The middle ear, in turn, is formed by three very small bones (ossicles), which are called anvil, hammer and stapes. The three ossicles are responsible for identifying the existence of a sound and directing it to the brain, through stimuli that amplify the noise.
Finally, the sounds reach the inner ear, which has a snail-shaped cavity called the cochlea, whose cells vibrate according to the sound vibration and thus finally send the information to the brain.
This path taken by sound, from the outer ear to the brain, is called the auditory pathway. Along the route, the sound vibrations receive various stimuli that help them to reach their destination.
Ringing in the ear occurs when, for some reason, the components of the auditory pathway are emitting these stimuli even when there is no sound passing through them.
Different types of ringing in the ear can occur, which are:
Subjective Tinnitus This is the most common type of ringing in the ear. It is a noise that only the patient can hear. It may be due to structural problems in the outer, middle or inner ear, imbalances in the auditory nerves or even in the channel that causes the captured sounds to reach the brain.
Objective Tinnitus It is a rare type of tinnitus. Objective tinnitus refers to a sound that can be heard not only by the patient, but also by the doctor at the time of the examination. It happens, in general, due to dysfunctions in the blood vessels, muscle contractions or problems in the ossicles of the middle ear.
Although there are no officially cataloged sounds related to specific disease-related ringing in the ear, there is a range of very different tinnitus that is often reported by patients.
In general, the same patient may have more than one type of ringing in the ear. The complaints of those who suffer from this disease are that the noises they hear are similar to pressure cookers, sirens, whistles, insect buzzing, car engines and even running water.
Tinnitus is usually constant, but not necessarily rhythmic (like a heartbeat, for example).
Ringing in the ear is not a disease, but a symptom. This means that the noise itself is a warning from the body that something is not working as it should. The list of possible diseases, imbalances and disorders that can cause ringing in the ear is very wide and varied.
Excessive noise exposure Noise pollution is a disadvantage of life in large urban centers, and can have serious consequences for ear health. Constant exposure to traffic noise or the habit of listening to loud music with headphones, for example, can damage some ear structures and cause the phenomenon of tinnitus.
Accumulated wax Ear wax plays an essential role in protecting the organ. However, when accumulated in excess, it can clog the auditory pathways and even affect the eardrum, causing pain, progressive hearing loss, dizziness, itching, and, of course, tinnitus.
Inflammation or infection in the ear Inflammation in the middle ear usually causes stiffness in the ossicles that make it up, impairing the ability of these structures to identify when there is actually a sound going through them or not.
Infections – such as otitis, for example – usually reduce the ear’s ability to clearly identify external sounds, causing and potentiating tinnitus.
Ear injuries Internal structures that are damaged by chemicals, high exposure to heat or even objects inserted into the ear can cause tinnitus. There is also the possibility that the hair cells inside the ear are damaged. The most common type of injury is a rupture or perforation of the eardrum.
Usually, the tinnitus caused by this type of incident is accompanied by characteristic symptoms, such as severe and sudden pain, bleeding and hearing loss.
Medicines Some substances such as antibiotics , quinine (used to treat malaria and heart disease), diuretics, aspirin, antidepressants and drugs used to treat cancer can be triggers for the development of ringing in the ear.
Jaw dysfunction and dental problems Incredibly, dental disorders – especially those that affect the jaw joint – can cause discomfort in the ear. In addition to tinnitus, tooth problems can also cause pops in the back of the ear when opening the mouth and stinging in the outer and middle ear.
Muscle aches Tension muscle pains, especially those that reach the neck region, can be responsible for the ringing in the ear. This is because the body releases certain substances in order to attenuate localized tension, and in the process, it ends up stimulating the auditory pathways.
Heart problems Cardiovascular diseases directly affect blood circulation, making it harder for blood to reach the blood vessels in the ear.
One of the consequences of this process is that the auricular structures are unable to gather enough nutrients to perform their functions properly, generating tinnitus as a form of alertness.
Other diseases related to the cardiovascular system, such as arteriosclerosis, hypertension and arteriovenous malformation can also be triggers for ringing in the ear.
Depression The depression is a disease that touches directly with several chemical functions of the body. One of them concerns the levels of neurotransmitters coming from the auditory nerves, impairing all the functionality of the ear and, thus, generating tinnitus.
Stress Although stress alone is not an agent that causes ringing in the ear, it is a major enhancer of this type of phenomenon. In general, in this case, tinnitus is also accompanied by dizziness.
Uncontrolled diabetes Insulin levels much higher than indicated may impair the stimuli responsible for transporting information from the ear to the brain. For this reason, people with diabetes should pay extra attention if they experience ringing in the ear.
Excessive caffeine consumption Caffeine is a highly stimulating substance that, when consumed in excess, affects the functioning of various organs in the body. One of them is the ear, which presents cellular activities much more accelerated after the excessive consumption of coffee, which ends up causing the tinnitus.
Aging Hearing loss is one of the main characteristic changes caused by reaching old age. The phenomenon ends up causing several side effects, such as dizziness and ringing in the ear.
