TINNITUS ti-NIGHT-us or TIN-i-tus: the perception of sound in the ears or head where no external source is present. Both pronunciations are correct; the American Tinnitus Association uses ti-NIGHT-us. The word comes from Latin and means "to tinkle or to ring like a bell."

In almost all cases, tinnitus is a subjective noise, meaning that only the person who has tinnitus can hear it. Someone with tinnitus often describes it as "ringing in the ears," but people report hearing all kinds of sounds: crickets, whooshing, pulsing, ocean waves, buzzing, even music.

Many people will experience it temporarily or intermittently. Most of the people we help here at the American Tinnitus Association experience this "ringing in the ears" 24 hours a day, seven days a week.


What is Tinnitus?
Tinnitus is the medical term for the perception of sound in one or both ears or in the head when no external sound is present. It is often referred to as "ringing in the ears," although some people hear hissing, roaring, whistling, chirping, or clicking. Tinnitus can be intermittent or constant-with single or multiple tones-and its perceived volume can range from subtle to shattering.

How many people have tinnitus?
The ATA estimates that over 50 million Americans experience tinnitus to some degree. Of these, about 12 million have severe enough tinnitus to seek medical attention. And about two million patients are so seriously debilitated that they cannot function on a "normal," day-to-day basis.

I have heard two different pronunciations. Which is correct?
Tinnitus has two pronunciations: tin-NIGHT-us or TIN-it-us. Both are correct, though the American Tinnitus Association uses tin-NIGHT-us. The word comes from Latin and means "to tinkle or to ring like a bell."

What causes tinnitus?
The exact physiological cause or causes of tinnitus are not known. There are, however, several likely sources, all of which are known to trigger or worsen tinnitus.

  • Noise-induced hearing loss - Exposure to loud noises can damage and even destroy hair cells, called cilia, in the inner ear. Once damaged, these hair cells cannot be renewed or replaced. Millions of Americans have hearing loss due to noise exposure, and up to 90 percent of all tinnitus patients have some level of noise-induced hearing loss.
  • Wax build-up in the ear canal - The amount of wax ears produce varies by individual. Sometimes, people produce enough wax that their hearing can be compromised or their tinnitus can seem louder. If you produce a lot of earwax, speak to your physician about having excess wax removed manually-not with a cotton swab, but by an otolaryngologist (also called an ear, nose, and throat doctor).
  • Certain medications - Some medications are ototoxic-that is, the medications are toxic to the ear. Other medications will produce tinnitus as a side effect without damaging the inner ear. Effects, which can depend on the dosage of the medication, can be temporary or permanent. Before taking any medication, make sure that your prescribing physician is aware of your tinnitus, and discuss alternative medications that may be available.
  • Ear or sinus infections - Many people, including children, experience tinnitus along with an ear or sinus infection. Generally, the tinnitus will lessen and gradually go away once the infection is healed.
  • Jaw misalignment - Some people have misaligned jaw joints or jaw muscles, which can not only induce tinnitus, but also affect cranial muscles and nerves and shock absorbers in the jaw joint. Many dentists specialize in this temporomandibular jaw misalignment and can provide assistance with treatment.
  • Cardiovascular disease - Approximately 3 percent of tinnitus patients experience pulsatile tinnitus; people with pulsatile tinnitus typically hear a rhythmic pulsing, often in time with a heartbeat. Pulsatile tinnitus can indicate the presence of a vascular condition-where the blood flow through veins and arteries is compromised-like a heart murmur, hypertension, or hardening of the arteries.
  • Certain types of tumors - Very rarely, people have a benign and slow-growing tumor on their auditory, vestibular, or facial nerves. These tumors can cause tinnitus, deafness, facial paralysis, and loss of balance.
  • Head and neck trauma - Physical trauma to the head and neck can induce tinnitus. Other symptoms include headaches, vertigo, and memory loss.

My neighbor has tinnitus but says it doesn't bother her. Mine drives me nuts. Why the difference?
Approximately 50 million Americans experience tinnitus, but not everyone experiences it to the same degree. Some people hear ringing or other noises in their ears immediately following exposure to excessive noise, like right after a concert, but the sound is temporary. Other people report hearing a slight noise all the time if they listen for it, but most of the time cannot distinguish the noise over all the other sounds in their environment. Other factors can affect the severity of the condition from patient to patient, such as different degrees of hearing loss and different kinds of noises heard. Interestingly, the loudness of the tinnitus, when measured in a laboratory setting, did not correlate to the severity of the tinnitus as rated by the patients themselves. Every person has his or her own level of tolerance to the tinnitus sounds. It is a very personal and individual experience.

