Tinnitus

Tinnitus is the perception of noise or ringing in the ears. A common problem, tinnitus affects about 15 to 20 percent of people. Tinnitus isn't a condition itself — it's a symptom of an underlying condition, such as age-related hearing loss, ear injury or a circulatory system disorder.

Although bothersome, tinnitus usually isn't a sign of something serious. Although it can worsen with age, for many people, tinnitus can improve with treatment. Treating an identified underlying cause sometimes helps. Other treatments reduce or mask the noise, making tinnitus less noticeable.

Symptoms
Tinnitus involves the sensation of hearing sound when no external sound is present. Tinnitus symptoms may include these types of phantom noises in your ears:

Ringing
Buzzing
Roaring
Clicking
Hissing
Humming
The phantom noise may vary in pitch from a low roar to a high squeal, and you may hear it in one or both ears. In some cases, the sound can be so loud it can interfere with your ability to concentrate or hear external sound. Tinnitus may be present all the time, or it may come and go.

There are two kinds of tinnitus.

Subjective tinnitus is tinnitus only you can hear. This is the most common type of tinnitus. It can be caused by ear problems in your outer, middle or inner ear. It can also be caused by problems with the hearing (auditory) nerves or the part of your brain that interprets nerve signals as sound (auditory pathways).
Objective tinnitus is tinnitus your doctor can hear when he or she does an examination. This rare type of tinnitus may be caused by a blood vessel problem, a middle ear bone condition or muscle contractions.
When to see a doctor
If you have tinnitus that bothers you, see your doctor.

Make an appointment to see your doctor if:
You develop tinnitus after an upper respiratory infection, such as a cold, and your tinnitus doesn't improve within a week
See your doctor as soon as possible if:
You have tinnitus that occurs suddenly or without an apparent cause
You have hearing loss or dizziness with the tinnitus
Causes
A number of health conditions can cause or worsen tinnitus. In many cases, an exact cause is never found.

A common cause of tinnitus is inner ear hair cell damage. Tiny, delicate hairs in your inner ear move in relation to the pressure of sound waves. This triggers cells to release an electrical signal through a nerve from your ear (auditory nerve) to your brain. Your brain interprets these signals as sound. If the hairs inside your inner ear are bent or broken, they can "leak" random electrical impulses to your brain, causing tinnitus.

Other causes of tinnitus include other ear problems, chronic health conditions, and injuries or conditions that affect the nerves in your ear or the hearing center in your brain.

Common causes of tinnitus
In many people, tinnitus is caused by one of these conditions:

Age-related hearing loss. For many people, hearing worsens with age, usually starting around age 60. Hearing loss can cause tinnitus. The medical term for this type of hearing loss is presbycusis.
Exposure to loud noise. Loud noises, such as those from heavy equipment, chain saws and firearms, are common sources of noise-related hearing loss. Portable music devices, such as MP3 players or iPods, also can cause noise-related hearing loss if played loudly for long periods. Tinnitus caused by short-term exposure, such as attending a loud concert, usually goes away; both short- and long-term exposure to loud sound can cause permanent damage.
Earwax blockage. Earwax protects your ear canal by trapping dirt and slowing the growth of bacteria. When too much earwax accumulates, it becomes too hard to wash away naturally, causing hearing loss or irritation of the eardrum, which can lead to tinnitus.
Ear bone changes. Stiffening of the bones in your middle ear (otosclerosis) may affect your hearing and cause tinnitus. This condition, caused by abnormal bone growth, tends to run in families.
Other causes of tinnitus
Some causes of tinnitus are less common, including:

Meniere's disease. Tinnitus can be an early indicator of Meniere's disease, an inner ear disorder that may be caused by abnormal inner ear fluid pressure.
TMJ disorders. Problems with the temporomandibular joint, the joint on each side of your head in front of your ears, where your lower jawbone meets your skull, can cause tinnitus.
Head injuries or neck injuries. Head or neck trauma can affect the inner ear, hearing nerves or brain function linked to hearing. Such injuries generally cause tinnitus in only one ear.
Acoustic neuroma. This noncancerous (benign) tumor develops on the cranial nerve that runs from your brain to your inner ear and controls balance and hearing. Also called vestibular schwannoma, this condition generally causes tinnitus in only one ear.
Eustachian tube dysfunction. In this condition, the tube in your ear connecting the middle ear to your upper throat remains expanded all the time, which can make your ear feel full. Loss of a significant amount of weight, pregnancy and radiation therapy can sometimes cause this type of dysfunction.
Muscle spasms in the inner ear. Muscles in the inner ear can tense up (spasm), which can result in tinnitus, hearing loss and a feeling of fullness in the ear. This sometimes happens for no explainable reason, but can also be caused by neurologic diseases, including multiple sclerosis.
Blood vessel disorders linked to tinnitus
In rare cases, tinnitus is caused by a blood vessel disorder. This type of tinnitus is called pulsatile tinnitus. Causes include:

