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4) What causes tinnitus?


This article is from the Tinnitus FAQ, by markb@cccd.edu (Mark Bixby) with numerous contributions by others.

4) What causes tinnitus?

In a database of 1687 tinnitus patients, no known cause was identified for
43% of the cases, and noise exposure was the cause for 24% of the cases.

* overexposure to loud noises

Repeated exposure to loud noises such as guns, artillery, aircraft,
lawn mowers, movie theaters, amplified music, heavy construction, etc,
can cause permanent hearing damage. Some people report auditory
fatigue from driving automobiles long distances with the windows down.
Anybody regularly exposed to these conditions should consider wearing
ear plugs or other hearing protection (see below).

* MRI, CAT, and other non-invasive scanning machines

These high-tech machines may take great images, but they are very,
very LOUD. Do not attempt this type of imaging without wearing
approved earplugs; any competent imaging facility should be able to
supply the earplugs. [Note: Mark Bixby reports that he had knee MRIs
done, and even with earplugs and his head outside the bulk of the
machine it was very loud.]

* wax/dirt build-up in the ear canal

If you're experiencing tinnitus, this is one of the first things you
should check for. NEVER try digging or suctioning the ear canal
yourself or allow a physician to do it as SERIOUS damage may result.
Numerous over-the-counter chemical washes are available from your
drugstore which will clean the ear canal in a safe and gentle manner.

* acoustic neuromas

Acoustic neuromas are small, slow growing benign tumors that press
against or invade the auditory nerves. If your tinnitus is only in one
ear, you should see your physician to rule this one out. An MRI will
probably be required for a definitive diagnosis, but one contributor's
ENT felt that an MRI wasn't warranted unless frequent dizziness was
present. Acoustic neuromas are removable by surgery but involve a risk
of hearing loss. Doing nothing should be considered an option by
elderly patients since these tumors grow so slowly.

* ototoxic drugs

Many prescription and over-the-counter drugs may cause tinnitus and/or
hearing loss that may be permanent or may disappear when the dosage is
reduced or eliminated. Before starting treatment with any prescription
drug, tinnitus sufferers should always ask their physician and/or
pharmacist about the potential for ototoxic side effects. See the next
section for more detail. These drugs include:

salicylate analgesics (higher doses of aspirin)
naproxen sodium (Naprosyn, Aleve)
many other non-steroidal anti-inflammatories
aminoglycoside antibiotics
loop-inhibiting diuretics
oral contraceptives

* severe ear infections

Many tinnitus cases onset after severe ear infections. But this may
also be related to the use of ototoxic antibiotics (see above).

* high blood cholesterol

High blood cholesterol clogs arteries that supply oxygen to the nerves
of the inner ear. Reducing your cholesterol level may reduce your

* vascular abnormalities

Arteries may press too closely against the inner ear machinery or
nerves. This is sometimes correctable by delicate surgery.

* Temporo-Mandibular Joint (TMJ) syndrome

This jaw disorder may cause tinnitus and is characterized by many
symptoms, including headaches, earaches, tenderness of the jaw
muscles, dull facial pain, jaw noises, the jaw locking open, and pain
while chewing. For a good online document on TMJ, see:


One contributor has this to say about the TMJ/tinnitus connection:

The Sternocleidomastoideus muscle connects on your sternum
by the collar bone on both sides and goes back to the back
of the ear. It's about 6-10 inches long and when it gets
tight, it can pull on the TMJ area thereby creating a pull
on the muscles and ligaments around the inner ear area.
Almost certainly the final "pull" is the sphenomandibular
ligament which connects the ear drum and TMJ. An osteopath
can work with this. Xanax or other benzo's can provide
tension relief as well. The masseter and temporalis muscles
(those in front of the ear and above the ear can cause the
same TMJ/tinnitus problems. If a person wants to know if
their tinnitus is connected to their TMJ in some way, have
them 1) clench their teeth- does it change the tinnitus? 2)
push in hard on the jaw with your palm. Does the tinnitus
change? (Get louder/softer, pitch or tone change) 3) Push in
on the forehead with your hand hard. Resist with the head.
Any changes? In about half the people I talk to, they find a
TMJ correlation they never even dreamed of...

