FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

Author’s note: I have had the pleasure of writing the Family Medicine® column since January 1988. For almost 15 years, I have taken great pride in answering your questions in print and have had a few private chuckles over the questions that were so “wild” I couldn’t publish them. I hope you have found my work helpful and also entertaining. With my retirement from the Ohio University College of Osteopathic Medicine, I now pass the responsibility for writing this column ­as well as the pleasure derived therefrom ­to my colleague Martha Simpson, D.O., M.B.A. I’m sure you will find her journalism and medical information to be of the highest caliber. -- JCW

LOUD NOISES AND LOUD MUSIC COMMON CAUSES OF “RINGING IN THE EARS”

Question: I’ve had periods when I hear buzzing in my head for the past 12 years. It occurs more often now, and it also lasts longer. What can I do when I get rid of these spells?

Answer: What you describe is a condition we doctors call tinnitus. It is the hearing of a sound -- often a buzzing, ringing or humming -- in the absence of a sound heard by others. It is estimated that 40 million Americans have experienced this phenomenon at one time or another and that up to 20 percent of those 50 and over have it relatively often. Perhaps one million have it with sufficient frequency and severity to be classified as being disabled because of it.

The incidence of tinnitus is the same in men and women. It is often first noticed when the afflicted person is trying to fall asleep. This is because the buzzing or ringing -- which may be in one or both ears -- becomes more apparent in a quiet bedroom or other environment where there is little noise.

Tinnitus is a symptom rather than a specific disease, and therefore, it can have several causes. The most common one is hearing loss that results from noise exposure. This can be one very loud sound, like an explosion, or repeated exposure to moderately noisy environments, as occurs in many factories. Ear damage may also result from repeated exposure to loud music even though you wouldn’t call this “noise.” Other causes of tinnitus include disorders such as middle- or inner-ear infection, jaw problems (e.g, TMJ disorder), tumors of the acoustic nerve, hardening of the arteries or other blood vessel abnormalities, or even muscle spasm of the tiny muscle that moves the bones of the middle ear.

As you may have found out, it usually requires the skill of an ear, nose and throat (ENT) specialist to track down the cause of tinnitus symptoms. In addition to his or her talent, a hearing test is always required, and CT or MRI images are usually needed as well.

The treatment of tinnitus is dependent upon the cause, so without knowing the cause of your condition I can’t give you specific recommendations. However, I can give you some general expectations. About 25 percent of those with tinnitus get substantial improvement with treatment, about 50 percent get some improvement, and the remaining 25 percent get no better despite the best of care. Fortunately, only a very few will have worsening of symptoms to the point of being seriously disabled by them.

The most common cause of tinnitus, loud noise exposure, has no treatment that eliminates the annoying ringing. However, it is quite important to avoid exposure to more loud noises. This reduces the progression of the disorder and its associated hearing loss. Often simply knowing the cause of tinnitus is reassuring. Those sufferers who have difficulty falling asleep because of their tinnitus my do better by softly playing a radio as background sound. You, however, will need to talk to your ENT doctor for other recommendations for easing your tinnitus symptoms based on the specific cause of your disorder.

"Family Medicine" is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. You can also email Dr. Simpson at simpsonm@ohio.edu. Past columns are available online at http://www.FamilyMedicineNews.org.