There’s noise inside my head

Should I be worried?

Tinnitus, more commonly referred to as “ringing in the ears,” is a good measure to help determine the health of your inner ear.  Many people experience it at some time in their lives, especially as they get older. We do not know exactly what causes it, but many believe it is the sound of dying hair cells in the cochlea (organ of hearing). 

The sound can be of differing quality and intensity. Some people may describe it as a distinct ringing like bells, chirping, cicada, buzzing, static, siren-like—the list is endless. Universally though, only the sufferer hears the sound, not even someone standing right next to them. So, what are some of the more common causes of tinnitus and what can be done to prevent and/or treat it?

Acoustic neuroma

Let’s begin with the most concerning cause of tinnitus—the possibility of a tumor on or near the nerve of hearing. This type of tinnitus often presents suddenly and often just in one ear. It is often accompanied by sound distortion where a person will acknowledge that they can hear the sounds but is having difficulty understanding the words. 

An MRI scan of the brain with gadolinium (contrast) is needed for a certain diagnosis, but a hearing test showing worse hearing or poorer word understanding on one side is an important part of the diagnosis and management. Thankfully this is a very rare occurrence. 

Treatment is based on the patient’s age and size of the tumor and can vary from repeat MRI scans to assess for growth, to radiation or surgery to shrink or remove the tumor.

Pulsatile tinnitus

If one plugs or puts a finger in the ear canal it becomes obvious that internal sounds become louder. Try talking alternating with a finger in the ear canal and then out and you will hear how loud the voice really sounds. 

Persons with pulsatile tinnitus will complain of a whooshing or heartbeat-like sounds in one ear or the other. Some persons might even be able to make the sound stop or diminish it by turning or tilting their head to a certain position.

Some potential causes of pulsatile tinnitus are obstruction or narrowing in the nearby carotid artery and aneurysms of the carotid artery or jugular vein. Treatment consists of physical exam with the provider listening to or obtaining an ultrasound of the vessels in the neck for a carotid bruit, heart murmur, or arteriovenous fistula. 

Treatment will be determined by the exact cause of the noise and assessing the role of intervention.

Noise exposure

While dancing and celebrating can seem to make time fly, if the music is too loud you may suffer at least temporarily from tinnitus. Dance in an area away from the speakers and plan to bring ear plugs or makeshift ones using tissue paper. 

Hydration, B complex, and avoidance of ongoing noise are helpful if the tinnitus causes difficulty with initiating or maintain sleep.

Aspirin, NSAIDs and salt

Frequent or chronic use of aspirin and nonsteroidal medication and a diet high in salt have all been shown to cause tinnitus. For many persons, using aspirin is not only a good thing, it is life-preserving to help decrease risk of blood clots, strokes, vasculitis and heart attacks. 

So please don’t change your aspirin usage unless so directed by your provider. Minimizing the salt or sodium in your diet is good for your tinnitus and cardiovascular health.

Aging

Most often tinnitus is just a sign of hearing loss as the hearing declines. Typically it is present in both ears, and persons often report that it is just there and not localizing to one or the other ear.

If it is interfering with sleep or peace and quiet time, then most practically getting a hearing aid with tinnitus protocol is helpful, along with tinnitus retraining and adding to what has been stated earlier. Adequate sleep and a balanced diet are also important elements needed to reduce tinnitus.

Overall, if you have tinnitus then please seek further evaluation with your primary provider or your local ear, nose and throat (ENT) specialist. 

Dr. Inell Rosario is a board-certified ENT and sleep physician practicing at Andros ENT & Sleep Center in Inver Grove Heights, Minnesota. She has many times been recognized as a Top Doctor and Best Doctor in various Minnesota magazines and can be reached at  drrosario@androsent-sleep.com  or 651-888-7800.