Atherosclerosis. With age and buildup of cholesterol and other deposits, major blood vessels close to your middle and inner ear lose some of their elasticity — the ability to flex or expand slightly with each heartbeat. That causes blood flow to become more forceful, making it easier for your ear to detect the beats. You can generally hear this type of tinnitus in both ears.
Head and neck tumors. A tumor that presses on blood vessels in your head or neck (vascular neoplasm) can cause tinnitus and other symptoms.
High blood pressure. Hypertension and factors that increase blood pressure, such as stress, alcohol and caffeine, can make tinnitus more noticeable.
Turbulent blood flow. Narrowing or kinking in a neck artery (carotid artery) or vein in your neck (jugular vein) can cause turbulent, irregular blood flow, leading to tinnitus.
Malformation of capillaries. A condition called arteriovenous malformation (AVM), abnormal connections between arteries and veins, can result in tinnitus. This type of tinnitus generally occurs in only one ear.
Medications that can cause tinnitus
A number of medications may cause or worsen tinnitus. Generally, the higher the dose of these medications, the worse the tinnitus becomes. Often the unwanted noise disappears when you stop using these drugs. Medications are known to cause or worsen tinnitus include:

Antibiotics, including polymyxin B, erythromycin, vancomycin (Vancocin HCL, Firvanq) and neomycin
Cancer medications, including methotrexate (Trexall) and cisplatin
Water pills (diuretics), such as bumetanide (Bumex), ethacrynic acid (Edecrin) or furosemide (Lasix)
Quinine medications used for malaria or other health conditions
Certain antidepressants, which may worsen tinnitus
Aspirin taken in uncommonly high doses (usually 12 or more a day)
In addition, some herbal supplements can cause tinnitus, as can nicotine and caffeine.

Risk factors
Anyone can experience tinnitus, but these factors may increase your risk:

Loud noise exposure. Prolonged exposure to loud noise can damage the tiny sensory hair cells in your ear that transmit sound to your brain. People who work in noisy environments — such as factory and construction workers, musicians, and soldiers — are, particularly at risk.
Age. As you age, the number of functioning nerve fibers in your ears declines, possibly causing hearing problems often associated with tinnitus.
Sex. Men are more likely to experience tinnitus.
Smoking. Smokers have a higher risk of developing tinnitus.
Cardiovascular problems. Conditions that affect your blood flow, such as high blood pressure or narrowed arteries (atherosclerosis), can increase your risk of tinnitus.
Complications
Tinnitus can significantly affect the quality of life. Although it affects people differently, if you have tinnitus, you may also experience:

Fatigue
Stress
Sleep problems
Trouble concentrating
Memory problems
Depression
Anxiety and irritability
Treating these linked conditions may not affect tinnitus directly, but it can help you feel better.

Prevention
In many cases, tinnitus is the result of something that can't be prevented. However, some precautions can help prevent certain kinds of tinnitus.

Use hearing protection. Over time, exposure to loud sounds can damage the nerves in the ears, causing hearing loss and tinnitus. If you use chain saws, are a musician, work in an industry that uses loud machinery or use firearms (especially pistols or shotguns), always wear over-the-ear hearing protection.
Turn down the volume. Long-term exposure to amplified music with no ear protection or listening to music at very high volume through headphones can cause hearing loss and tinnitus.
Take care of your cardiovascular health. Regular exercise, eating right and taking other steps to keep your blood vessels healthy can help prevent tinnitus linked to blood vessel disorders.

Ruptured eardrum (perforated eardrum)
Overview
A ruptured eardrum — or tympanic membrane perforation as it's medically known — is a hole or tear in the thin tissue that separates your ear canal from your middle ear (eardrum).

A ruptured eardrum can result in hearing loss. A ruptured eardrum can also make your middle ear vulnerable to infections or injury.

A ruptured eardrum usually heals within a few weeks without treatment. Sometimes, however, a ruptured eardrum requires a procedure or surgical repair to heal.

Symptoms
Signs and symptoms of a ruptured eardrum may include:

Ear pain that may subside quickly
Clear, pus-filled or bloody drainage from your ear
Hearing loss
Ringing in your ear (tinnitus)
Spinning sensation (vertigo)
Nausea or vomiting that can result from vertigo
When to see a doctor
Call your doctor if you experience any of the signs or symptoms of a ruptured eardrum or pain or discomfort in your ears. Your middle and inner ears are composed of delicate mechanisms that are sensitive to injury or disease. Prompt and appropriate treatment is important to preserve your hearing.

