by Neil Bauman, Ph.D.
A lady asked:
What causes ringing in both ears?
There are a good number of causes of ringing in the ears—what we call tinnitus. Here are some of them.
- Exposing your ears to loud sounds
- Taking any of the 450 drugs that can cause tinnitus
- Hearing loss, especially sudden hearing loss
- Exposing your ears to various chemicals and heavy metals
- Eating certain “foods” such as alcohol, nicotine, caffeine, monosodium glutamate (MSG) and some spices
- Head trauma—blow to the head, head injury
- Whiplash, neck injuries
- Barotrauma (sudden pressure changes)
- Certain illnesses
- Allergies
- Colds/sinus infections
- Viral ear infections
- Middle ear infections (otitis media) or other ear problems
- Surgery
- Acoustic neuromas
- Meniere’s Disease
- Otosclerosis
- Diabetes
- Stress, anxiety, depression
- Extreme fatigue
In addition to the above, there are various somatic (body) kinds of tinnitus. Somatic tinnitus can result from such things as moving your head/neck, bending over, clenching your teeth, TMJ, moving your eyes, pulsatile tinnitus—tinnitus in unison with each heart beat and related to vascular causes. You can also get tinnitus from ear wax, or if the stapedius or tensor tympani muscle “spasms” in your middle ears.
The first three in the above list are probably the most common causes of ringing tinnitus.
I always like to find out what happened just before the tinnitus started. Often that gives a clue as to the cause of the tinnitus. For example, if you begin a new medication and 3 days later you get loud tinnitus, that could be the cause, or perhaps you are under extraordinary stress—then that could be the cause, etc.
My noises simply started 3 months ago while I was sitting. It was a constant tone about 1K herts in right ear. A week later, whistle sounds started in my left ear. 2 months later I hear high pitch screeching noises in both ears when moving my head left/right or up/down. Also, external sounds at this same pitch enhances the amplitude of this sound in my ears. This is like doubling the sound so that I prceive it much louder than what it is.
There are times when my head/neck movement does not produce this audio condition
The only drug I take is one 500mg naproxen 3 times a week for lower back.
Hi Julius:
Interesting about your tinnitus. Naproxen (Aleve) is known to cause tinnitus in up to 9% of the people taking it. Some people don’t get tinnitus from Naproxen until they have been taking it for a few years. Others get it within a few weeks. Everyone is different.
The tinnitus you get when you move your head/neck is most likely related to problems with your neck being “out”. Chiropractic treatments should help solve this somatic kind of tinnitus.
Sometimes tinnitus reacts to sounds and makes this makes the tinnitus louder. This seems to be the case when you hear sounds of similar pitch to your tinnitus. They call this reactive tinnitus. I don’t know why some people react to tinnitus like this, and others don’t.
Regards
Neil
Sir; you mention chiro. treatments possibly helping w/ somatic tinnitis, is it possible the opposite could be true, neck manipulation cause the Tn.?
I took 800 mgs.of bactrimds and 4 days later the miserable tn. began,but I also had neck manipl. at the chiro same day. I would appreciate your comments.
It is both pulsatile and somatic. JB
Hi Jay:
Somatic tinnitus can be caused by your neck being “out”. When you go to a chiropractor, you assume he will put it back “in”, but there are no guarantees.
For example, your neck could quickly slip “out” again as the ligaments could be too stretched to hold things in the proper place with just one treatment.
Also, the chiropractor could have used a bit more force than necessary, or you could have relaxed more than he expected just when he went to do the adjustment and as a result, he adjusted you too far. Therefore, you could now be “out” the other way. This does happen from time to time.
As a result since your neck is still “out” your tinnitus can act up. You may need to go back for a further adjustment.
However, maybe the drugs are the culprit. Bactrim is a combination of Trimethoprim and Sulfamethoxazole. Both of these drugs are known to cause tinnitus in some people.
Therefore, it is hard to say whether your increased tinnitus is because of the drugs, because of the chiropractic treatment or in spite of the chiropractic treatment.
Neil
My tinnitus started slowy, in soft pitch in 1995. I was taking no drugs at the time. It has increased over the years to a roaring sound with different levels of pitch. It generally starts out almost tollerable in the a.m. but throughout the day, continues in pitch until it is almost unbearable. I do, now, takes drugs for varius autoimmune issues. I was on methotrexate for over a year and although it helped tremendously with the pustular psorisis I had, it did nothing for the AIED/bilateral Meniere’s I’d been diagonised with in 2002. I’m not allergic to foods or flora. I’m now on a program of probiotics (self-induced). Supplements like L-lysine (viral medication) and extra vitamin C have not made a difference in my symptoms. The tinnitus gets worse as I grow older. I rarely leave my house now because the noise “outside” leaves me taking zanax (prescribed) to help with the tinnitus.