Is tinnitus hereditary?
There appears to be a predisposition based on heredity for some people when they are exposed to loud sounds, but whether or not tinnitus is genetically indicated is not certain. Scientists working on the Human Genome Project, for example, have not discovered a "tinnitus gene," but they have identified genes that are responsible for a few rare varieties of hearing loss, temporomandibular joint (TMJ) dysfunction, Ménière's Disease, and acoustic Neuroma. These conditions frequently include tinnitus as a side effect, which suggests that there might be a connection. For now, however, a connection between your mother's tinnitus and your tinnitus is still unknown.

We have recently funded a three-year study that is attempting to improve our understanding of a genetic component, if any. In 2002, Avril Holt, Ph.D., from the
University of Michigan, received $200,000 from the American Tinnitus Association for "Differential Gene Expression in a Central Tinnitus Model." Her abstract states:

ABSTRACT: Tinnitus, the perception of sound in the absence of an acoustic stimulus, is a significant problem in the
United States that affects more than one third of the population and is the most commonly referred otological problem. In light of recent studies implicating increased spontaneous activity in specific brain regions, testable hypotheses that address the underlying mechanisms of tinnitus can be posed. The studies proposed here will provide key insights into the mechanisms underlying central tinnitus and provide a basis for future studies to develop methods and interventions to prevent, treat, or cure central tinnitus.

Can a one-time exposure to loud noise cause tinnitus?
Many people write to the American Tinnitus Association asking if a one-time exposure to loud noise experienced many years ago can cause tinnitus. Noise is damaging if you must shout to be heard, if your ears hurt, or if your hearing is lessened immediately following noise exposure. The noise exposure could occur just one time or over months or years. The level of noise can affect the degree of hearing loss. For example, sounds of 100 decibels experienced for more than 15 minutes can cause hearing loss. Sounds of 110 decibels experiences for more than a minute can cause hearing loss.

A one-time exposure to loud noise is not guaranteed to cause tinnitus or permanent hearing loss, since people's ears vary in sensitivity. It is also possible that the damage from noise exposure might not be noticeable for many years.

Does tinnitus cause depression?
In some cases, yes. The chronic sound of tinnitus can cause difficulty with sleep, concentration, reading, interpersonal relationships, and other everyday activities – all of which can lead a person, especially one who is predisposed to it, towards a state of depression.

In a 2003 study on depression and tinnitus, researchers found that most people with tinnitus were neither depressed nor seriously bothered by their tinnitus. But the patients who were depressed were far more disabled by their tinnitus than the non-depressed patients. If depression is a problem for you, it would be wise to seek help from a mental health professional.

What is pulsatile tinnitus?
Pulsatile tinnitus is a rhythmic, pulsing sound most often in time with the heartbeat. It can usually -– but not always -- be heard objectively through a stethoscope on the patient's neck or through a microphone placed inside the ear canal. While it is not a common form of tinnitus, it has some well-known causes: hypertension, a heart murmur, Eustachian tube disorder, a glomus tumor, an abnormality of a vein or artery, and others. Very often, this kind of tinnitus can be treated.

If you are experiencing pulsatile tinnitus, it is always a good idea have a medical examination

Can you tell me more about other kinds of hearing disorders?
Other hearing disorders are associated with tinnitus, including hearing loss, Ménière's disease, and hyperacusis.

Is there anything I can do to protect myself from tinnitus?
First, protect your hearing. At work, make sure Occupational Safety & Health Administration (OSHA) regulations are met: hearing protection is required under OSHA for any job in which noise levels exceed 90 decibels over the course of an eight-hour workday. Many hearing specialists counsel that this sound level is too high, and for some people, 90 decibels is still too loud. Further, as noise levels increase, the recommended time of exposure decreases. OSHA mandates that workplaces with excessive noise levels must protect workers by implementing a continuing, effective hearing conservation program. In other words, wear your earplugs or earmuffs, limit the amount of time you spend in noisy environments, and follow hearing conservation guidelines established by your employer.

Recreational noise also has an impact on your hearing. The next time you are around a noise that bothers your ears—for example, a sporting event, concert, or while hunting—wear hearing protection, which can reduce noise levels 15 to 20 decibels. For extremely loud situations, earmuffs over earplugs might be necessary. Be aware of other activities or situations that include loud noises, like hair drying or lawn-mowing. Make it easy for yourself to protect your ears by hanging earmuffs over the lawn mower handle, or keeping ear plugs in the bathroom next to your hair dryer. Repeated exposure to loud noises can have a cumulative, damaging effect on your hearing.