Causes
Causes of a ruptured, or the perforated, eardrum may include:

Middle ear infection (otitis media). A middle ear infection often results in the accumulation of fluids in your middle ear. Pressure from these fluids can cause the eardrum to rupture.
Barotrauma. Barotrauma is stress exerted on your eardrum when the air pressure in your middle ear and the air pressure in the environment are out of balance. If the pressure is severe, your eardrum can rupture. Barotrauma is most often caused by air pressure changes associated with air travel.

Other events that can cause sudden changes in pressure — and possibly a ruptured eardrum — include scuba diving and a direct blow to the ear, such as the impact of an automobile airbag.

Loud sounds or blasts (acoustic trauma). A loud sound or blast, as from an explosion or gunshot — essentially an overpowering sound wave — can cause a tear in your eardrum.
Foreign objects in your ear. Small objects, such as a cotton swab or hairpin, can puncture or tear the eardrum.
Severe head trauma. Severe injury, such as skull fracture, may cause the dislocation or damage to middle and inner ear structures, including your eardrum.
Complications
Your eardrum (tympanic membrane) has two primary roles:

Hearing. When sound waves strike it, your eardrum vibrates — the first step by which structures of your middle and inner ears translate sound waves into nerve impulses.
Protection. Your eardrum also acts as a barrier, protecting your middle ear from water, bacteria and other foreign substances.
If your eardrum ruptures, complications can occur while your eardrum is healing or if it fails to heal. Possible complications include:

Hearing loss. Usually, hearing loss is temporary, lasting only until the tear or hole in your eardrum has healed. The size and location of the tear can affect the degree of hearing loss.
Middle ear infection (otitis media). A perforated eardrum can allow bacteria to enter your ear. If a perforated eardrum doesn't heal or isn't repaired, you may be vulnerable to ongoing (chronic) infections that can cause permanent hearing loss.
Middle ear cyst (cholesteatoma). A cholesteatoma is a cyst in your middle ear composed of skin cells and other debris.

Ear canal debris normally travels to your outer ear with the help of ear-protecting earwax. If your eardrum is ruptured, the skin debris can pass into your middle ear and form a cyst.

A cholesteatoma provides a friendly environment for bacteria and contains proteins that can damage the bones of your middle ear.

Prevention
Follow these tips to avoid a ruptured or perforated eardrum:

Get treatment for middle ear infections. Be aware of the signs and symptoms of middle ear infection, including earache, fever, nasal congestion and reduced hearing. Children with middle ear infection often rub or pull on their ears. Seek prompt evaluation from your primary care doctor to prevent potential damage to the eardrum.
Protect your ears during flight. If possible, don't fly if you have a cold or an active allergy that causes nasal or ear congestion. During takeoffs and landings, keep your ears clear with pressure-equalizing earplugs, yawning or chewing gum. Or use the Valsalva maneuver — gently blowing, as if blowing your nose, while pinching your nostrils and keeping your mouth closed. Don't sleep during ascents and descents.
Keep your ears free of foreign objects. Never attempt to dig out excess or hardened earwax with items such as a cotton swab, paper clip or hairpin. These items can easily tear or puncture your eardrum. Teach your children about the damage that can be done by putting foreign objects in their ears.
Guard against excessive noise. Protect your ears from unnecessary damage by wearing protective earplugs or earmuffs in your workplace or during recreational activities if a loud noise is present.

People may think that earaches are just a minor nuisance, but they can cause debilitating pain. While waiting for medical care or for antibiotics to work, some home remedies can help.
Ear pain can feel unbearable, making it difficult to sleep, eat, or do anything but think about the pain. Many children find it particularly difficult to deal with an earache.

People who are experiencing severe ear pain should always speak to a doctor, especially for the first time. However, there are remedies that people can use at home to relieve less severe earaches, or as a means of reducing pain.

This article explores nine effective home remedies that may help people experiencing ear pain.

Causes of ear pain
man with an earache
An earache can be mild but an ear infection can cause debilitating pain.
Ear infections are the most common cause of ear pain. When the ear becomes infected, inflammation and buildup of pressure cause pain that can be intense.

People with ear infections often have other symptoms, such as sinus pressure or a sore throat because infections from nearby areas may affect the ear. An ear infection can also be a standalone condition. Most ear infections are bacterial, not viral.

Only a doctor can diagnose an ear infection. People should not take antibiotics without a prescription, or assume that symptoms are due to an ear infection.

However, earaches are not always caused by an ear infection. Other conditions can also cause pain in the ear.

