The Causes of Ringing in the Ears

Dr. O’Leary explains the causes of ringing in the ears and what can be done about it.

Boy, you just hit the number one complaint of anybody who goes to see an ear, nose, and throat doctor. It is so common, and you have to accept the fact that the ringing is not normal and secondly, it probably reflects some injury to the very delicate hair cells that exist in our inner ear. You know, even single loud noises are enough to disrupt a hair cell and actually kill the small hair cell, mechanically displace it so it’s no longer working. The good news in that picture is, we have 9,000 or more such cells in the ear system, but you can’t afford to be clipping these off. When you damage those hair cells, the nerves that still remain that used to be getting stimulated all the time by just background noise, suddenly have no stimulation. And they start making their own signal and that’s perceived in the higher levels of the brain as the sound that those hair cells represented. The model really is a very good one. We have it for phantom limb pain. You may have heard of that before, but a person can have an amputated limb from trauma or from a medical problem and in a pinky that doesn’t exist, they close their eyes and they feel the pain of a needle or burning on that non-existent finger. It’s same system, sending inputs all the time since birth; suddenly no signal and the first order brain cells start making its own neurotransmitter and that is perceived up for the rest of the system as the genuine signal, a real article. Well that’s what tinnitus is. So, first things first, tinnitus is a sign of true damage in the ears. Secondly, all tinnitus is not the same. For most patients with tinnitus, you will find that after about a year they get used to that signal and it becomes part of the background. If I asked you right now to wiggle your big toe and we look and feel what it feels like, you will feel your sock; you will feel how warm and moist your toes is. All those signals have been playing the whole time we have been talking and you pay no attention to them. If it even got up a little higher with little itches and you might scratch yourself, but you still wouldn’t think about it. So the system is a background system called our adaptive world where we actually register or habituate to the environment, and there are thousands of such signals coming from the eyes, from every bit of skin, from your GI tract, all of this. The brain manages that very well in this little area called habituated space. New signals, it’s designed to say, “Hey, is this here to kill me? I mean, how am I going to survive this new signal?” And then as soon as it’s managed it, it moves back on to being background, and that’s what will happen in the majority of cases of tinnitus. But in a rare number of cases, the stress of the tinnitus actually makes the tinnitus worse, and patients actually start to lose sleep and that’s a very vicious cycle. Once your reserves of sleep are decreased, stresses increase, and this actually becomes a very bad problem; can lead to suicidal tendencies, etcetera. I had a patient who said it rivetingly to me one time. She said, she’d call me three times on a weekend while I was on call asking about if I could see her tinnitus and I set up an appointment for the next day, and I said to her in the third call, I said, “You know, this is unusual. No one has ever called me three times for this one problem,” and she said to me, “Doctor, if you can imagine standing next to a jet engine, that’s what it feels like in my ear.” It really made me realize boy, you know, this is not the same sound to everybody, and this can be a real problem in some people. The good news for that small percent of patients is that they actually can do very well with some treatments we have now to relax it, just like patients do with phantom limb, where they can actually change the feedback that the body has from this signal. We can do things now with tinnitus in those rare groups that are having real trouble with it, but number one key with tinnitus is, knowing it represents true damage to the ear and something should be looked into.