Tinnitus (Ear Fluttering) is the sensation of sound in the ear that occurs without any external stimuli.
Tinnitus can occur in one or both ears, be permanent or temporary, loud or muffled, monotonous or pulsating.
Up to 45% of adults experience tinnitus from time to time, and 8% experience it all the time.
For some people, the hum or ringing in their ears is uncomfortable: it comes and goes and the person may not even pay attention to it. But sometimes the noise is so intrusive that it becomes difficult to concentrate on work tasks, communicate with people or fall asleep.
Depending on the cause, tinnitus can be treated completely or corrected so that it does not interfere with normal life.
Objective and Subjective Tinnitus
A distinction is made between objective (vibratory) and subjective (non-vibratory) tinnitus.
Objective tinnitus is rare. It occurs against a background of diseases that provoke vibrations in certain parts of the body: involuntary contractions of the middle ear muscles, tremors of the soft palate. Objective noise is called because it can be heard by others, such as a doctor during a physical examination.
Subjective noise is not audible to others. It occurs during irritation of the ear, decreased blood flow to the inner ear as a result of acute inflammation, cerebral circulation problems, some chronic illnesses (including inflammatory), medications, or trauma. This is the most common form of tinnitus – it accounts for up to 99% of cases.
Causes of tinnitus
The most common causes of tinnitus are damage to components of the ear (inner, middle or outer), damage to the nerve cells of the brain that perceive and interpret sound, or tinnitus damage to the auditory nerve which conveys sound information from the ear to the brain.
Tinnitus can be caused by damage to parts of the ear, the auditory nerve or the part of the brain that is responsible for perceiving sound
Up to 85% of patients who report tinnitus have a documented hearing loss. This means that the majority of tinnitus cases are related to ear pathology.
However, the hearing loss may be less noticeable, especially if the damage is not very severe or develops gradually over several months, so tinnitus is often the first sign of such pathologies.
Quite often tinnitus appears against the background of age-related hearing impairment.
But the symptom may be unrelated (or not directly related) to hearing organ pathologies: for example, can occur with vascular, neuromuscular, endocrine and other disorders, as well as head and neck trauma.
Pathologies of the inner ear
Injuries, inflammation, neoplasms and other problems can damage the inner ear, the auditory nerve or the part of the brain responsible for sound recognition – resulting in decreased hearing, distorted perception of sound and tinnitus.
If tinnitus is accompanied by dizziness or distorted sounds, it is most likely due to a disturbance of the inner ear, the piedmont nerve, or its centers in the brain.
Pathologies of the inner ear that cause tinnitus:
- Neurosensory hearing loss – a hearing impairment (including one that is invisible to the patient) caused by damage to elements of the inner ear, the auditory nerve, or the area of the brain responsible for sound perception;
- acoustic neurinoma – a small benign mass that irritates the auditory nerve;
- acoustic trauma – damage caused by exposure of the ear to very loud sounds (over 120 dB), which is accompanied by hemorrhage in the cochlea, displacement or deformation of elements of the inner ear;
- Vibration injury – injury caused by prolonged or severe vibration exposure in manufacturing, construction, or transportation that causes degenerative changes in the cochlea and other parts of the inner ear;
- Otosclerosis – damage to the inner ear labyrinth caused by bone overgrowth due to metabolic disorders;
- Meniere’s disease – non-infectious inflammation, which is accompanied by excessive fluid accumulation in the inner ear;
- Labyrinthitis – inflammation of the inner ear caused by bacterial or viral infection.
Middle ear abnormalities
Tinnitus can be caused by trauma, inflammation or neoplasms in the middle ear.
The symptom is most often caused by damage to the eardrum or by a disturbance of the intra-ear pressure.
When immersed in water, the change in pressure can cause damage to the inner or middle ear
Middle ear abnormalities that cause tinnitus:
- Barotrauma – damage to the middle or inner ear due to a sudden change in pressure – can occur during an airplane flight, diving to great depths, a palm strike to the ear, or an explosion nearby;
- Eustachian tube dysfunction (connects the middle ear to the nasopharynx) – a pathology in which there is increased pressure and noise in the ear;
- Clogging of the ear canal by a wax or wax plug, foreign objects or water leads to increased pressure inside the ear;
- otitis media and other ear infections lead to tissue swelling, narrowing of the ear canals, and changes in pressure inside the ear;
- Otosclerosis – hardening and overgrowth of bone tissue, resulting in impaired mobility of the middle ear elements;
- tympanic cavity tumors – benign or malignant neoplasms in the middle ear can disrupt middle ear elements, lead to increased intra-ear pressure or tympanic membrane defects;
- Myoclonia is a short-term contraction of the middle ear muscles due to neuromuscular diseases (such as trigeminal neuralgia or epilepsy). This pathology results in objective tinnitus.
Abnormalities of the outer ear
Abnormalities at the level of the outer ear are usually accompanied by muscle abnormalities or narrowing of the ear canal.
Abnormalities of the outer ear which cause tinnitus:
- neoplasms of a benign or malignant nature in the outer part of the ear canal may cause tissue destruction and distortion of perceived sound;
- exostoses – bony overgrowths in the external auditory canal – can obstruct or distort sound from entering the ear;
- Otitis externa, an acute infectious disease that is accompanied by severe swelling of the ear canal, which closes the ear canal lumen.
Other possible causes of tinnitus
Tinnitus can be caused by pathologies not directly related to the organs responsible for hearing. This may be a circulatory, metabolic, musculoskeletal system disorders. In this case the noise is caused by deterioration of tissue nutrition, increased pressure on the walls of blood vessels or muscle spasms.
Causes of noise not related to ear pathology:
- Benign or malignant head and neck tumors – can interfere with nutrition and blood flow to the elements of the hearing organ or cause their irritation, leading to improper operation;
- Trauma to the head and neck – can damage the auditory nerve or the area of the brain responsible for sound recognition. Injuries are characterized by the development of noise in one ear;
- Neuropsychiatric disorders, including schizophrenia. Depressive states are accompanied by an imbalance of neurotransmitters – substances responsible for the proper transmission of nerve impulses. This can lead to subjective extraneous sounds. In addition, tinnitus in some mental disorders may be part of auditory hallucinations;
- neurodegenerative and demyelinating diseases of the central nervous system: multisystem atrophy, chronic encephalopathy of various nature, multiple sclerosis can be accompanied by disturbance of the hearing centers;
- Pathologies of the temporomandibular joint, which connects the lower jaw to the skull, can also cause noise, as the joint is located very close to the ear;
- Vascular disorders – hypertension or, conversely, a tendency to hypotension, atherosclerosis, impaired straightness of blood vessels – all these conditions disturb the blood supply to the inner ear, leading to pathological impulses from the auditory nerve;
- Some chronic diseases – diabetes mellitus, thyroid disorders, migraine, anemia, rheumatoid arthritis or lupus;
- Taking some medications – non-steroidal anti-inflammatory drugs, antibiotics, chemotherapy, anti-edema drugs and antidepressants. As a rule, the noise goes away after the medication is withdrawn.
Noise or ringing in the head does not always indicate systemic disorders in the body. Under certain circumstances, there may be a local functional hearing impairment, or a person may hear blood flow, muscle contractions or joint movements more clearly.