A Straight Dope Classic from Cecil's Storehouse of Human Knowledge

What causes ringing in your ears?

December 9, 1994

Dear Cecil:

Did you ever uncover the mystery behind the tiny ring that one sometimes gets in the ears? You know, that tiny pitch you may hear in one ear that temporarily blocks out sound and you think some CIA agent is trying to contact you through some unknown computer chip in your head? (Well, maybe not that scenario.) Or you think some alien planet is trying to reach you? Or you feel like you have a calling somewhere, but you have no idea where? Did you ever get that, or hear of it, or am I just completely mental?

Cecil replies:

Well, I wouldn't want to rule anything out. But to be honest, I've heard the tiny ring myself, although I'd call it more a tone, like the ones used in hearing tests. Other people hear low-pitched "ocean noise," roaring, buzzing, cricket sounds, sirens, or some combination of the above. However you experience it, the sensation of sound without an external stimulus is called tinnitus. Lots of people get it — including, I would venture to say, virtually everyone who's ever been to a rock concert. One UK study found that nearly 40 percent of respondents reported experiencing tinnitus at least occasionally, roughly a sixth had persistent symptoms (episodes lasting more than five minutes not associated with exposure to noise), and around 2 percent described their tinnitus as severe.

Doctors traditionally have distinguished between objective or "real" tinnitus and subjective or "false" tinnitus. In objective tinnitus an actual sound can be detected with a stethoscope or, in the odd case, simply by standing near the patient. The noise may arise from some deformation of the blood vessels, in which case it may signal a tumor or aneurysm; twitching of the muscles of the middle ear; a eustachian tube that remains open when it shouldn't; and so on.

Subjective tinnitus, which is far more common, is tougher to pin down. Clinicians caution that tinnitus should be considered a symptom of some larger problem, and in fact it's often associated with other symptoms like hearing loss or dizziness. But in many cases no definite cause can be established. "Subjective tinnitus … is presumed to originate from some type of electrophysiologic derangement in the cochlea, cranial nerve VIII, or central nervous system," one Mayo Clinic review notes, but beyond that the subject remains mysterious. After running through a list of theories, all of them too numbingly complex to present here, one research team observed tartly, "None of these speculations has been (nor can many of them be) put to the experimental test." In short, the CIA and alien planets can't be ruled out.

There is no cure for subjective tinnitus, but some progress has been made in alleviating it. Around 1825 the French doctor Jean-Marc-Gaspard Itard (whom regular readers of this column will remember as the tutor of the wild boy of Aveyron) was the first to notice that tinnitus would diminish or subside if masked with a similar external sound. For example, if the patient complained of hearing a high-pitched noise Itard recommended listening to a fire of green wood, the hissing of which often brought some relief. Later generations of patients found it helpful to listen to a water fountain, FM radio static, or even an electric razor. (Although not just any electric razor. When one tinnitus sufferer sent his lucky razor in for repair, he was devastated when the company sent back a new one instead — unlike the old one, it had no effect on his tinnitus.)

Since the 1970s sufferers have been able to avail themselves of electronic tinnitus maskers, which may be combined with (and worn like) a hearing aid. One researcher claims two-thirds of severe tinnitus cases can be helped by hearing instruments of one kind or another. Failing that there's the drug lidocaine, which also works about two-thirds of the time, the main drawbacks being that you have to inject it intravenously and the relief is short-lived. I don't know how much this bugs you, Nina, but here's hoping the alien planets don't come calling too often.

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