There is a highly recommended dentist knowledgable about TMJ/tinnitus
cases who has 30 years of experience and has authored/co-authored
several papers on the subject:

Doug Morgan, DDS
308 Foothill Boulevard
Glendale, CA USA 91214
+1 818 248-1283

For more information about TMJ, visit the TMJ Foundation (a California
public nonprofit corporation) WorldWideWeb site at
http://www.tmjfound.com/ , or contact them at:

TMJ Foundation
P.O. Box 28275
San Diego, CA USA 92128-0275
fax +1 619 592-9107

* traumatic head injuries

Some automobile crash victims have reported a sudden onset of

* cochlear implant or other skull surgeries

Sometimes poking around inside the skull will accidentally damage the
hearing system. Tinnitus can result, or even profound deafness caused
by severe inner ear infections.

* stress

Stress is not a direct cause of tinnitus, but it will generally make
an already existing case worse.

* diet and other lifestyle choices

Like stress above, a poor diet can worsen an existing case of
tinnitus. Alcohol, tobacco, caffeine, quinine/tonic water, high fat,
high sodium can all make tinnitus worse in some people.

* food allergies

Specific foods may trigger tinnitus. Problem foods include red wine,
grain-based spirits, cheese, and chocolate. One contributor reported
hearing tones after consuming honey. Another contributor notes that
these same foods are on the list known to trigger migraine headaches;
additional migraine foods include soy and anything including soy, MSG,
very ripe bananas, avocados, and citrus fruits.

* foods rich in salicylates

There is a long list of foods that are supposed to be "rich" in
salicylates. See the Shulman book listed below for details. [Ed. note:
I'm not listing the foods here since no data is given on exactly how
rich the foods are, i.e. "13 mangoes = 1000mg aspirin" as a
hypothetical example.]

* glaumous tumors

These tumors can cause pulsatile tinnitus. They are confirmed with a
CAT scan or other imaging, and may be surgically removable by a
delicate procedure.

* mercury amalgam tooth fillings

Researchers June Rogers and Jacyntha Crawley (P.O. Box 413, London SW7
2PT, U.K.) have found a possible connection between mercury tooth
fillings and tinnitus. They publish a booklet on the subject available
for 6 International Reply Coupons, and they also have a questionnaire
that interested people can fill out. Their research suggests following
a vegetarian diet, plus eating 2 raw African green chillies one day,
followed by 1 chilli the next day for temporary relief.

But a prominent American tinnitus specialist says that no such link
has been established.

* marijuana

Marijuana usage may worsen pre-existing cases of tinnitus.

* Lyme Disease

Lyme is a parasitic, tick-borne disease, which in the United States is
most commonly seen in eastern states. In some cases, tinnitus has been
a side-effect of Lyme.

Lyme disease deserves special mention partly because it is so
difficult to diagnose objectively; the commonly available serological
tests have very high rates of false negatives. In the only study (by
McDonald) in the literature which used objective measures
(histopathology) to confirm test results, over 50% of currently
infected patients were negative by ELISA and/or Western Blot. False
positives are infrequent, occurring primarily in pts. exposed to other
nasties such as syphilis or rocky mountain spotted fever. So
serologies can be used to confirm but not to rule out diagnosis.

The Lyme Urine Antigen Test is a useful supplement test to serologies;
it tests for current infection, as opposed to a history of exposure.
It has some problems with low sensitivity; these can be improved by
the following regimen. Give amoxicillin 500mg tid q5d; on days 3,4,5
take and test first-in-the morning urine specimens. The LUAT can be
ordered by your MD from Immugenex, 1-415-424-1191. Other, better tests
(including PCR) are under development, expected to be available for
clinical use within the next few years.

For further online information about Lyme Disease, you may send the
following command in the body of an e-mail message to

subscribe LymeNet-L yourfirstname yourlastname

A regular newsletter is published here, and patients & physicians may
exchange their stories.

* dental procedures

Certain dental procedures such as difficult tooth extractions and
ultrasonic cleaning can cause hearing damage via bone conduction of
loud sounds directly to the ear. Wearing ear plugs will not guard
against bone conduction.

* intracranial hypertension

Intracranial hypertension can cause pulsatile tinnitus. If you can
stop your tinnitus by slight pressure to the neck on the affected
side, that is an indication. The definite way to find out is if you
get a spinal tap and your Opening Pressure is higher than 200.

