What Is Tinnitus: It's Causes, Effects and Brain Connections

In ancient times, people referred to the ringing in their ears as buzzing, whispering or even singing. Today, we call it tinnitus.  

Despite being a common medical disorder, tinnitus continues to challenge medical professionals, affecting 5 to 15 percent of the population and significantly impacting their quality of life. Explore the causes, symptoms and current treatment approaches of tinnitus.  

Tinnitus is a medical condition marked by the perception of sound within the ears, even in the absence of any external sound. Normally, we hear sounds only when they make our eardrums vibrate. The vibrations cause nerve hairs in the inner ear to shiver, and that triggers electric signals that travel along the auditory nerve into the brain.  

One of their first stops is a patch of gray matter called the auditory cortex. Each nerve hair is tuned to a particular frequency of sound and excites only certain neurons in the auditory cortex. As a result, the neurons in the auditory cortex form what is known as a tone map. The neurons at one end of the auditory cortex are tuned to low frequencies; the farther you go toward the other end, the higher the tuning of the neurons.  

This sound system comes with an elaborate feedback mechanism. Neurons do more than just relay signals forward into the brain. They also signal back down the line, reaching out to neighboring neurons tuned to nearby frequencies, exciting some and muzzling others. These feedback controls allow us to sift through incoming sounds for the most important information, so we are not overwhelmed by meaningless noise.  

In ancient civilizations, various home remedies were used for tinnitus, reflecting different beliefs about its origins. While the remedies ranged from holding freshly baked bread loaves over the ears to placing earthworms boiled in goose grease in the ears, there was logic behind these unique methods.

In the distant past, doctors offered all sorts of strange cures for it. One example is how the Assyrians poured rose extract into the ear through a bronze tube. 

The Roman writer Pliny the Elder suggested that people should put earthworms boiled in goose grease in the ear. 

Medieval Welsh physicians in the town of Myddfai recommended that their patients take a freshly baked loaf of bread out of the oven, cut it in two, “and apply to both ears as hot as can be borne, bind and thus produce perspiration, and by the help of god you will be cured.” 

Early physicians based these prescriptions on what they believed tinnitus to be. Some were convinced it was caused by wind that got trapped inside the ear and swirled around endlessly. They tried to liberate the wind by drilling a hole into the bones around the ear or used a silver tube to suck air out of the ear canal. The treatments didn’t work, but they did have an internal logic. 

 Read More: Scientists Discover Specific Neurons Involved in Making Memories  

Ringing in the ears can have various causes. Things may start to happen when toxic drugs, loud noises or even whiplash cause damage to the nerve hairs in the ears. Here are some common causes of tinnitus.

Prolonged exposure to loud noises, such as concerts, machinery or firearms, can damage the delicate hair cells in the inner ear, leading to tinnitus. This is one of the most common causes, especially in individuals with occupational noise exposure.

The buildup of earwax can block the ear canal and cause tinnitus symptoms. Removing the earwax usually alleviates the condition.

Psychological factors like stress and anxiety can lead to muscle tension in various parts of the body, including the neck, shoulders and jaw. This muscle tension can affect the auditory system and, in some cases, exacerbate tinnitus or make it more noticeable.

TMJ disorders often involve muscle tension or spasms in the jaw and neck area. This muscle tension can sometimes radiate to the ear, leading to a sensation of fullness or ringing sounds.

Sinus allergies can lead to an accumulation of fluid in the middle ear, a condition known as otitis media with effusion. This buildup of fluid can affect the function of the middle ear and may lead to tinnitus.

Head injuries, including concussions, can impact various parts of the brain, including those involved in processing auditory signals. Changes in brain function can lead to the development of tinnitus.

Conditions like high blood pressure and cardiovascular diseases can impact blood flow in the inner ear, potentially leading to tinnitus. Meanwhile, inner ear disorders like Meniere's disease and otosclerosis can directly disrupt normal auditory function, resulting in persistent ringing or buzzing sounds.

