The Causes of Tinnitus

Tinnitus is phenomenon in which an individual perceives a sound or noise within the ears which is not produced by any external source. It could be unnoticeable to some, while others may find it extremely troubling and interfering with their daily routine.

Tinnitus could be caused temporarily due to loud sounds like a concert or, for instance, being in close proximity to a fire-cracker or gun shot. Some people may find that lack of sleep or stress induces or aggravates their tinnitus symptoms. On a more long term basis, aging and systemic factors could lead to the development of tinnitus in any individual. For the many causes, it is simpler to classify each.

Hearing Loss

Hearing loss is one of the leading causes of the development of tinnitus. This is mainly due to the accumulative effect of aging on hearing known as ‘presbycusis’, but may also be due to constant loud noises, trauma to the ear or a systemic disease leading to inner ear damage. In either case hearing loss occurs, allowing tinnitus to develop.

Causes of hearing loss are:

  • Aging (‘presbycusis’)
  • Ear infection
  • Trauma to the ear or injury
  • Stress
  • Systemic or autoimmune diseases
  • Ototoxic drugs such as opiates (eg. Vicodin)
  • Post-surgical effects

Loud External Noise

Prolonged exposure to loud noise, such as those from fire arms, car stereos, heavy machinery and equipment in factories can lead to hearing loss and eventually tinnitus. This is because the tiny hair cells present within the ear that move and transmit sound waves to the brain get damaged, leading to hearing loss. People who work in areas of loud noise, such as factory laborers, construction workers, soldiers and musicians are at a higher risk of developing tinnitus.

Other sources of loud noise such as from portable music devices and music systems played on loud volume for prolonged periods can also lead to hearing loss and tinnitus. It may be short-term, when the exposure to the loud noise is temporary, and may diminish after the noise ceases. Long term exposure to loud noise leads to permanent tinnitus symptoms.

Mechanical blockage or Trauma to the Ears

Blockage of the external auditory meatus (the ear canal through which sound travels to the inner ear) due to ear wax can be a cause of tinnitus or may accentuate the sounds of tinnitus as it becomes difficult to wash away. It is meant to protect the ear drum by trapping dirt particles and slowing down the growth of bacteria, but overgrowth can also cause irritation of the eardrum and even hearing loss.

Damage to the inner ear bones by abnormal overgrowth or hardening, a condition known as otosclerosis, can greatly impair hearing, bringing about hearing loss and tinnitus.

Injuries to the head and neck can damage the inner ear, the nerves leading to the ear or even the part of the brain that controls hearing. This can cause hearing loss and tinnitus in one or both ears, depending on the side of the injury.

Systemic conditions and Diseases

A disease affecting the inner ear due to abnormal ear fluid pressure, known as Meniere’s disease, can easily be indicated by the onset of tinnitus.

Acoustic neuroma, a benign tumor that grows on the nerve supplying the inner ear that controls hearing and balance, can cause tinnitus on the affected side.

Temporomandibular Joint (TMJ) disorders or those affecting the jaw joint are another cause of tinnitus as they can impair jaw movement by damage to the joint capsule, which is in close proximity to the external ear.

Disorders related to the Cardiovascular System

Tumors within or around the blood vessels (vascular neoplasms) that supply the head and neck can cause tinnitus due to the disturbed blood flow to the ears.

Atherosclerosis, blockage and hardening of core arteries due to high cholesterol, can be a major cause of tinnitus. This is because the blood vessels harden and lose their ability to easily expand with each heartbeat, making the flow of blood through them more difficult and in turn, causing the flow of blood to be more forceful and lead to easy detection of beating sounds in both ears. Furthermore, a high systemic blood pressure due to any reason can accentuate or worsen tinnitus.

Malformations in arteries and veins, a condition known as arteriovenous malformation (AVM) that creates abnormal communications between them and in turn disturbs blood flow, can also lead to tinnitus.

Drugs that induce or aggravate tinnitus

Some drugs have the potential to either cause or aggravate tinnitus, making it worse as the dosage or intake increases. Once their intake decreases or stops, tinnitus may improve or disappear altogether.

The following are some drugs that are either ototoxic (toxic to the ears) or known to aggravate the symptoms of tinnitus:

  • Antibiotics such as Erythromycin, Vancomycin and Neomycin
  • Anti-Cancer or chemotherapeutic drugs such as Mechlorethamine and Vincristine
  • Diuretics (also called ‘water pills’) such as Bumetanide or furosemide
  • Anti-parasitic drugs such as Quinine medications for the treatment of malaria
  • Antidepressants have the potential to aggravate tinnitus
  • Aspirin taken in high doses

Stress, Depression and Anxiety

It is strongly believed that emotional, physical and mental stress is a leading aggravator or even inducer of tinnitus.

Stress can cause a poor intake of a healthy diet, lack of sleep, lack of healthy mental activity and generally impair the quality of life. Similarly, depression and anxiety too worsen tinnitus symptoms. It is all a vicious cycle that includes a stressful lifestyle, followed by poor dietary intake of essential vitamins which is detrimental for health and worsens tinnitus. This further increases the levels of stress and impairs quality of life as one’s ability to concentrate and hear can become increasingly difficult.

Such a lifestyle could cause tinnitus to become permanent. It also adversely affects the rest of the body’s systems.