Tinnitus hissing sound in head, buzzing in ears when quiet - Review

Constant noise in the head -- such as ringing in the ears -- rarely indicates a serious health problem, but it sure can be annoying. Tinnitus (pronounced tih-NITE-us or TIN-ih-tus) is sound in the head with no external source.
Almost everyone has had tinnitus for a short time after being exposed to extremely loud noise. While there's no cure for chronic tinnitus, it often becomes less noticeable and more manageable over time.
Sound waves travel through the ear canal to the middle and inner ear, where hair cells in part of the cochlea help transform sound waves into electrical signals that then travel to the brain's auditory cortex via the auditory nerve.
Most people who seek medical help for tinnitus experience it as subjective, constant sound, and most have some degree of hearing loss.
Tinnitus can arise anywhere along the auditory pathway, from the outer ear through the middle and inner ear to the brain's auditory cortex, where it's thought to be encoded (in a sense, imprinted).
Most tinnitus is "sensorineural," meaning that it's due to hearing loss at the cochlea or cochlear nerve level.
Tinnitus that's continuous, steady, and high-pitched (the most common type) generally indicates a problem in the auditory system and requires hearing tests conducted by an audiologist. Your general health can affect the severity and impact of tinnitus, so this is also a good time to take stock of your diet, physical activity, sleep, and stress level — and take steps to improve them. In addition to treating associated problems (such as depression or insomnia), there are several strategies that can help make tinnitus less bothersome. There is no FDA-approved drug treatment for tinnitus, and controlled trials have not found any drug, supplement, or herb to be any more effective than a placebo. The most effective approaches are behavioral strategies and sound-generating devices, often used in combination. Not all insurance companies cover tinnitus treatments in the same way, so be sure to check your coverage. The most common types of tinnitus are ringing or hissing ringing and roaring (low-pitched hissing).
Tinnitus is usually static noise in the auditory system that is associated with loss of sound from the external environment. People who take large amounts of aspirin may experience tinnitus which goes away if they stop the aspirin. Pulsatile tinnitus (tinnitus that beats with your pulse) can be caused by aneurysms, increased pressure in the head (hydrocephalus), and hardening of the arteries. Because tinnitus is a symptom rather than a disease, it is important to evaluate the underlying cause. In persons with pulsatile tinnitus, additional tests may be proposed to study the blood vessels and to check the pressure inside the head.
Based on these tests, tinnitus can be separated into categories of cochlear, retrocochlear, central, and tinnitus of unknown cause. If a specific cause for tinnitus is determined, it is possible that treating the cause will eliminate the noise. In most cases of tinnitus, the sound is an abnormal auditory sense perception of a sound that is really neither in the body nor coming from the outside.
Similarly, we have found that tinnitus can be diminished by not listening to it; ignoring the abnormal perception of sound until it is no longer bothersome.
We do know that individuals who focus on the tinnitus and listen to it constantly seem to aggravate the degree to which it is bothersome and seem to enhance the abnormal perception of the sound. We recommend that persons with tinnitus limit salt (no added salt), and refrain from drinking caffeinated beverages, other stimulants (like tea), and chocolate.
Because tinnitus has been linked to changes in neural activity within the brain, stimulation of the nerves within the cortex has been studied as a treatment option. Anxiety or depression that often accompanies tinnitus may be as big a problem as the tinnitus itself. Your inner ear's cochlea is lined with thousands of fine, hair-like cells that vibrate when exposed to sound waves. Outside of avoiding ototoxic medications and quinine, the best treatment for tinnitus is prevention. For those that already suffer from Tinnitus, there is no FDA-approved medication available to treat it, though treating the underlying cause often relieves the ringing.
Tinnitus is the perception of sound within the human ear in the absence of corresponding external sound.
Tinnitus is not itself a disease but a symptom resulting from a range of underlying causes. For many, it's a ringing sound, while for others, it's whistling, buzzing, chirping, hissing, humming, roaring, or even shrieking. Things that cause hearing loss (and tinnitus) include loud noise, medications that damage the nerves in the ear (ototoxic drugs), impacted earwax, middle ear problems (such as infections and vascular tumors), and aging.
One of the most common causes of tinnitus is damage to the hair cells in the cochlea (see "Auditory pathways and tinnitus"). She or he will take a medical history, give you a physical examination, and do a series of tests to try to find the source of the problem.
Pulsatile tinnitus calls for a thorough evaluation by an otolaryngologist (commonly called an ear, nose, and throat specialist, or ENT) or neurotologist, especially if the noise is frequent or constant. You may also be able to reduce the impact of tinnitus by treating depression, anxiety, insomnia, and pain with medications or psychotherapy.


