Tinnitus (Ringing in Ear)

Overview of Tinnitus (Ringing in Ear)

Tinnitus ( دانگ) refers to the ringing, buzzing, roaring or humming sounds in the ears or the loud noise that a person receives to the ear. Tinnitus is not a disease; it's a symptom of a complication or underlying condition such as ear injury, cogan's syndrome, age-related hearing loss or a circulatory system disorder.

About 15 to 20% of people suffer from tinnitus due to different conditions. It is a common problem, not considered as a sign of critical conditions. Treating the exact cause of tinnitus may help to improve this issue.

Prevalence of Tinnitus in Pakistan

According to one of the studies conducted in Pakistan, only 70% of people reported a single type of tinnitus sensation (ringing or buzzing). In which 48.18% of people heard a buzzing sound and 12.4% are ringing impulses. About 11.8% of people suffered from the combined sounds of tinnitus like buzzing along with ringing, or whooshing along with hissing, or humming, and, roaring, beeping, and buzzing, etc. But if they hear one sound at a time then the percentage of these kinds of tinnitus are whooshing 9.1%, hissing 7.3%, and other 5.4%. 

Signs and Symptoms of Tinnitus (Ringing in Ear)

Tinnitus is characterized by a noise in the ear. The sounds can be continuous or come at different intervals. Such sounds include buzzing, rining, whistling, roaring, buzzing etc.

Types of Tinnitus (Ringing in Ear)

There are two types of tinnitus a person usually feels are listed below.

  • Subjective Tinnitus- It is quite a common type of tinnitus in which only a patient can hear. It can be caused by outer, middle or inner ear problems. It affects the hearing nerves or parts of the brain that detect nerve signals into sound.

  • Objective Tinnitus- It is a rare type in which a doctor can hear the sound during an examination. It can be caused by a blood vessel problem, middle ear bone complications or contraction of the muscle.

Causes of Tinnitus (Ringing in Ear)

Involving the several factors can cause tinnitus, depending on the patient's conditions that are:

Generally, the middle ear receives the sound waves and the inner ear transmits the electrical impulses to the brain where these impulses convert into sound waves. In this way, a person hears a sound. Any damage in the inner ear or middle ear due to some external objects may cause tinnitus. 

If the eardrums or tiny bones in the eardrum get disrupted can also be a problem of irregular conduction of sound. Another reason for tinnitus is the growth of tumours in the ear or on the auditory nerve.

An individual exposed to extremely loud sounds on a daily basis can be a reason for experiencing ringing of bells.

By using the jackhammers, chainsaws, or other heavy equipment it is more likely to have tinnitus. A person's interest is listening to loud music through headphones or attending a concert might produce temporary symptoms of tinnitus.

Excessive use of some medications or ototoxicity (hearing damage) can also cause tinnitus in some people. Below are the specific drugs include:

  • Very high doses of aspirin, such as more than 12 doses daily for a longer period
  • Loop diuretic medications, such as bumetanide
  • Antimalarial drugs, such as chloroquine
  • Antibiotics, such as erythromycin and gentamicin
  • Anti-cancer drugs, such as vincristine

Other medical problems that can also cause ringing in the ears.


  • Age-related hearing loss
  • Muscle spasms in your middle ear
  • Meniere's disease, affecting an inner ear that causes hearing and balance loss
  • High blood pressure
  • High cholesterol
  • Head and neck injuries
  • Chronic pain in jaw and head such as Temporomandibular joint disorders
  • Excessive accumulation of earwax in the ear

Risk Factors of Tinnitus (Ringing in Ear)

Tinnitus is a symptom that everyone may have due to some condition, but it may increase the risk by given factors:

  • Prolonged Loud Exposure: Those individuals who are exposed to loud noise can destroy the sensory cells of the inner ear that transmit the sound to the brain such as factory and construction workers, musicians and soldiers — are particularly at risk.
  • Age: As the person grows older, the function of nerve fibres in-ear starts to reduce day by day, which may cause hearing problems.
  • Sex: Men are more sensitive to tinnitus.
  • Smokers: Tobacco Smokers have a higher risk of having tinnitus.
  • Cardiovascular Problems: Conditions affect the blood flow, such as high blood pressure or narrowed arteries (atherosclerosis), can increase your risk of tinnitus.

Complications of Tinnitus

Tinnitus can significantly affect those people who are suffering from following conditions:




In many cases, tinnitus is not controlled due to the underlying cause. But there are few steps a person needs to follow in order to prevent tinnitus in acute cases.

  • Use hearing protection when a person goes to a noisy environment such as rattling machinery, industry workers, firearms (pistols or shotguns) etc.
  • Avoid long-term exposure of the louder sounds.
  • A person should prevent themselves from cardiovascular diseases by changing their lifestyle, such as regular exercise, and eating a healthy diet.


A ENT specialist examines the patient's ears and recommends doing a hearing test for diagnosing the tinnitus or may send it to an audiologist for hearing analysis. An audiologist passes the sounds through headphones to one ear at a time. Patients act in response to hearing the sound either they raise their hands or make a gesture of each sound.

There are other ways to diagnose the tinnitus such as ask the queries regarding the health or can also evaluate the ringing of sounds on the basis of age and sex.

An ENT specialist conducts the imaging studies such as CT scan or MRI scans, to check any deformities or damage in the ears. But the standard plain film X-rays don't always view the tumours, blood vessel disorders, or other abnormalities that can be the reason for hearing problems.

Treatment of Tinnitus (Ringing in Ear) | When to Consult a Doctor

An ENT specialist identifies the cause of tinnitus by performing the diagnostic tests. After that, the appropriate treatment is to be chosen for the patients. This helps to reduce the variety of irregular noise in the ears.

Following are the suitable treatment options that are required for an affected person.

  • Removing the accumulated earwax can decrease tinnitus symptoms.
  • Treating an underlying vascular condition may require medication, surgery or another treatment to fix the problem.
  • Changing the medication is appropriate for the patients. Sometimes, tinnitus is a side effect of various medications.

Noise Suppression

To suppress the noise, a doctor advised using different electronic devices which include:

  • White Noise Machines: This treatment is considered an effective treatment for tinnitus.These devices are used to control the simulated environmental sounds such as falling rain or ocean waves. A person can also try a white noise machine with pillow speakers to sleep well. Other devices are Fans, humidifiers, dehumidifiers and air conditioners in the bedroom may help cover the internal noise at night.
  • Hearing Aids: These are the small powerful electronic devices that are worn in or behind the ear. It can be helpful to a person who is experiencing hearing problems as well as tinnitus.
  • Masking Devices: Like hearing aids, this device wears in the ear to suppress the louder noises that ultimately recover tinnitus.
  • Tinnitus Retraining: A wearable device masks the tonal music to specific frequencies of tinnitus that a person is experiencing.


Drugs cannot treat the tinnitus but have the ability to reduce it as much as they can. In some cases, these medications play a vital role to control the severity of symptoms or complications associated with tinnitus. Possible medications include the following:

Tricyclic antidepressants, such as amitriptyline and nortriptyline, have been used to treat severe tinnitus and can cause some side effects including:

Alprazolam (Xanax) is useful to reduce tinnitus symptoms, with some side effects including drowsiness and nausea. A person can be addicted to these medications. 


In case you exhibit any signs and symptoms for tinnitus, consult a medical professional as soon as possible.