Only a doctor will be able to diagnose the source of a patient’s ringing in the ear with certainty. In this case, the specialist indicated is an otorhinolaryngologist. The professional must perform several tests to find the answer. The most common are:
Movement tests, which lead the patient to move different parts of the body at different intensities and observe whether the ringing in the ear increases or decreases with locomotion; Audiometry exam, which should measure how efficient the patient’s ear is in capturing, identifying and processing sounds; Diagnostic imaging exams, depending on the doctor’s suspicions. In addition, describing the type of sound the patient is hearing can help the doctor to identify the cause of the noise. Tinnitus that sounds like a high-pitched bell, for example, may indicate that the root of the problem lies in prolonged exposure to very loud noises. Those that are similar to a severe bell may be signs of Ménière’s disease or even labyrinthitis .
Therefore, it is important to be sincere when opening the game with the otorhinolaryngologist. All details can be crucial to arrive at the final diagnosis.
Is ringing in the ear curable? Ringing in the ear is curable depending on the cause, but, in general, it has treatment and remission or stabilization of the condition.
Hissing or noises from hearing problems are generally stabilized with the use of hearing aids. If the condition is due to bad habits (sedentary lifestyle, poor diet, excess caffeine), some simple changes solve the condition.
In some cases, treatments for emotional disorders can bring relief from the symptom.
What is the treatment for ringing in the ear? The treatment for reducing or curing tinnitus will depend directly on the cause of this symptom. In the case of hearing loss, the doctor may recommend the use of hearing aids.
Some conditions may require specific medication, while others may depend only on the control of a pre-existing disease – as in the case of diabetes and cardiovascular diseases, for example.
While investigating the causes of tinnitus, the doctor can work with the patient to identify which triggers intensify the sensation, such as caffeine consumption or the use of headphones.
Although most cases will be resolved as soon as the source of the problem is found, there is a possibility that the root cause of the problem will never be identified. In that case, it can be said that tinnitus has no cure.
For this situation, the doctor can also indicate palliative ways to alleviate the discomfort. This palliative treatment may include the prescription of medications, such as anticonvulsants, vasodilators and anxiolytics .
Therapy for tinnitus In the 90’s, the Tinnitus Habituation Therapy (from the English “ Tinnitus Retraining Therapy ”, or TRT) was created. This procedure teaches the patient how to deal with ringing in the ear, until the noise perception progressively decreases until it reaches the point of no longer being heard.
The process takes place in two stages:
In the first, there is the orientation of the patient and identification of the tinnitus type, so that the therapy is adjusted according to his needs and presents satisfactory results.
Based on this stage of the procedure, it is possible to move to the second, where a special device will be configured to emit a hiss compatible with the tinnitus heard by the patient.
This specific hiss is emitted in therapy sessions and, today, it can be inserted directly into a hearing aid, constantly ringing in the patient’s ear. Progressively, hearing the wheezing causes the person with tinnitus to pay less and less attention to the tinnitus, until he stops listening to it completely.
The treatment has success rates of more than 80%. On the other hand, it is a long journey: the therapy lasts at least 18 months, and can extend up to two years.
Noise suppression equipment The doctor may also recommend some instruments to suppress the patient’s exposure to noise. Some of them are:
White noise generator: white noise is what we call noises that can be used to disguise and soften the perception of external noises that are bothersome. This machine emits sounds like rain falling and waves of the sea reaching the beach, for example, and can be a great ally in the treatment against ringing in the ear;Hearing aids: for those who are experiencing hearing loss in addition to ringing in the ear, this can be an excellent alternative to solve both problems.Alternative Therapies Some alternative therapies can serve as a complementary treatment to eliminate or decrease ringing in the ear. Among the techniques that can be used are:
Acupuncture; Hypnosis; Zinc supplements; Vitamin B supplements; Ginkgo biloba capsules . It is important to note that this type of therapy has no proven efficacy and should not replace the treatment recommended by the doctor.
Is there a remedy for tinnitus or wheezing in the ear? There are some remedies that can reduce hissing, noises or ringing in the ear. But the choice depends on the cause. That is, it is necessary to identify whether the problem is caused by psychological conditions, changes in the ear canal, undue habits or other causes.
Among the drugs that can be prescribed, always after a correct diagnosis, are peripheral vasodilators, anxiolytics and anticonvulsants.
It is possible to make some changes in the routine that guarantee a better quality of life for the person who is living with ringing in the ear.
Avoid very noisy environments As far as possible, avoid staying exposed or exposed to places with very loud noises. In addition to parties and nightclubs, environments with a lot of traffic or under renovation also need to be avoided as much as possible.
Watch your headphones Use headphones wisely. Avoid using them when listening to loud music and prefer the above-the-ear models – those that do not need to be fitted inside the ear to be used. If possible, reduce your daily exposure time to this type of equipment.
Don’t self-medicate Some anti-inflammatories, antibiotics and painkillers can make tinnitus worse. Consult your doctor before taking any medication.
Moderate intake of alcohol and coffee Both caffeine and alcohol in excess can make tinnitus worse. It is not necessarily necessary to eradicate these products from your menu, but rather to eat them sparingly.
Beware of the cotton swab Be careful when cleaning your ears. Although they are very useful in this mission, the swabs can push the wax into the ear canals, causing clogging, or even injure internal structures of the ear, which can further aggravate the sensation of tinnitus.
Ringing in the ear is an extremely exhausting symptom and, for this reason, can cause very characteristic complications. Those who live with tinnitus may present the following consequences:
Fatigue; Depression and anxiety; Change in sleep habits; Memory problems; Difficulty concentrating; Irritability. 
