What are the causes of tinnitus?

From the Guidelines

Tinnitus is primarily caused by damage to the inner ear's hair cells, often due to exposure to loud noises, aging, or certain medications. Common causes include noise-induced hearing loss from prolonged exposure to loud environments or sudden acoustic trauma; age-related hearing loss (presbycusis); earwax blockage that irritates the eardrum; ear and sinus infections; head or neck injuries that affect hearing nerves; certain medications like high doses of aspirin, some antibiotics (gentamicin, neomycin), certain cancer drugs (cisplatin), and some diuretics; diseases affecting the ear such as Meniere's disease or otosclerosis; blood vessel disorders including high blood pressure, atherosclerosis, or abnormal blood vessel formation near the ear; and temporomandibular joint (TMJ) disorders. Medical conditions like diabetes, thyroid problems, and multiple sclerosis can also contribute to tinnitus development. Stress and depression don't directly cause tinnitus but can worsen its perception. Understanding these causes is important because while tinnitus itself often cannot be cured, identifying and addressing the underlying cause may help manage symptoms or prevent worsening, as noted in the most recent guidelines 1.

Some key points to consider when evaluating tinnitus include:

• The type of tinnitus, such as pulsatile or nonpulsatile, which can help guide the choice of imaging studies and their appropriateness 1
• The presence of other symptoms, such as hearing loss, vertigo, or neurological deficits, which can indicate an underlying condition that needs to be addressed 1
• The patient's medical history and medications, which can help identify potential causes of tinnitus 1
• The importance of a thorough otologic examination and audiometric examination to determine the cause of tinnitus and guide treatment 1
• The need for prompt identification and intervention for patients with severe anxiety or depression, as these conditions can worsen tinnitus perception and increase the risk of suicide 1

Overall, identifying and addressing the underlying cause of tinnitus is crucial for managing symptoms and improving quality of life, and a comprehensive evaluation and targeted treatment approach can help achieve this goal, as recommended in the latest clinical practice guidelines 1.

From the Research

Causes of Tinnitus

The causes of tinnitus are diverse and can be categorized into several groups, including:

• Otologic problems, such as hearing loss, external ear infection, cerumen impaction, and middle ear effusion 2
• Exposure to excessive loud noise, presbycusis, ototoxic medications, or Meniere's disease, which can cause sensorineural hearing loss 2
• Neurologic, metabolic, or psychogenic disorders, which can also contribute to subjective tinnitus 2
• Vascular abnormalities of the carotid artery or jugular venous systems, which can cause objective tinnitus 2
• Head or cervical vertebra trauma, and psychological disorders, such as anxiety and depression 3
• Inflammatory diseases or tumors of the ear, which can also lead to tinnitus 3

Risk Factors

Several risk factors have been identified, including:

• Age, with older adults being more likely to experience tinnitus 3
• Hearing loss, which is a common comorbidity with tinnitus 3, 4, 2
• Noise exposure, which can damage the auditory system and lead to tinnitus 3, 5
• Ototoxic drugs, which can harm the ear and cause tinnitus 3, 6
• Head injury, which can increase the risk of developing tinnitus 6
• Depression, which is often comorbid with tinnitus and can exacerbate its symptoms 3, 6

Types of Tinnitus

There are two main types of tinnitus:

• Subjective tinnitus, which is the most common form and is characterized by a phantom sensation with no physical sound reaching the ear 5
• Objective tinnitus, which is less common and is caused by sounds generated in the body that reach the ear through conduction in body tissue 5