CBT uses techniques such as cognitive restructuring and relaxation to change the way patients think about and respond to tinnitus. Masking devices, worn like hearing aids, generate low-level white noise (a high-pitched hiss, for example) that can reduce the perception of tinnitus and sometimes also produce residual inhibition — less noticeable tinnitus for a short time after the masker is turned off.
Other treatments that have been studied for tinnitus include transcutaneous electrical stimulation of parts of the inner ear by way of electrodes placed on the skin or acupuncture needles, and stimulation of the brain using a powerful magnetic field (a technique called repetitive transcranial magnetic stimulation, or rTMS).
Tinnitus is common — nearly 36 million Americans have tinnitus and more than half of the normal population has intermittent tinnitus. Therefore, tinnitus is common and in most, but not all, cases it is associated with some degree of hearing loss.
Anything that increases blood flow or turbulence such as hyperthyroidism, low blood viscosity (for example, anemia), or tortuous blood vessels may cause pulsatile tinnitus.
Persons who experience tinnitus should be seen by a physician expert in ear disease, typically an otolaryngologist.
The temporomandibular joints (TMJ) of the jaw should also be checked, since about 28% of persons with TMJ syndrome experience tinnitus. For many people with tinnitus, the sound is usually masked, or covered up, when there is a usual level of noise in the environment. Therefore, it is very important to understand that the individual is very much in control of the degree to which the tinnitus is distracting or annoying. You should certainly consider surgery if your tinnitus is due to a tumor and also if it is due to a venous source (usually pulsatile in this situation). If you have tinnitus associated with a hearing loss, a hearing aid is the first thing to try. At the American Hearing Research Foundation (AHRF), we have funded basic research on tinnitus in the past, and are interested in funding sound research on tinnitus in the future.
In fact, an estimated 90 percent of tinnitus sufferers also experience some degree of noise-induced hearing loss. This damage can cause hearing loss and a small number of the affected people develop tinnitus as a consequence of this hearing loss. But now the Neuromonics Tinnitus Treatment lets you relieve these symptoms and reclaim your life. Some medications (especially aspirin and other nonsteroidal anti-inflammatory drugs taken in high doses) can cause tinnitus that goes away when the drug is discontinued. For example, if you have a heart murmur, you may hear a whooshing sound with every heartbeat; your clinician can also hear that sound through a stethoscope.
This stimulates abnormal activity in the neurons, which results in the illusion of sound, or tinnitus. Tinnitus can also be a symptom of Mnire's disease, a disorder of the balance mechanism in the inner ear.
Our bodies normally produce sounds (called somatic sounds) that we usually don't notice because we are listening to external sounds.
She or he will also ask you to describe the noise you're hearing (including its pitch and sound quality, and whether it's constant or periodic, steady or pulsatile) and the times and places in which you hear it. If you have age-related hearing loss, a hearing aid can often make tinnitus less noticeable by amplifying outside sounds. The aim is to habituate the auditory system to the tinnitus signals, making them less noticeable or less bothersome.
The most common causes of tinnitus are damage to the high frequency hearing by exposure to loud noise or elevated levels of common drugs that can be toxic to the inner ear in high doses. We know of people who have focused on and listened to tinnitus until it dominated their lives. For venous tinnitus, possibilities include jugular vein ligation, occlusion of the sigmoid sinus, or closure of a dural fistula.
Be sure that you try the hearing aid before buying one, as tinnitus is not always helped by an aid. Direct intracranial electrical stimulation of the cortex also has positive effects on tinnitus (De Ridder et al 2007a, Seidman et al 2008).
A recent systematic review of the literature concluded that CBT was an effective treatment of tinnitus distress, although the authors cautioned that larger studies should be completed (Hesser et al 2011). Learn more about donating to American Hearing Research Foundation (AHRF) to diagnose tinnitus.
Theta, alpha and beta burst transcranial magnetic stimulation: brain modulation in tinnitus. Transcranial magnetic stimulation and extradural electrodes implanted on secondary auditory cortex for tinnitus suppression. Methodological considerations in treatment evaluations of tinnitus distress: a call for guidelines.
A systematic review and meta-analysis of randomized controlled trials of cognitive-behavioral therapy for tinnitus distress.
Effect of daily repetitive transcranial magnetic stimulation for treatment of tinnitus: comparison of different stimulus frequencies. Transcranial magnetic stimulation (TMS) for treatment of chronic tinnitus: clinical effects.