If your physician prescribes you medications, be sure to ask if the prescribed medications are ototoxic, or harmful to the ears, or if the drugs are associated with tinnitus as a side effect. This information is easily obtained in the Physicians Desk Reference.

Can anything make tinnitus worse?
Exposure to loud noises, as mentioned earlier, can have a negative effect on your hearing and exacerbate tinnitus. Be sure to protect yourself with earplugs, earmuffs, or by simply not taking part in noisy events.

Some medications can make tinnitus worse. Tell all of your physicians—not just your ear, nose, and throat doctor—about all prescription and over the counter medications you are currently taking or have recently taken.

Many people find that alcohol, nicotine, and caffeine can worsen their tinnitus, as can eating certain foods. Some people find that foods with a high sugar content or any amount of quinine (tonic water) make their tinnitus seem louder. Monitor how you respond to different stimuli, and find a healthy balance where you do not eliminate all the foods that you love, but also where you do not unnecessarily exacerbate your tinnitus.

Finally, stress and fatigue can affect your tinnitus. Make time to relax, and understand that life events can manifest themselves in your body in the form of increased tinnitus. Of course, this is easier said than done. Finding a good support network can help.

What kind of tinnitus research is being done?
Research funded by the American Tinnitus Association focuses on two main areas: mechanisms and management. "Tinnitus mechanisms" research explores what the condition is about, where it occurs, how it occurs—the who, what, where, when, and why questions. "Tinnitus management" research looks into treatments available, how well those treatments work, and how they compare to one another. The ATA attempts to find a balance between the two types of research.

What is the role of the ATA Scientific Advisory Committee?
The ATA Scientific Advisory Committee is a group of volunteer researchers and clinicians who review grant applications for tinnitus research funding. After their review, SAC members make recommendations to the ATA Board of Directors on which studies should be funded. Many SAC members are researchers, and several have applied for and received ATA grants, but they must excuse themselves from deliberations on their own submitted grants or on grants from their affiliated hospitals or universities because of conflict of interest.

Where can I find a health care professional to help me figure out the best treatment?
ATA maintains a listing of health care professionals who self-report their interest in treating tinnitus patients. This listing is available online in our Members section. Or you can call or write to ATA headquarters for a copy. The listing is not exhaustive: there are no doubt many other physicians, audiologists, hearing instrument specialists, and other providers with an active interest in and awareness of tinnitus. If you know of a health professional not included in the listing who would be a good addition to this resource, please let an ATA staff member know. Staff members can also help you track down professionals in your area using other resources; please let us know how we can assist you.


Tinnitus Health Care for Veterans

The American Tinnitus Association supports legislation that improves recognition of and compensation for tinnitus experienced by Veterans. Back in 2002, the American Tinnitus Association strongly supported legislation that would require the Department of Veterans Affairs (VA) to contract with the National Academy of Sciences to assess noise-induced hearing loss and tinnitus associated with military service from World War II to the present. Congress passed this law in December of that year.

The study is now underway, as mandated by Congress, by the
Institute of Medicine, a division of the National Academy of Sciences. The Committee overseeing the project includes members of the American Tinnitus Association Scientific Advisory Committee: Anthony Cacace, Ph.D., and Richard Tyler, Ph.D.

The expert committee is charged with providing recommendations to the VA on the assessment of noise-induced hearing loss and tinnitus associated with service in the Armed Forces—that includes Army, Navy, Air Force, Marine Corps, and Coast Guard. The committee will also review data on compliance with hearing testing regulations, review and assess available data on hearing loss, identify sources of potentially damaging noise during active duty, and identify risk factors for noise-induced hearing loss.

Additionally, and perhaps most interesting to ATA members, the
IOM committee will try to determine levels of noise exposure necessary to cause hearing loss or tinnitus and if the effects of noise exposure can be of delayed onset.

A final report is expected in August 2005.

The American Tinnitus Association has collected a wealth of information about applying for a VA service connected claim. Call 800-634-8978 for more details.



Tinnitus Advocacy Tools: How to Apply for VA Disability Claim


The American Tinnitus Association receives dozens of phone calls each month related to veterans seeking service connection for their tinnitus. By establishing this connection, veterans can receive compensation for their tinnitus, with a maximum 10 percent disability rating, as well as healthcare services and tinnitus devices. The following information is provided as a service to veterans who believe their tinnitus is related to their time in the military, and who seek appropriate compensation for their tinnitus.






American Tinnitus Association



Tinnitus Remedies
Natural tinnitus remedies and treatments to provide fast, safe relief from tinnitus.


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