While tinnitus generally doesn't directly trigger these issues, it can be associated with underlying conditions like Meniere's disease and acoustic neuroma, which may lead to vertigo. Tinnitus can also indirectly affect memory, contribute to headaches and alter brain network activity, revealing its complex nature and impact.

Tinnitus itself does not directly cause vertigo or dizziness. However, there are certain underlying conditions that can lead to tinnitus, vertigo and dizziness as co-occurring symptoms. One notable example is Meniere's disease, which affects the inner ear and can result in both tinnitus and recurrent episodes of vertigo. In Meniere's disease, the fluid-filled compartments of the inner ear become disrupted, leading to hearing loss, tinnitus and balance problems, including vertigo. Another condition, vestibular schwannoma (acoustic neuroma), a non-cancerous tumor affecting the vestibular nerve, can also lead to both tinnitus and vertigo as symptoms.

Tinnitus can indirectly impact your memory. The distress and cognitive load associated with persistent tinnitus may lead to sleep disturbances, stress, anxiety, and difficulty concentrating. Sleep disturbances can have a negative impact on memory consolidation, as sleep plays a crucial role in the brain's ability to store and retrieve information.

Additionally, the emotional and cognitive burden of tinnitus can affect attention and concentration, potentially leading to difficulties in memory-related tasks. While tinnitus does not cause memory loss, its associated symptoms and emotional effects can influence cognitive function in certain cases.

You may experience headaches or migraine attacks with tinnitus, but these headaches are not caused by the tinnitus. Instead, the presence of tinnitus can contribute to stress, anxiety, and increased muscle tension in the head and neck region, which may trigger or exacerbate headaches.

Additionally, the emotional distress and anxiety related to chronic tinnitus can indirectly contribute to tension-type headaches or migraines. If you experience headaches alongside tinnitus, it's essential to consult with a healthcare professional to determine the underlying causes and develop an appropriate treatment plan to manage both symptoms effectively.

Tinnitus doesn't typically cause brain damage, but it does lead to changes in brain network activity. Using brain scans, neuroscientists have found that changes ripple out across the entire brain. Winfried Schlee of the University of Konstanz in Germany and his colleagues used a method called magnetoencephalography (MEG) to detect changing patterns of activity in the brain.

They found that individuals with tinnitus exhibited synchronized neural activity in specific brain regions, both front and back. Moreover, there was a stronger synchronization of signals into the temporal cortex, including the auditory cortex, in those with tinnitus.

Interestingly, the level of distress caused by tinnitus correlated with the strength of these brain signals, suggesting that tinnitus is not solely an ear-related issue but a condition involving brain network abnormalities. This complexity may explain why various tinnitus treatments are effective to some extent but often provide only modest relief. 

Tinnitus does not cause hearing loss, although it is often a symptom or a consequence of an underlying condition that can also be associated with hearing loss. The auditory cortex is just an early stop on the journey that sound takes from the outside world to our awareness, but its impact extends beyond this.

Some neurons in the auditory cortex connect to the caudate nucleus and putamen in the brain stem, which are believed to play roles in categorizing sounds. In a unique case study, Louis Lowry, an ear-nose-and-throat doctor, discovered that these brain regions are significant in tinnitus. Lowry, who had tinnitus for 40 years due to hearing loss, found relief from his tinnitus when a mild stroke damaged his caudate and putamen, without causing further hearing loss. This unexpected outcome shed light on the potential involvement of these brain regions in tinnitus.

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Tinnitus continues to resist medicine’s best efforts, despite being one of the more common medical disorders. Research shows that over 25 million people in the U.S. experience some sort of phantom ringing of the ears. For tinnitus sufferers, they have a range of treatment options to consider, such as medication, noise suppression, counseling and sound therapy.

