Tinnitus: Signs, Risk factors & prevention!

Tinnitus is the condition in which there is a perception of sound when no real external sound is present. It can be described as ringing, buzzing, clicking or roaring in the ear.

Tinnitus is a symptom rather than a disease and is part of many ear disorders & side effects of drugs.


  • Subjective: Arises from hearing loss & diseases of the ear.
  • Objective: Objective tinnitus can be detected by other people and is sometimes caused by an involuntary twitching of a muscle
  • Pulsatile: Sound heard that beats with the pulse around the ear & caused due to underlying conditions like hypertension & atherosclerosis. Can be a symptom of a life threatening condition like carotid artery aneurysm.


  • Present in one or both ears
  • Can be described as ringing, buzzing, hissing, humming, tinging, whistling, ticking, clicking, roaring, beeping, sizzling, etc.
  • Problems in concentration
  • Anxiety disorder
  • Depression
  • Sleep disturbance
  • In many people tinnitus is present with some amount of hearing loss or impairment
  • Complications of tinnitus include: Deafness.


  • Traumatic noise exposure that damages hair cells in the inner ear.
  • Somatic or craniocervical tinnitus in which movement of the head or neck can cause the condition.
  • Neuroplastic alteration in the brain due to disturbed sensory input caused by hearing loss.
  • Noise induced hearing loss
  • Due to drug side effects: Drugs that have ototoxic side effects can cause tinnitus. As many as 260 medications have this side effect, some of them are; aminoglycosides, loop diuretics, ciplatin, quinine, etc.
  • Due to underlying conditions like hypertension & atherosclerosis which can cause pulsatile tinnitus; increased awareness of blood flow or turbulence in the blood flow near the ear.


  • Middle ear effusion
  • Otitis
  • Presbycusis, age associated hearing loss
  • Meniere’s Disease
  • Mercury or lead poisoning
  • Exposure to ototoxic agents like certain solvents & chemicals
  • Neurological disorders like Arnold–Chiari malformation & multiple sclerosis
  • Metabolic disorders like vitamin B12 deficiency & iron deficiency anemia
  • Vasculitis
  • Benzodiazepine withdrawal
  • Intracranial hypertension
  • Carotid artery aneurysm or dissection
  • Trauma or injury to the head, neck or ear
  • Earwax accumulation.


  1. Physical examination of the head, neck & ear. The patient may be asked to make head & neck movements, for checking tinnitus associated with such movements.
  2. A pure tone audiometry is conducted and an audiogram is generated for measurement of various parameters associated to the condition like pitch, loudness & hearing threshold.
  3. Diagnostic test called Electronystagmography (ENG), performed to detect the cause of the condition & detect presence of balance problems.
  4. Imaging test like MRI or CT scan are done to obtain the images of the vestibular system & the area of the brain associated with the ear, for detection & diagnosis of any neurological disease, structural problems or functional problems. 
  5. Otoscopy for aid in diagnosis & detection of infection or inflammation in the ear or presence of a foreign body in the ear.


  • Treatment of underlying conditions or disorders with relevant drugs to manage the associated symptoms like tinnitus.
  • Management of hypertension & atherosclerosis
  • Treatment of ear infections & inflammation
  • Stopping use of drugs that can lead to ringing in the ear
  • Medications for the management of anxiety & depression
  • Botox injection prescribed in objective tinnitus
  • Caroverine, a drug used in few countries for management of tinnitus.
  • Cognitive behavioral therapy


  • Physiotherapy
  • Relaxation exercises
  • Meditations
  • Sound therapy
  • Use of hearing aids
  • Use of tinnitus masking machines
  • Transcranial magnetic stimulation
  • Earwax removal
  • Reducing alcohol consumption & smoking
  • Taking extra care when a person is involved in or dealing with harmful chemicals, solvents & agents.