Although I’ve always had tinnitus, I have used Welbutrin in the past and didn’t notice any difference. Is this only an issue for some folks?
Hi Karen:
With very few exceptions, all drugs that are associated with tinnitus, do not result in tinnitus in every person taking it. In fact, such drugs may only cause tinnitus in a small fraction of the people taking it, or may cause tinnitus in a much larger portion of the people taking it.
So you may never have tinnitus as a result of taking this drug, or it may only show up if you take it for a couple of years or longer.
Cordially,
Neil
Hi Neil,
I wasn’t sure where to post this question. I have tinnitus and my neurologist wants to do a brain MRA with and without contrast dye. Do you know if the dye is ototoxic?
Hi Renee:
The various gadolinium contrast dyes are all ototoxic to some degree. However, they seldom cause tinnitus problems, they most often cause ataxia (a balance problem).
These dyes aren’t good for your body, so I wouldn’t use them unless it was critical to the success of the MRI. I’d tell them to just do the MRI without the contrast dyes and see if the results are good enough. THEN if it is critical to have the contrast dye, go for it (if you choose). That’s how I approach MRIs.
Cordially,
Neil
Dear Dr.Neil,
I’m really seeking for your advice.
Over the past two weeks I’ve been noticing my tinnitus and hyperacusis getting worse. I had also aggravations before but they have always been explained by taking ototoxic meds
/exposing to loud sounds. So I knew the cause and took all the measures to protect my ears every time. This time I can’t get the cause…
I don’t take any medicines and I don’t listen to anything loud at all. I’m just trying to cure my trigeminal neuralgia for 5th month with physiotherapy (and without meds because the majority of them are ototoxic according to your book) that is called magnetic laser (but it has never made me any harm). And also I’ve visited dentist twice during this period.
At first visit I noticed that anesthesia made my tinnitus gradually worse over the day (not right after the dentist, so I was sure it wasn’t noise exposure). The following days I felt my tinnitus also a tiny bit worse but didn’t really pay attention to it.
So after I decided to find a dentist who could avoid using any anesthesia while treating me. I managed to find one, had a visit and everything was good for another two days. After, the third day I noticed a small aggravation after waking up but thought it was temporary. On the 4th day I went out during the night to walk a little bit, smoke two cigarettes bcs of being nervous and returned home. I don’t smoke usually but can let myself have a one-two cigarettes per week or couple of weeks maximum and it never ever did any harm to my tinnitus. After I returned home I found myself having a significant obvious spike. I got really scared and thought it was due to nicotine. I never smoked ever since. It was 4 days ago.
Over those past 4 days I still have my tinnitus and hyperacusis gradually aggravating day by day. Usually I find the aggravation during the morning. I can’t find any reason and I’m desperate to find a cause. I’ve done several examinations already and been to several doctors. For now my tests for blood circulation, audiogram and ABR came out to be good. Tomorrow I’m gonna do an MRI and CT. Today I also did some blood examinations.
What it can be for to? Some dental work and reaction to fillings? I checked fillings materials – Vitremer and Filtek Ultimate are not ototoxic agents according to your book. I don’t use any type of anesthesia also…
Can my trigeminal neuralgia cause tinnitus/hidden hearing aggravation? My TN is super mild and I almost forgot about pain without using any meds but only thank to physiotherapy…
Sudden Sensorial Hearing Loss? Autoimmune diseases? How I can detect them? Which indispensable blood tests maybe I should also undergo?
I’m looking forward to going to my study in Milan in a week and I hope I will be able to find a high frequency audiogram as in the city where I am I can’t find any… maybe I will be able to find problems with my hearing on high frequencies this time (my previous high frequency audiogram came out to be almost perfect, 10db loop on 16.000hz only)
Could you please share your thoughts about my situation and what I should do in order to stop my situation from getting worse… I’m really scared and desperate as my tinnitus is already very loud and I don’t know how I will be able to live with ever worse sounds in my head…
Thank you very much, your website and work tremendously help people with hearing problems,
Anna
Hi Dr. Neil,
I believe I got acoustic trauma 5 weeks ago but did not realise it was such until reading this blog. In the week since acquiring it, I tried to live normally and tried to continue listening to music but could not go above minimal sound levels due to pain and sensitivity.
I remember one day I turned up the volume on my headphones loud to compensate for a loud study hall/ common area. This could have gone on for a minute onwards, but not too long. My ears already ached so I don’t know if the sound caused pain. I also already had tinnitus from the a/t and would not be able to say if this aggravated it.