One common medication used to treat tinnitus involves the use of lidocaine, a local anesthetic, to help manage or alleviate the symptoms of tinnitus. This treatment is typically administered in a controlled medical setting and can take various forms, including oral, intravenous or topical applications. The goal is to temporarily reduce tinnitus symptoms, although the effectiveness can vary from person to person, and it may not provide a permanent cure for the condition.

Your doctor may suggest using electronic devices for noise suppression. These devices may include white noise machines, which emit sounds resembling static or soothing natural sounds like rainfall or ocean waves. Particularly effective, they can even have pillow speakers to improve sleep quality.

Additionally, common bedroom appliances like fans can produce white noise, potentially making nighttime tinnitus less intrusive. Another option is the use of masking devices, which emit a sustained white noise to alleviate tinnitus symptoms.

Counseling can make people better aware of the sounds they experience by explaining the brain process that may underlie the disorder, so they can consciously reduce their distress. It could include applying magnetic pulses to the brain or implanting electrodes in the brain stem.

Some of the most effective treatments for tinnitus appear to work by altering the behavior of the front of the brain. A comprehensive 2014 study revealed that counseling treatments for tinnitus substantially reduced symptoms.

Christo Pantev of the University of Münster in Germany and his colleagues, for example, have brought some relief to people with tinnitus by rewiring their tone map. To do so, they edited recordings of music, filtering out the frequencies of the ringing in the ears of their patients, who then listened to the filtered music an average of 12 hours per week. Pantev and his collaborators found that their patients’ tinnitus significantly eased. They also found that the neurons tuned to the tinnitus frequency in the auditory cortex became less active. 

The scientists cannot say for sure how the filtered music soothed their patients, but they speculate that the incoming signals encouraged the tone map to change its structure. The overactive, eavesdropping neurons became stifled by their neighbors. 

Read More: How the Brain Processes Music for Those With Hearing Loss

Solving the mystery of tinnitus will probably get even more urgent in years to come. Traffic, technology and other features of modern life may cause more hearing damage, hence more tinnitus.

But if a real cure ever comes, it will probably not fix everything. It will instead attack the tinnitus network from the top-down and bottom-up. For now, though, you should probably skip the hot bread on the ears.

It is important to understand the causes of tinnitus because it allows healthcare professionals to provide better diagnosis and treatment options. Here are some commonly asked questions about tinnitus.

Loud noises can indeed cause tinnitus. Extended exposure to high-volume sounds, like concerts, machinery or firearms, has the potential to harm the fragile hair cells within the inner ear. This cause is particularly prevalent, notably among individuals exposed to loud noises at work.

Yes, accumulated earwax can cause tinnitus because it can obstruct the ear canal and trigger tinnitus symptoms, but typically, these symptoms subside upon earwax removal.

Factors such as stress and anxiety can lead to tinnitus. They may result in muscle tension in different areas of the body, such as the neck, shoulders and jaw can impact the auditory system and occasionally worsen tinnitus or increase its perceptibility.

TMJ can trigger tinnitus. Conditions related to TMJ often entail muscle tension or spasms in the jaw and neck region, which can occasionally extend to the ear, causing feelings of fullness or ringing sounds.

Yes, sinus allergies can cause tinnitus. Fluid can collect in the middle ear, causing a condition called otitis media with effusion, which can disrupt the middle ear's functioning and potentially give rise to tinnitus.

Head injuries can lead to tinnitus. Head injuries, which may include concussions, have the potential to affect different regions of the brain, including those responsible for processing auditory signals, and alterations in brain function.

Yes, underlying health conditions could lead to tinnitus. Conditions such as hypertension and heart-related ailments may influence blood circulation within the inner ear, which can potentially give rise to tinnitus. On the other hand, inner ear disorders like Meniere's disease and otosclerosis can directly interfere with regular auditory function, causing ongoing ringing or buzzing noises. 

Read More: Research Reveals Surprising Conversations Between Our Brain Cells 

This article was originally published on October 27, 2010 and has since been updated with relevant medical information and recent research.