Tinnitus – When whistling and ringing become part of everyday life

Everyone has probably experienced ringing in the ears at some point: a beeping, buzzing, or hissing sound in the ear, often after particularly loud situations, but which usually disappears quickly.

But these noises don't always go away; sometimes they become an unwanted part of everyday life. 

The following section explains what tinnitus is, what causes it, when it becomes chronic, and what treatment options are available.

What is tinnitus?

Tinnitus is noise that people hear even though it cannot be attributed to any external sound source. Rather, these noises originate in the ear or in the auditory system itself. Nevertheless, they can also sound like external noises to those affected.

These noises in the ears manifest themselves in very different ways depending on the person and the cause, for example as hissing and roaring, as humming or hissing, or as ringing, whistling, or beeping. The duration, volume, and pitch can vary. Sometimes the noises in the ears are unilateral, and in some cases they occur in both ears. 

Ear noises are usually harmless and short-lived. They occur, for example, when we have been exposed to noise such as loud music or tool noises. They usually disappear again after a few minutes. However, if the ear noises are persistent and have not disappeared even after several weeks, this is referred to as chronic tinnitus.

What types of ear noises are there?

As already mentioned, tinnitus can manifest itself in many different ways, ranging from whistling and ringing to roaring, hissing, humming, crackling, or other sounds.

Typical ear noises include

• Ringing in the ears: Ringing in the ears often refers to short-term noises in the ears—in contrast to tinnitus, where the sound is usually heard continuously by the person affected. However, ringing in the ears can also manifest itself in different tones (cracking, humming, whistling, etc.), volumes, and frequencies.
  
  
• Tinnitus: For many sufferers, tinnitus sounds like a constant background noise. For some people, this noise sounds like the sound of water or wind, for others like television or radio static. The noise can be continuous or temporary, and vary in volume and intensity. Sometimes the noise in the ear is unilateral, sometimes bilateral. 
  
  
• Ringing in the ears: Ringing in the ears is often described as particularly unpleasant, especially when it is a constant ringing or buzzing sound. Ringing in the ears is often associated with tinnitus, although tinnitus can also manifest itself in other ways, such as hissing or humming noises. This depends on the individual and the cause, etc. 

Pulsating tinnitus: Pulsating tinnitus sounds or feels like a regular throbbing, as if you could hear your heartbeat in your ear. This may also be a case of "pulse-synchronous tinnitus." In this case, the tinnitus is synchronized with your heartbeat, increasing and decreasing with it.

Tinnitus can also occur in many other forms or sounds, including roaring, humming, crackling, ringing, or hissing. For some sufferers, tinnitus sounds like a babble of voices or murmuring, as if several people were talking. Others even experience tinnitus as music or melody.

Which noises in the ear are normal? Which ear noises are dangerous?

Ear noises are often no cause for concern. They occur quickly when we have been exposed to noise for too long, for example at concerts or in discos, on construction sites, or in traffic. Afterwards, "normal" ear noises such as buzzing or ringing occur, but these usually disappear on their own after a short time.

However, tinnitus can sometimes indicate illness or serious disease. These ear diseases include, for example, middle ear infection, ear canal inflammation, Ménière's disease, tympanic effusion, sudden hearing loss, or cholesteatoma. In addition, tinnitus can indicate the onset of hearing loss.
If you notice other symptoms such as ear pain, fever, dizziness, or hearing loss in addition to tinnitus, or if the tinnitus does not go away on its own, you should definitely see an ENT doctor. They can discuss the appropriate treatment with you.

Ringing in the ears or tinnitus?

Contrary to popular belief, ringing in the ears is not always tinnitus. Tinnitus is only diagnosed when the ringing in the ears is persistent, i.e., when it occurs not just temporarily but over a longer period of time. 

The triggers for tinnitus can vary greatly, because what many people also don't know is that tinnitus is a symptom and not a disease. 

