Hearing Health Foundation advises that those who think they may have hearing loss, tinnitus, and/or balance concerns, to make an appointment with a hearing health professional, such as an audiologist and/or an ear, nose and throat specialist (ENT).
During your evaluation, your doctor or audiologist will examine your ears, head and neck to look for possible causes of tinnitus. Tests include:
- Hearing (audiological) exam. As part of the test, you’ll sit in a soundproof room wearing earphones through which will be played specific sounds into one ear at a time. You’ll be asked to indicate when you can hear the sound, and your results are compared with results considered typical for your age. This can help rule out or identify possible causes of tinnitus.
In addition to routine pure tone and speech audiometry, a range of audiological tests can help assess the health and function of your middle ear, inner ear, and auditory pathway. They may include tympanometry, otoacoustic emissions, electrocochleography, auditory brainstem responses, and vestibular evoked myogenic potentials.
Movement. Your doctor may ask you to move your eyes, clench your jaw, or move your neck, arms and legs. If your tinnitus changes or worsens, it may help identify an underlying disorder or other medical causes that need treatment.
Medical causes range from simple cerumen (earwax) impaction in the ear canal to complex conditions that involve the inner ear or auditory neural pathways.
Common auditory conditions that can lead to tinnitus include otitis media (a middle ear infection); otosclerosis (an abnormal bone growth in the middle ear); sudden sensorineural hearing loss (sudden deafness); Ménière’s disease; noise-induced hearing loss; and presbycusis (age-related hearing loss). Rarely, tinnitus is caused by acoustic neuroma (a benign, slow-growing tumor on the auditory nerve), and some brain diseases that involve the auditory system.
Vascular system disorders in the head and neck area can cause tinnitus that pulses in time with the heartbeat. Head and neck injuries including whiplash are frequently associated with tinnitus. Severe temporomandibular (jaw) joint disorders can sometimes result in tinnitus. Tinnitus can also occur with systemic diseases such as severe anemia, hypertension, hypothyroidism, and syphilis.
- Imaging tests. Depending on the suspected cause of your tinnitus, you may need imaging tests such as CT or MRI scans.
The sounds you hear can help your doctor identify a possible underlying cause.
- Clicking. Muscle contractions in and around your ear can cause sharp clicking sounds that you hear in bursts. They may last from several seconds to a few minutes.
- Rushing or humming. Usually vascular in origin, you may notice sound fluctuations when you exercise or change positions, such as when you lie down or stand up.
- Heartbeat. Blood vessel problems, such as high blood pressure, an aneurysm or a tumor, and blockage of the ear canal or eustachian tube can amplify the sound of your heartbeat in your ears (pulsatile tinnitus).
- Low-pitched ringing. Conditions that can cause low-pitched ringing in one ear include Meniere’s disease. Tinnitus may become very loud before an attack of vertigo — a sense that you or your surroundings are spinning or moving.
- High-pitched ringing. Exposure to a very loud noise or a blow to the ear can cause a high-pitched ringing or buzzing that usually goes away after a few hours. However, if there’s hearing loss as well, tinnitus may be permanent. Long-term noise exposure, age-related hearing loss or medications can cause a continuous, high-pitched ringing in both ears. Acoustic neuroma can cause continuous, high-pitched ringing in one ear.
- Other sounds. Stiff inner ear bones (otosclerosis) can cause low-pitched tinnitus that may be continuous or may come and go. Earwax, foreign bodies or hairs in the ear canal can rub against the eardrum, causing a variety of sounds.
In many cases, the cause of tinnitus is never found. Your doctor can discuss with you steps you can take to reduce the severity of your tinnitus or to help you cope better with the noise.