When is tinnitus more than a nuisance?
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Q. I recently developed ringing in my ears, especially my right ear. I know this is common. But when does someone need to worry that this is a sign of a more serious medical problem?
A. Ringing in the ears, also known as tinnitus, is a sound you hear in your ears or head that no one else can hear. It is often described as buzzing, humming, ringing, static, or whooshing. The sound can be soft or loud, intermittent or constant, unchanging or ever-changing. It can affect one or both ears.
Tinnitus is estimated to affect more than 17% of the population. The condition commonly occurs with age-related hearing loss and after prolonged exposure to loud noises. However, it could also result from something as simple as earwax buildup.
While tinnitus is rarely linked to a serious medical problem, there are some important causes to consider. For instance, tinnitus associated with episodes of new or worsening hearing loss and vertigo are typical symptoms of M'nière's disease, a disorder of the inner ear. Current or past ear infections can also lead to tinnitus.
New onset of tinnitus affecting both ears can be a side effect of certain medications, such as high doses of non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve). The antibiotics azithromycin, clarithromycin, and erythromycin can also cause tinnitus, especially if taken for long periods. Usually, stopping the medication resolves the tinnitus.
The one type of tinnitus that always requires medical evaluation is pulsatile tinnitus. Here, the rhythmic ringing or whooshing feels like it corresponds to your heartbeat. Pulsatile tinnitus, which is more prominent on one side, could be due to turbulent blood flow through an artery or vein close to the ear. An artery narrowed by atherosclerosis or a tortuous vein (a twisted, dilated vein) can affect how smoothly blood moves through the area. (It's like when a doctor hears a heart murmur due to an abnormal heart valve.)
Other causes for pulsatile tinnitus are anemia (a disorder where the body doesn't produce enough red blood cells), very high blood pressure, hyperthyroidism (an overactive thyroid gland), and very rarely a bulging artery known as an aneurysm.
If your tinnitus continues, it's best to make an appointment with your doctor to have your ears examined. The evaluation will likely begin with a hearing test.
Image: © Victor Habbick Visions/Science Photo Library/Getty Images
About the Author
Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
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