Those include:

Referred pain: This may be from infections or inflammation elsewhere in the body. For example, a toothache may cause aching pain in the ear.
Chronic conditions: These include temporomandibular joint (TMJ) dysfunction.
Skin infections: If they are in or around the ear.
Allergic reactions: These could be from a range of things, such as soap, shampoo, or earrings.
Water: This may cause pain if trapped in the ear.
Pressure: Changes in altitude can affect pressure in the ears. This usually resolves on its own, often with a popping sensation.
If left untreated, ear infections can spread to the jaw and other regions of the body. They may also damage the ear itself and can cause dangerously high fevers.

When symptoms of an ear problem are present and do not resolve on their own within a day or two, people should speak to a doctor. If the pain is intense, is accompanied by a high fever, or includes hearing loss, people should seek medical attention immediately.

Ear Infection

What is an ear infection?
Ear infections can affect the ear canal or the middle ear.
Acute otitis externa (AOE) is the scientific name for an infection of the ear canal, which is also called swimmer’s ear.
Middle ear infections are called Otitis Media, and there are two types of middle ear infections:
Otitis Media with Effusion (OME) occurs when fluid builds up in the middle ear without pain, pus, fever, or other signs and symptoms of infection.
Acute Otitis Media (AOM) occurs when fluid builds up in the middle ear and is often caused by bacteria, but can also be caused by viruses.


Causes
Bacteria
AOM is often caused by bacteria, and Streptococcus pneumoniae is a common bacterial cause of AOM.
Breast feeding exclusively until your baby is 6 months old and continuing to breastfeed for at least 12 months can protect your baby from infections, including AOM.

Cold and Flu Season
AOM often occurs after a cold. Viruses cause OME (fluid in the middle ear), and then bacteria can grow in the fluid leading to AOM.

Injury to the Ear
Foreign objects, like cotton swabs and bobby pins, can cause cuts and bruises in the ear canal that can get infected, causing acute otitis external AOE.
Avoid putting foreign objects in the ear.

Cigarette Smoke
Exposure to cigarette smoke can lead to more colds and more AOM.
Avoid smoking and exposure to secondhand smoke.

Family History
The tendency to develop AOM can run in families.
Family history is not preventable. Instead, focus on other prevention methods, like staying up to date on vaccinations, breast feeding, and avoiding smoke.

How are ear infections treated?
AOE is usually treated with antibiotic ear drops.
OME usually goes away on its own and does not benefit from antibiotics.
AOM may not need antibiotics in many cases because the body’s immune system can fight off the infection without help from antibiotics, but sometimes antibiotics are needed.

Ear discharge (otorrhea) is drainage from the ear. The drainage may be watery, bloody, or thick and whitish, like pus
(purulent). Depending on the cause of the discharge, people may also have ear pain, fever, itching, vertigo, ringing in
the ear (tinnitus), and/or hearing loss. Symptoms range from sudden and severe to slowly developing and mild.
Causes
Discharge may originate from the ear canal, the middle ear, or, rarely, from inside the skull.
Overall, the most common causes of ear discharge are
Acute (sudden and severe) middle ear infection (otitis media) with perforation (puncture) of the eardrum
Chronic otitis media(with perforation of the eardrum, cholesteatoma, or both)
External ear infection (otitis externa)
In some people with otitis media (usually children), the eardrum ruptures, releasing the infected material collected
behind the eardrum. The hole in the eardrum almost always heals, but sometimes a small perforation remains. A
perforation may also result from injury or surgery to the eardrum. When a perforation is present, people are at risk of
chronic middle ear infections, which can cause ear discharge.
Serious, but rare, causes of ear discharge include
Cancer of the ear canal
Fracture of the base of the skull
Necrotizing external otitis
Cholesteatoma (a noncancerous growth of white skinlike material in the middle ear)
The ear canal passes through the base of the skull. If a skull fracture (from a severe head injury) involves that part of
the skull, blood and/or cerebrospinal fluid may leak from the ear.
Necrotizing, or malignant, external otitis is a particularly severe form of external ear infection that typically occurs only
in people with diabetes or those who have a compromised immune system (due to HIV infection or chemotherapy for
cancer).
Some people with chronic otitis media develop a noncancerous (benign) growth of skin cells in the middle ear
(cholesteatoma) that can cause discharge. Although a cholesteatoma is noncancerous, it can cause significant damage
to the ear and nearby structures. In severe cases, a cholesteatoma may lead to deafness, facial weakness or paralysis,
and complications with the brain such as an abscess and other infections.
Evaluation
The following information can help people decide when a doctor's evaluation is needed and help them know what to
expect during the evaluation.
Warning signs
In people with ear discharge, certain symptoms and characteristics are cause for concern:
Recent major head injury
Any neurologic symptoms (such as vertigo or difficulty seeing, speaking, swallowing, and/or talking)
Hearing loss in the affected ear
Fever
Redness and/or swelling of the ear or area around the ear