* otosclerosis

Otosclerosis is a bony growth around the footplate of the stapes (one
of the 3 middle ear bones). This footplate forms the seal that
separates the middle ear space from the inner ear. When the footplate
moves normally, the sound vibrations are passed from the middle ear
"chain" of bones into the fluid of the inner ear. If the footplate is
fixated, the vibrations cannot pass into the inner ear as well and
hence a resulting hearing loss. Tinnitus may also be involved.
Treatment is by surgery, as one poster to alt.support.tinnitus

When should surgery be performed? Well IMHO, it all depends
upon the amount of loss (or progression of the condition)
and the amount of difficulty that the patient experiences.
If the amount of loss caused by the otosclerosis is 40 dB or
more, then surgery may be an option that you may want to
think about. But remember that surgeries can be complicated
and can always end up with no real improvement.

Stapedectomy involves removal of the stapes, along with the
fixated footplate, and insertion of a prosthetic stapes into
the window that contains the oval window.

One "nice" thing about people with conductive hearing loss
(i.e. otosclerosis) is that they are excellent candidates
for hearing aids. They often do not experience the
overwelming loudness that people with sensorineural hearing
loss often report, and speech is not distorted.

If your condition involves a 40 dB loss *DIRECTLY* due to
otoscelerosis, you may want to thnik about surgery, but if
it is less than that, you may want to try a hearing aid, and
think about surgery in the future (if the condition develops

* aspartame

Some people allege (quite controversially) that the artificial sugar
substitute aspartame is linked to tinnitus, vertigo, and many other
serious problems (I agree). To retrieve further information about the
allegations against aspartame, send e-mail to freeinfo@servint.com and
include the lowercase command "info mp" in the body (not the Subject:)
of the message.

* Arnold Chiari Malformation (ACM)

An *unscientific* response of 30 ACM patients revealed that 14 had
ringing in the ears (significant) and 9 had a whooshing sound in their
ears (also significant). The survey of patients was conducted by
Darlene Long-Thompson, RN, MHSc.

Essentially there is (in ACM) extra cerebellum crowding the outlet of
the brainstem/spinal cord from the skull on its way to the spinal
canal. This crowding will commonly lead to headaches, neck pain, funny
feelings in the arms and/or legs, stiffness, and less often will cause
difficulties with swallowing, or gagging . There are those that
believe it can cause tinnitus. Often the symptoms are made worse with

Untreated, the chronic crowding of the brainstem and spinal cord can
lead to very serious consequences including paralysis. There are many
ways to treat Chiari malformations, but all require surgery.

When the diagnosis is suspected the study of choice is an MRI scan.
These malformations are very difficult to see on CT scans and
impossible to see on plain x-rays.

If you are intending to have an MRI for another reason, e.g., Acustic
Neuroma, the MRI technicians should be alerted to the possibility of
ACM (if you are showing any symptoms listed above) since the "MRIing"
will have to concentrate on the brain stem/cerebellum area to detect
the problem.

Most of the preceding (ACM) information provided courtesy of: Bernard
H. Meyer

Arnold Chiari Malformation involves the herniation of the cerebellum
and/or brainstem through the foramen magnum. This can cause problems
in the areas of cerebellar compression and dysfunction, cranial and
spinal nerve (including trigeminal and acoustic nerve) compression and
inflammation, CSF blockages and increased intracranial pressure
(constant or intermittent), and brainstem compression and
inflammation. ANY of these components can cause symptomology
associated with tinnitus...(Think of the ringing in the ears or
buzzing sound associated with light headedness or fainting...many ACM
sufferers experience this either due to acoustic nerve involvement or
to fluid and pressure dynamics).

Because hard data on ACM is difficult to find (and often
contradictory) it is difficult to find a source that says specifically
any one symptom is related to ACM...but the symptoms are often
categorized as...cerebellar syndrome, brainstem deficits, CSF
obstruction, and cranial nerve deficits. Due to the close proximity of
the acoustic nerve to the hindbrain region it would be one of the
primary cranial nerves involved in the compression/inflammation

Two of my references on this are as follows...

Tinnitus and Neurosurgical Disease
Journal: Journal of Laryngology & Otology
Authors: WA Shucart
M. Tenner
Citation: (4): 166-8

Tinnitus from Intracranial Hypertension
Journal: Neurology
Authors: KJ Meador
TR Swift
Citation: 34(9): 1258-61
ISSN 0028-3878

Preceding (ACM) information provided courtesy of: Darlene
Long-Thompson, RN, MHSc.


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