But unlike "normal" noises in the ear, tinnitus noises do not disappear. They remain permanently. Furthermore, the noises associated with tinnitus cannot be attributed to a specific source, as they do not come from outside, but originate inside the ear of the person affected. This makes tinnitus difficult to treat and can also be very stressful, both physically and psychologically.

Causes of tinnitus

Similar to earaches, the reasons, causes, or triggers for tinnitus can vary greatly. Some triggers are listed below:

• Noise: Noise is a particularly common cause of ringing in the ears. If we are exposed to loud noises such as music, traffic, or construction noise for too long, we often notice a ringing, buzzing, or hissing sound afterwards. Noise can also damage the cochlea in the inner ear, causing tinnitus.
  
  
• Stress: Inner turmoil, anxiety, and stress can manifest themselves in various physical symptoms, including tinnitus. 
  
  
• Diseases: Ear noises are also among the symptoms of many ear diseases or injuries, such as sudden hearing loss, middle ear infection, ear canal inflammation, or otosclerosis, which causes changes in the bone structures in the inner and middle ear that impair the transmission of sound. However, tinnitus can also occur as a symptom of colds, flu, or COVID-19. 
  

• Impairments of the cervical spine: In addition to various diseases, muscle tension is also believed to be a trigger for tinnitus—ear noises caused by neck tension in particular are therefore currently still being researched. 
  
  
• High blood pressure: High blood pressure is also considered a cause of ringing in the ears. This is because high blood pressure can impair blood supply to the inner ear. A pulsating noise in the ear, on the other hand, can be an early symptom of high blood pressure and should be checked by a doctor.
  
  
• Tinnitus after surgery: Many patients also notice tinnitus after surgery. This can be caused by factors such as high blood pressure, stress and anxiety related to the surgery, or, in the case of ear surgery, a tamponade in the ear. It is important to inform your doctor about any tinnitus in order to rule out possible damage to the inner ear. 
  
  
• Medications: Taking certain medications can also cause ringing in the ears. It is therefore important that you inform your doctor about any medications you are taking during the examination.

Hearing loss: Hearing loss occurs when signals from the ear are no longer transmitted or processed correctly by the brain. This can be caused by damage to the hair cells in the inner ear or problems with the auditory nerve, for example. These damaged hair cells can result in certain sounds and frequencies no longer being transmitted, or being transmitted incorrectly.

What to do about ringing in the ears?

If you notice ringing in your ears, it is important not to ignore it and to monitor it closely. If the symptoms do not improve, regardless of their severity, it is always important to consult an ENT doctor. They can make the correct diagnosis and, if necessary, determine the appropriate treatment. 

If you are diagnosed with chronic tinnitus, there are a number of aids and measures that can help alleviate the symptoms, reduce the ringing in your ears, and thus improve your quality of life.

These include, among other things

• Hearing aids: Ear noises or tinnitus can be treated with hearing aids. Special hearing aids with a so-called tinnitus noiser or tinnitus masker are usually used for this purpose. These noise generators produce "white noise," a steady noise that masks the tinnitus.
  
  
• Tinnitus apps: There are now various apps for smartphones and tablets designed to help tinnitus patients. They offer information, relaxation exercises, meditation, and sound therapy, for example, or filter out the personal tinnitus frequency from the user's favorite music for individual therapy.
  
  
• Medication: Various medications that promote blood circulation and reduce inflammation can also be used to treat ear noises and tinnitus. The medication is prescribed by an ENT specialist.
  
  
• Home remedies for tinnitus: As is often the case, a healthy, balanced diet is recommended to prevent ear problems. In addition, there are a few foods that promise relief from tinnitus, such as ginger and garlic, which promote blood circulation, or foods with anti-inflammatory properties such as turmeric or onions.
  
  
• Relaxation and rest: Since stress can trigger tinnitus, rest and relaxation are another way to reduce it. Various techniques and exercises, such as meditation, yoga, and autogenic training, are ways in which you can actively learn to relax.

Audiotherapy: As part of audiotherapy with an audiotherapist, you learn how to cope with hearing loss or tinnitus, and are introduced to tips and tricks as well as technical aids, etc.