Published January 5, 2018, 12:05 AM

by Dr. Jose Pujalte Jr.

Jose Pujalte Jr.
Jose Pujalte Jr.

By Jose Pujalte Jr.


“The bell invites me. Hear it not, Duncan; for it is a knell That summons thee to heaven or to hell.”

William Shakespeare (1564-1616), English poet and playwright Macbeth (1623), Act ii. Sc. 1


Tinnitus is simply “ringing in the ears.” Sometimes it is the “perception of noise” and has been likened to chronic pain syndromes where the cause of pain (like whiplash or a fracture) has long healed but the patient still hurts. Tinnitus can also be soft or loud, low or high-pitched. It could be clicking, hissing, or buzzing but it is definitely not a voice in your head because that’s another (worse) problem, believe me. Tinnitus lasts for at least five minutes. It is a symptom, and this means that it is subjective and a doctor will rely on the patient’s narrative. However, although rarely, there is objective tinnitus. The otorhinolaryngologist (or your ear-nose-throat, ENT specialist), will be able to isolate a cause such as abnormalities in muscle contraction, blood vessels or the middle ear.

Causes. There’s age-related hearing loss (starts at 60) or presbycusisin which hearing is affected by the loss of sensory hair cells of the inner ear. Hair cells are responsible for converting vibrations into electrical signals for the brain to perceive as sound. Unfortunately, over time they can be damaged irreversibly. Long term exposure to loud sounds can cause permanent hearing damage – one symptom is tinnitus. Something as mundane as earwax blockage can cause ringing in the ears.

In Meniere’s disease, from deranged inner ear fluid pressure, the classic triad of vertigo, hearing loss and tinnitus can be elicited. Tinnitus can also follow disorders of the temporo-mandibular joint or TMJ. One sided tinnitus has been observed in a benign nerve tumor called acoustic neuroma and in head or neck injuries.

Medical textbooks list the following medications that can cause or aggravate tinnitus:

  • High dose aspirin (greater than 12 tablets a day).
  • Antibiotics (neomycin, erythromycin, vancomycin).
  • Diuretics (furosemide).
  • Anti-malaria medicine (quinine).
  • Cancer drugs (vincristine, mechlorethamine).

Treatment. Tinnitus has no cure – unless the objective cause is ascertained and treated. If tinnitus is associated with hearing loss, then hearing aids are in order. Once a patient begins to hear better, tinnitus becomes less a concern. Anti-anxiety and antidepressants improve the mood of a patient suffering from tinnitus. Wearable and table top sound generators produce “white noise” that mask the ringing. Visit your doctor for treatment options.

Prevention. Wearing over the ear protection is recommended for those always exposed to loud sounds: factory workers around loud machinery and firearms, musicians, and the henpecked. Loud noise tends to cause tinnitus and ear damage. Decreasing the volume of music by those who use earphones or headphones help versus tinnitus.

There is no reason to endure ringing in the ears. In fact, sometimes it does not stop. That is always a good time to see the doctor.


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