From the Guidelines
Hearing loss and tinnitus are primarily caused by damage to the inner ear structures, particularly the hair cells in the cochlea, with common causes including age-related degeneration, noise exposure, and certain medications, as noted in the most recent study 1. The causes of hearing loss and tinnitus can be multifaceted, involving various factors such as age-related degeneration (presbycusis), noise exposure, certain medications (ototoxic drugs like aminoglycoside antibiotics, loop diuretics, and some chemotherapy agents), infections, head trauma, and vascular disorders.
Key Causes and Prevention Strategies
- Prolonged exposure to loud sounds above 85 decibels can permanently damage hearing, as highlighted in a study on occupational noise-induced hearing loss 2.
- Genetic factors may also contribute to hearing loss susceptibility.
- Tinnitus specifically results when damaged hair cells send random electrical signals to the brain, which interprets them as sound despite no external sound source being present.
- Medical conditions like Meniere's disease, otosclerosis, acoustic neuroma, and temporomandibular joint disorders can also cause both hearing loss and tinnitus.
- Prevention involves avoiding excessive noise exposure, using hearing protection in loud environments, promptly treating ear infections, and monitoring medications that may affect hearing, as recommended by the American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO-HNSF) 3.
Importance of Early Intervention
Early identification and intervention are crucial, especially for patients with severe anxiety, depression, or psychological disturbances, as they may require prompt treatment to improve their quality of life, as noted in the ACR Appropriateness Criteria® Tinnitus: 2023 update 1.
Diagnostic Considerations
The type of tinnitus and associated symptoms often determine the choice of imaging studies and their appropriateness, with the ACR Appropriateness Criteria topics for “Hearing Loss and/or Vertigo” and “Head Trauma” providing guidance on imaging in these settings 1.
From the FDA Drug Label
Ototoxicity has been observed in up to 31% of patients treated with a single dose of cisplatin 50 mg/m2, and is manifested by tinnitus and/or hearing loss in the high frequency range (4000 to 8000 Hz). The risk of ototoxicity may be increased by prior or simultaneous cranial irradiation, and may be more severe in patients less than 5 years of age, patients being treated with other ototoxic drugs (e.g. aminoglycosides and vancomycin), and in patients with renal impairment. Genetic factors (e. g. variants in the thiopurine S-methyltransferase [TPMT] gene) may contribute to cisplatin-induced ototoxicity; although this association has not been consistent across populations and study designs.
Cisplatin causes hearing loss and tinnitus (ringing in the ears) due to ototoxicity, which may be related to the peak plasma concentration of the drug. The risk of ototoxicity may be increased by:
- Prior or simultaneous cranial irradiation
- Treatment with other ototoxic drugs (e.g. aminoglycosides and vancomycin)
- Renal impairment
- Genetic factors (e.g. variants in the thiopurine S-methyltransferase [TPMT] gene) 4
From the Research
Causes of Hearing Loss and Tinnitus
- Hearing loss and tinnitus can be caused by various factors, including age, hearing loss, noise exposure, inflammatory diseases or tumors of the ear, ototoxic drugs, head or cervical vertebra trauma, and psychological disorders such as anxiety and depression 5
- Noise-induced hearing loss is a common cause of hearing loss, resulting from exposure to recreational and occupational noise, and can be prevented by avoiding excessive noise and using hearing protection such as earplugs and earmuffs 6, 7, 8
- Long-term noise exposure can also result in tinnitus, the generation of phantom sounds, although the underlying mechanisms are not fully understood 7
- Other causes of hearing loss and tinnitus include age-related hearing loss, tumors of the brain and skull base, and rare genetic disorders 9
Risk Factors and Prevention
- Risk factors for hearing loss and tinnitus include exposure to loud noises, age, and certain medical conditions such as otosclerosis and Meniere's disease 5, 6, 9
- Preventative strategies, such as educating the public about hearing health, using hearing protection, and avoiding excessive noise, can reduce the risk of hearing loss and tinnitus 6, 7, 8
- Early detection and treatment of hearing loss and tinnitus can also improve outcomes and reduce the risk of further complications 9
Diagnosis and Treatment
- Diagnosis of hearing loss and tinnitus typically involves a focused history, otoscopic and tuning fork examination, and formal hearing testing 9
- Treatment options for hearing loss and tinnitus include counseling, psychotherapy, pharmacological approaches, masking devices, individualized sound stimulation, and cognitive behavioral therapy (CBT) 5
- While there is currently no cure for noise-induced hearing loss, preventative strategies and early detection can reduce the risk of further damage 6, 7, 8