnitus, but it’s not always a one size fits all.

Nishant Reddy:

The other thing is just avoiding certain triggers, right?

Greg Smith:

Correct.

Nishant Reddy:

So the most common trigger is aspirin use. Aspirin has been shown to actually make tinnitus worse for a lot of people. And other people, it can be ibuprofen use. So something as simple as just switching from an over-the-counter ibuprofen use for pain relief to Tylenol may be helpful in some people. And then Dr. Smith was alluding to hearing aids and some hearing aids, they have what’s called a masking feature. And the audiologist typically will employ this masking feature for your particular type of tinnitus, the frequency of your tinnitus, to try to mask the noise. And it works similarly to having some type of background noise, like a pink noise or a white noise machine. So that could be also very helpful. And in terms of monitoring over the long run, it’s just typically if you have tinnitus and it’s noise induced, we usually recommend just a surveillance exam once a year with a hearing test. And I think that’s pretty much all of it, right?

Greg Smith:

Yeah. So to sum things up tinnitus, don’t just shrug it off and say, “Oh, there’s nothing that can be done.” Certainly definitely warrants and evaluation to see if there’s something that’s easily removable or improvable from the hearing loss perspective. As far as the stress and anxiety that feeds it and can sometimes hurt and hinder the habituation process, there are things that can be done for that too. So as far as tinnitus goes, don’t just think, “Oh, I’m stuck with this for life.” There are a lot of things that can be done for it, and sometimes it’s just better education on tinnitus as itself.

So for that, Dr. Reddy, Dr. Smith, thank you for joining us for our podcast. Please make sure to like us and subscribe to us. Share it with a friend. Rate us five stars and join us next time.

Nishant Reddy:

Great. Take care.

Greg Smith:

Take care.

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