Peter (name changed), a 25-year-old man, visited me because he often heard sounds in his ears. On talking to him, I found that he enjoyed listening to music and used earphones for long hours. Over time, this habit led to tinnitus.

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The term "tinnitus” is derived from the Latin word meaning ringing. In this condition, a person perceives sounds in the ears despite the absence of any external sound. These sounds may be described as ringing, roaring, hissing, hoarse, or buzzing, and they vary according to the individual’s subjective perception. At times, the sound may be pulsatile, occurring in synchrony with the heartbeat.

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This condition is somewhat similar to auditory hallucinations, a psychiatric disorder in which individuals falsely perceive sounds in the environment when none actually exist. However, in tinnitus, there is usually an identifiable underlying cause for the perceived sound. In the majority of cases, tinnitus results from internal damage to the ear and is often associated with varying degrees of hearing loss and, or vertigo – a sensation of spinning, and sometimes nausea.

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Tinnitus may occur due to excessive exposure to loud external sounds, such as constant machine noise in heavy industrial areas. Prolonged exposure can lead to permanent hearing loss. Similarly, the long-term use of earphones for listening to music can also cause tinnitus over time.

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Tinnitus is also commonly associated with aging. About 15–20% of elderly individuals experience tinnitus along with significant hearing loss and vertigo, due to degenerative changes in the auditory nerve and the balance apparatus located within the inner ear.

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People who suffer from frequent colds may also complain of tinnitus. This occurs due to congestion and inflammation of the Eustachian tube, which connects the ear to the nose and affects the middle and inner ear. Accumulation of ear wax can impair sound conduction and lead to tinnitus. Infections of the middle or inner ear, tumours of the auditory nerve, and vascular lesions involving the middle or inner ear are also known causes of tinnitus. Trauma to the ear may result in tinnitus along with other associated symptoms.

Certain medications are known to cause tinnitus as a side effect. Anti-malarial drugs such as quinine, antibiotics like gentamicin and ciprofloxacin, and painkillers such as aspirin and brufen have been associated with tinnitus and can damage the inner ear. Individuals dependent on benzodiazepines (commonly used as sleeping pills) may experience tinnitus when the drug is suddenly discontinued. Similarly, abrupt cessation of caffeine or smoking in habitual users can induce tinnitus in some individuals.

When a person complains of hearing sounds that do not exist, the underlying cause is identified through thorough clinical examination. The middle and inner ears are examined using an otoscope to detect infection or inflammation. Advanced investigations such as audiometry (to assess hearing ability) and calorimetry (to evaluate the balance apparatus of the inner ear) help identify disorders of the auditory nerves or blood vessels.

The use of earplugs helps prevent exposure to loud sounds. Professional musicians protect their ears and reduce the risk of tinnitus by using earplugs that filter damaging high-frequency sounds.

Keeping the ears well covered and avoiding exposure to extreme heat, cold, or dampness helps prevent congestion and tinnitus. Prompt treatment of ear infections plays an important role in prevention. Similarly, removal of impacted ear wax often leads to improvement or resolution of tinnitus. Drug-induced tinnitus usually improves after withdrawal of the offending medication. Healing of ear injuries also leads to significant relief.

Tumours affecting the auditory nerve or structures within the ear are treated surgically. Various electrical, magnetic, or radiation-based stimuli applied to the ear or head using different techniques have been found useful in the management of tinnitus.

Certain antidepressant and anticonvulsant medications have shown benefit in the treatment of tinnitus. The use of local anaesthetic agents may also provide symptomatic relief. Psychotherapy and hearing aids are particularly useful for elderly individuals suffering from hearing loss associated with tinnitus.

Dr. Rachna Pande is a specialist in internal medicine.