Tinnitus: why it happens and what can be done

What is tinnitus?

Tinnitus is the perception of sound without an external source. Everyone describes it differently: a high-pitched whistle, a hiss, a waterfall, a cicada, an engine. It may be constant or intermittent, in one ear, in both, or “inside the head”.

The essential point is this: tinnitus is a symptom. It signals that something in the auditory system, or close to it, deserves attention.

What usually causes tinnitus?

• Hearing loss, including mild degrees. This is the most frequent association.
• Exposure to intense noise, whether occupational or recreational.
• Earwax obstructing the ear canal — a simple and reversible cause.
• Middle ear conditions, such as otitis, Eustachian tube dysfunction or otosclerosis.
• Medications with the potential to affect the ear.
• Inner ear disorders, such as Ménière’s disease.
• Vascular and muscular causes, more often linked to pulsatile tinnitus.

Factors such as stress, insomnia, excess caffeine and blood pressure changes do not usually create tinnitus, but they substantially change how intrusive it feels.

What types of tinnitus are there?

Type	What it is like	What it suggests
Subjective	Heard only by the patient; the large majority	Origin in the auditory system
Pulsatile	Pulses in time with the heartbeat	Vascular origin; calls for specific investigation
Unilateral	Always in the same ear	Warrants imaging and detailed assessment
Bilateral	In both ears	Common in noise-related or age-related hearing loss

How is it investigated at Clínica Rhinus?

The consultation details the characteristics of the tinnitus: when it began, whether it is continuous, what makes it worse, what relieves it, whether there is hearing loss, dizziness or a history of noise exposure. Examination of the ear rules out simple causes such as earwax.

The tests that usually follow:

• Audiometry and tympanometry.
• High-frequency audiometry, which tests sounds above the range covered by conventional audiometry and may reveal hearing loss in someone whose standard audiogram is within normal limits.
• Tinnitus matching, which characterises the pitch and loudness of the tinnitus.
• ABR and imaging, in unilateral cases or where there are warning signs.

What are the treatment options?

1. Treat the identified cause. Remove earwax, treat otitis, review medications with the prescribing doctor, manage associated medical conditions.
2. Amplification. Where there is hearing loss, a hearing aid usually reduces the perception of tinnitus, because it restores the environmental sounds that used to mask it.
3. Sound therapy. Use of soft background sound to reduce the contrast between silence and tinnitus, particularly at night.
4. Addressing the distress. Follow-up directed at how tinnitus occupies attention, working on sleep, stress and habits.

The honest conversation is this: in a good proportion of cases the sound is not eliminated entirely. What is sought — and what is usually achievable — is that it should be reduced and, above all, that it should stop occupying the foreground of the person’s life.

When to seek assessment without waiting

• Tinnitus accompanied by sudden hearing loss.
• Tinnitus in one ear only, which appeared and did not settle.
• Pulsatile tinnitus.
• Tinnitus with severe dizziness, persistent headache or neurological change.

Sources: Brazilian Association of Otorhinolaryngology and Cervico-Facial Surgery (ABORL-CCF) · Flint PW, Francis HW, Haughey BH, et al. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Elsevier; 2020. · Bento RF, Bittencourt AG, Voegels RL. Seminários em Otorrinolaringologia. Fundação Otorrinolaringologia.