Synonyms
ringing in the ears engl. tinnitus
Introduction
Whistling in the ear is harmless, but it is an extreme burden for many of those affected. Here you can find out everything important about tinnitus. Noises in the ear are auditory perceptions which can be traced back to various causes and functional disorders.
The type and intensity of the tinnitus can vary. They can occur on one side or both sides. Although tinnitus is more of a symptom, it is nevertheless listed as an independent diagnosis according to the ICD-10.
Ear noises are classified according to various criteria. A distinction is made between subjective and objective tinnitus and between acute (lasting less than 3 months) and chronic tinnitus (lasting more than 3 months). Furthermore, the place of origin of the tinnitus is also important.
Tinnitus can occur in the outer ear, middle ear, inner ear, but also in the auditory pathway or brain. Finally, tinnitus is divided into degrees of severity, which refer to the quality of life in private as well as professional life. Grade 1 does not correspond to any degree of suffering, grade 4 leads to occupational disability and is associated with a very high degree of suffering. The type of tinnitus can be very different.
Frequency
About 25% of the population have experienced tinnitus, 4% even suffer from chronic, i.e. persistent, tinnitus. The incidence, i.e. the number of new cases in the population, continues to rise. Increased exposure to noise probably has something to do with this. Tinnitus usually manifests itself between the ages of 40 and 50. Men and women are affected to the same extent.
Causes
There are many causes that can lead to tinnitus. A distinction is made between those that lead to an objectifiable finding and those that cause a subjective ringing in the ears. These symptoms indicate a magnesium deficiency.
For example, a stenosis (narrowing) of the carotid artery can lead to an objective ringing in the ears. Typically, a pulse-synchronous noise then occurs. Other flow noises from vessels (arteries) are also possible.
Another cause is a tumor of the glomus tympanicum. This is a tumor of the middle ear, which originates from an accumulation of nerve cells, the paraganglion tympanicum. The tumor also causes a pulsating noise in the ear (usually a murmur), which can be associated with hearing loss.
Furthermore, breathing sounds, vascular malformations (aneurysm, AV fistula), tension in the middle ear muscles or opening movements of the auditory trumpet can cause objective tinnitus. In the foreground of the therapy of such objective tinnitus is the treatment of the underlying disease. However, this is not always possible.
Another cause is a tumor of the glomus tympanicum. This is a tumor of the middle ear, which originates from an accumulation of nerve cells, the paraganglion tympanicum. The tumor also causes a pulsating noise in the ear (usually a murmur), which can be associated with hearing loss.
Furthermore, breathing sounds, vascular malformations (aneurysm, AV fistula), tension in the middle ear muscles or opening movements of the auditory trumpet can cause objective tinnitus. In the foreground of the therapy of such objective tinnitus is the treatment of the underlying disease. However, this is not always possible.
The subjective tinnitus is only perceived by the person affected. The causes of tinnitus can be divided into four categories: These causes can be located both inside and outside the skull. This group includes tumors (e.g.
brain tumors, acoustic neuroma), traumas (craniocerebral trauma, petrous bone fracture) and operations (e.g. on the brain or ear). Stress and great psychological strain can lead to tinnitus. However, they can also occur in conjunction with tinnitus or be the result of a chronic ringing in the ears.
The more stressful the noise is for a person, the more likely it is that a psychological symptom, such as depression, will occur. These include cardiovascular diseases such as high blood pressure or cardiac arrhythmia. Furthermore, hyperthyroidism, multiple sclerosis or the cervical spine syndrome can be a cause.
Psychiatric diseases such as schizophrenia can also cause auditory hallucinations. Strictly speaking, however, this is not a typical ear noise.
- Intra- and extracranial causes
- Mental causes
- Systemic diseases
Damage to the ear and the central auditory pathway can lead to the perception of annoying ringing in the ear, sometimes painful hyperacusis or even hearing loss.
Triggers are, for example, drugs toxic to the inner ear (drugs that damage the ear) such as loop diuretics or aminoglycosides (gentamycin, erythromycin). The latter can cause acute or chronic acoustic trauma. Inflammations in the ear, such as inflammation of the middle ear or labyrinthitis, can also cause ringing in the ears.
Other diseases such as otosclerosis, Meniere’s disease, perforation of the eardrum and sudden deafness must also be mentioned. The latter is accompanied by a sudden inner ear hearing loss and a feeling of “absorbent cotton in the ear”, which is often accompanied by tinnitus.
- Functional disorders of the ear and the central auditory pathway
The symptom complexes in a cervical spine syndrome can vary greatly.
Frequent are ringing in the ears, dizziness, neck and throat pain and a tingling sensation of numbness. The causes may be functional, degenerative or traumatic processes. Possible causes include whiplash, functional tension or a facet syndrome.
The muscular tone of the cervical spine influences the function of the cranial nerve nuclei, which are indispensable for the function of hearing. Thus, disorders of auditory perception can be caused by tension or joint problems in the cervical spine. Furthermore, the blood flow to the cranial nerve nuclei also plays an important role.
These are sometimes supplied by vessels that run closely along the cervical spine. Degenerative changes in the bony structures of the cervical spine can constrict these vessels and thus impair the blood supply to the cranial nerve nuclei. The type of ringing in the ears can vary.
However, a deep, muffled, one-sided tone is often reported, or an irregular noise. Affected people sometimes describe the ringing in the ears as a hissing, humming, whistling, cracking or knocking sound. The noise can also have a rhythmic-pulsating character or be rather monotonous.
In addition, it can lead to a hearing loss, but more often even to hyperacusis. Those affected often show comorbidities (concomitant diseases) such as muscle tension in the jaw and cervical spine, depression, anxiety and even suicidal thoughts. Sleep disorders due to the unpleasant ringing in the ears are also common.
Headaches and dizziness as well as a deterioration of hearing are often described. Some affected persons perceive their ringing in the ears more strongly when lying down or claim to perceive a louder noise than usual, especially in the morning after getting up. This may be related to the fact that there is a greater silence when going to bed than at other times of the day.
The same applies to waking up in the morning. Accordingly, the body is not distracted by other stimuli and there are no other sounds that could overlay the disturbing ear noise. It can help to listen to soft relaxing music while falling asleep. In addition, relaxation techniques can also help you to become less focused on the sound in your ears and perceive it as less annoying.