Did I set back my healing by doing this or worse, did I potentially cause permanent damage by doing this while my ears were still in a sensitive state? I still have tinnitus in one ear.
Hi Mary:
You want to give your ears time to heal before you expose them to loud sounds again, not live normally if that includes exposing your ears to louder sounds.
You may have had a bit of a setback–but don’t worry–setbacks, but their very nature are temporary and it just takes a bit longer to heal. I doubt you caused permanent damage from this. Just protect your ears from loud sounds in the future.
Cordially,
Neil
Hello Dr. Neil,
From the symptoms you describe on this site, I think I suffered an acoustic trauma 2 months ago (8 weeks) and had 24/7 tinnitus throughout that time. One ear seemingly stopped or at least went down to a level that was passable. For reference, the initial injury came from less than an hour at a gig. My doctor said I had blocked eustachian tubes and treated that, once the left unblocked, the tinnitus went away, or else I thought it did. Right still remains blocked.
However, I was exposed to a brief loud noise- couple of seconds- close to my ears a couple of days ago which restarted the tinnitus in the “healed” ear, and increased it in the other. There is also new frequencies in both. There was brief pain in the right, I immediately left and the pain stopped as soon as the noise stopped. Measuring the noise however, it was all below the limit of 75, even below 70, but my ears must be in a sensitive state. I had earplugs in during this. Could it have been the vibrations through bone conduction?
Throughout the 2 months I’ve been wearing earplugs, especially on the street, in bars, even if the television is loud, although I potentially had setbacks early on as I wasn’t aware of the extent of the injury initially and didn’t have earplugs then- google saying ringing will stop in a couple days, just a case of concert ear etc.
I’m writing to ask what the potential prognosis is, if the tinnitus will once again go away from the “healed” left ear, if my right still has a chance to heal completely, or if this spike will even go down at all. These new frequencies have me worried that it’s serious.
I’d also like to ask, does an increase in the severity of tinnitus from another exposure to noise indicate further damage done and a reversal of the healing done to that date? I’m asking this, because I’d hate to think the effort put in to mind my ears has been undone due to this.
Thank you very much,
Sarah
Hi Sarah:
An hour of excessively loud sounds like you get at nightclubs and concerts could certainly give you acoustic trauma. That is why you should always wear ear protection at such venues.
A sound below 70 dB should not have affected your tinnitus, nor should it have caused pain. That is just a normal level of sound. And with earplugs in, the sound would have been reduced down to below 50 dB which is normal speech loudness.
So something else is going on. I am almost certain the acoustic trauma you experienced, not only gave you tinnitus and a feeling of blocked ears, but it also gave you loudness hyperacusis–hence your sensitivity to normal levels of sound.
I also fear you have been overusing ear protectors and that has just made your hyperacusis worse. You should only wear ear protectors when sounds are too loud, but it seems you are wearing them in other situations as well. For example, how can the TV been to loud? You just turn the volume down a bit, not wear ear protectors.
You may now also have reactive tinnitus where you tinnitus gets louder (spikes) as the background sound level increases.
I don’t think your ears “healed”–just that the pain and tinnitus went away–but you still had the hyperacusis. Normally, it takes several months and up to 2 or 3 years for it to completely go away. And when you expose your ears to louder sounds during that time, not only can it get worse, but so can your tinnitus.
Probably your tinnitus will go away eventually, assuming you haven’t caused yourself a hearing loss. If you now have a hearing loss, your tinnitus will likely remain permanent.
However, you can learn how to successfully deal with your tinnitus so it won’t bother you. This is called habituating to your tinnitus. In order to habituate to your tinnitus, you must not think of your tinnitus as a threat to your well-being, but rather that it is just a totally unimportant background sound that is safe to ignore–then ignore it by focusing your attention on the loves of your life.
When you expose your ears to sounds that make your tinnitus worse, you know those sounds are too loud for your ears. It doesn’t necessarily mean you have caused more physical damage, but it is a warning that you are messing up your auditory system in some way.
Cordially,
Neil
Hello Dr. Neil,
Thank you very much for your reply. In terms of the hearing loss, is it possible to have caused that in this situation, from a sound lower than 70db but close to my ears?
Kind regards,
Sarah
Hi Sarah:
When you are determining how loud a sound is for purposes of hearing loss, you need to measure the sound right at your ears–not at the source of the sound as the intensity of the sound rapidly drops as the distance increases.
Mathematically, the sound intensity in free space varies inversely with the square of the distance.
So to be accurate, you’d need to measure the sound level in your ear canals and if it is less than 70 dB, it should not be hurting your ears at all.
Cordially,
Neil