Tinnitus, commonly known as ringing in the ears, is the perception of sound by a person when there is no external sound source present. This sound may manifest as ringing, buzzing, hissing, whistling, or pulsing. It can be felt in one ear, both ears, or inside the head. Tinnitus is not a disease itself, but a symptom of an underlying condition. Therefore, the correct approach is to investigate the cause before attempting to silence the ringing.
What Are the Types of Tinnitus?
Tinnitus is broadly classified into two main groups:
1. Subjective Tinnitus
It is the most common type.
Only the patient can hear it.
It is generally associated with hearing loss or inner ear (cochlea) damage.
2. Objective Tinnitus
It is rare.
The doctor can hear the sound during examination.
It is most often linked to vascular causes or muscle spasms.
3. Pulsatile Tinnitus
A sound synchronized with the heartbeat is perceived.
This condition must always be investigated in detail.
What Causes Tinnitus?
Tinnitus can have many causes. The most common include age-related hearing loss (presbycusis), noise exposure, acoustic trauma, earwax buildup, middle ear infections, otosclerosis, auditory nerve tumors (e.g., vestibular schwannoma), vascular causes (high blood pressure, anemia, vascular anomalies), systemic and metabolic causes (thyroid disorders, diabetes, vitamin deficiencies), and medications (Ototoxic Effect) (certain antibiotics, chemotherapy drugs, high-dose aspirin).
How Does Tinnitus Develop in the Brain?
According to current scientific data, tinnitus is not solely a problem originating from the ear. Following damage to the inner ear, the auditory pathways in the brain reorganize. While the brain attempts to “complete” the missing sound, it generates a phantom sound. This is related to neuroplasticity. Additionally, the limbic system (emotional center) can amplify the intensity of tinnitus perception. This is why stress, anxiety, and sleep deprivation make the ringing more pronounced.
How Is Tinnitus Evaluated?
Tinnitus evaluation is personalized and includes the following steps:
✔ Detailed medical history
✔ Audiological tests (hearing test)
✔ Tympanometry
✔ MRI imaging if necessary
✔ Blood tests
Further investigation is essential for tinnitus that is unilateral, sudden in onset, accompanied by hearing loss, or synchronized with the pulse.
Is There a Treatment for Tinnitus?
The treatment of tinnitus is directed at the underlying cause.
If an underlying cause is identified:
- Earwax is removed
- Infection is treated
- A hearing aid is recommended if hearing loss is present
- Vascular causes are investigated
If cause-directed treatment is not possible:
- Sound therapy (white noise)
- Tinnitus retraining therapy (TRT)
- Cognitive behavioral therapy
- Hearing aids
- Masking devices
- Lifestyle modifications
There is currently no definitive medication that completely eliminates tinnitus; however, with proper management, significant relief can be achieved in the vast majority of patients.
When Should You Seek Urgent Care?
If accompanied by sudden hearing loss
If there is continuously worsening ringing in one ear
If it is pulsatile
If dizziness and loss of balance are present
In these situations, an ENT specialist should be consulted without delay.
Prof. Dr. Elif Aksoy
ENT Head and Neck Surgery Specialist
Voice and Swallowing Disorders