Sulpiride and melatonin decrease tinnitus perception modulating the auditolimbic dopaminergic pathway.
Effects of repetitive transcranial magnetic stimulation on chronic tinnitus: a randomised, crossover, double blind, placebo controlled study.

Drug treatments for subjective tinnitus: serendipitous discovery versus rational drug design. It's known as tinnitus, and it's a surprisingly common affliction, affecting some 50 million people in America alone. Tinnitus is not a disease itself, but rather typically a symptom of an underlying condition.
This neural loop normally allows us to pick up very faint and distant sounds by detecting subtle changes in the vibrations of various hairs. In the rare cases where people on these low doses of quinine do report tinnitus it is temporary and ceases as soon as they discontinue the medication. Tinnitus is also a side-effect of some oral medications, such as aspirin, and may also result from an abnormally low level of serotonin activity.
Many people can hear their heartbeat — a phenomenon called pulsatile tinnitus — especially as they grow older, because blood flow tends to be more turbulent in arteries whose walls have stiffened with age. The main components of TRT are individual counseling (to explain the auditory system, how tinnitus develops, and how TRT can help) and sound therapy.
Individual studies have reported improvements in as many as 80% of patients with high-pitched tinnitus. In two small trials, rTMS compared with a sham procedure helped improve the perception of tinnitus in a few patients. For example, after you have been to a loud rock concert you may experience tinnitus for a while in association with dulling of hearing. Tinnitus may be heard when there is a temporary conductive hearing loss due to ear infection or due to blockage of the ear with wax, or may be associated with any other cause of conductive hearing loss.
If you can ignore tinnitus rather than obsess about it, this may be the best way to handle it. But when these hairs are damaged or killed by repeated loud noise exposure, the underlying neurons remain active, sending a false signal to the brain that there is incoming sound when there really isn't.
Pulsatile tinnitus may be more noticeable at night, when you're lying in bed, because more blood is reaching your head, and there are fewer external sounds to mask the tinnitus. The resulting electrical noise takes the form of tinnitus — a sound that is high-pitched if hearing loss is in the high-frequency range and low-pitched if it's in the low-frequency range.
Tinnitus can be a side effect of many medications, especially when taken at higher doses (see "Some drugs that can cause or worsen tinnitus"). A 2010 review of six studies by the Cochrane Collaboration (an international group of health authorities who evaluate randomized trials) found that after CBT, the sound was no less loud, but it was significantly less bothersome, and patients' quality of life improved. A device is inserted in the ear to generate low-level noise and environmental sounds that match the pitch, volume, and quality of the patient's tinnitus. In a Cochrane review of the one randomized trial that followed Jastreboff's protocol and met the organization's standards, TRT was much more effective in reducing tinnitus severity and disability than a technique called masking (see below). If the tinnitus goes away and hearing seems to come back, this is called a temporary threshold shift.
Tinnitus is typically associated with the fluctuation in hearing that occurs with Meniere’s disease. Masking of the sound by providing noise from the outside was a popular area of focus in the treatment of tinnitus for several years, but has not proven long-term to be the solution to cure that was hoped. Occasionally persons with Meniere’s disease have relief or reduction of tinnitus from transtympanic gentamicin. Many people worry that tinnitus is a sign that they are going deaf or have another serious medical problem, but it rarely is. If you notice any new pulsatile tinnitus, you should consult a clinician, because in rare cases it is a sign of a tumor or blood vessel damage. This kind of tinnitus resembles phantom limb pain in an amputee — the brain is producing abnormal nerve signals to compensate for missing input. An enlarged jugular bulb on the involved side is common in persons with venous type pulsatile tinnitus. For example, the carotid artery (the main supply of blood to our brains) runs right next to the inner ear and yet we usually do not hear the pulse or heart sounds that are carried in the artery.
Studies have shown that there is not a correlation between the loudness or pitch of the tinnitus and the degree to which it bothers the individual.
Microvascular compression syndrome, in theory, may cause tinnitus, but we have had very little success when the few patients we have seen with this syndrome have undergone surgery.
The interested reader is referred to Meng (2011) for a recent meta-analysis of TENS as a treatment for tinnitus.
Controlling the perception by ignoring it is such a simple and effective approach for most individuals that it is the first line of coping with tinnitus for the vast majority of people. Or, tinnitus which pulsates in time with your blood pulse may be due to a vascular problem that can be corrected.
Steady, constant tinnitus is usually due to some cause of hearing loss, but people with no measurable hearing loss may hear tinnitus if they are in a totally quiet environment in which little sound is coming into their auditory system from the outside.

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