Humming, whistling, pressure in the ears, tinnitus: what are its main causes?

Tinnitus is an unpleasant sound sensation. It is also described as ear noise. This perception of acoustic noise has no external sound source.

It occurs occasionally, but also over a long period of time or permanently.

It is usually experienced in a mild form where it does not bother the person. However, in some sufferers the hum is so intense that it prevents the person from carrying out normal activities and can also disturb the person during sleep.

Humming, whistling, whirring, ringing, buzzing, hissing, clicking, popping, pressure with clapping. All these terms are grouped under the name: tinnitus.

Tinnitus auris from the Latin tinnire (to ring or whistle) and auris (ear).

The perception of tinnitus is individual to each individual and varies in intensity, frequency and character of sound. The difficulty is often exacerbated by psychological stress and increases in intensity in silence.

Tinnitus is a symptom, not a disease.

It affects 15-20% of the world's population and is the third most common head-related problem after headaches and dizziness.

The incidence is highest in people over 60.
Tinnitus can flare up much earlier.
However, the risk increases with age and with the level of noise.

It often occurs in people with hearing impairment, along with a feeling of pressure or with lying down. But many people with pre-existing hearing impairment do not have it.

You ask:
What causes tinnitus?
What conditions does it accompany?
How to get rid of it effectively?
Is there any prevention?

Tinnitus is divided into two main forms

Tinnitus does not have an external sound source, but it is not a hallucination. Although a deterioration in mental condition can provoke it, it is not a psychiatric disorder.

Tinnitus may be temporary, lasting only a few seconds, but it is also encountered with tinnitus that lasts a lifetime.

Accordingly, it is divided into:

• acute up to 3 months
• subacute up to 6 months
• chronic over 6 months
• possibly only acute if it lasts up to 12 months, and chronic if it persists for more than a year

There may be no obvious reason for the tinnitus.
The reason remains undiscovered.
It is a combination of several triggering and provoking factors.

You ask:

1. Where does tinnitus originate?

Although it is a real sound that one hears, its source is not an external object.

It originates either in the head or in the throat.

It can be present in one ear or both ears. It can even come from the centre of the head.

Bilateral tinnitus is the most common.
In unilateral tinnitus, it is more common in the left ear.
Central tinnitus is rare.

2. What are the causes?

They are roughly divided into internal (brought together by various genetic predispositions) and external, represented by biological (infection with bacteria or viruses and others), social (alcohol, drugs, coffee) and physical factors (excessive noise).

Subsequently, the degree to which it is present is also assessed. This is a subjective assessment:

1. degree = when one hears it only in silence
2. Grade = audible in a normal environment but masked by loud ambient sounds, may disturb sleep
3. Grade = it is intense and can be heard in any situation, disturbs the person during normal activities and sleep, significantly impairs quality of life

The vast majority fall into the subjective form, i.e. externally inaudible. Objective is very rare.

Tinnitus is divided into:

1. subjective - a form that cannot be detected externally
2. objective - it can be recorded during examination, for example with a sensitive microphone

Both of these forms have different factors of occurrence and can sometimes even be distinguished by the nature of the perceived sound. An example is:

• clicks are produced by spasms of the muscles
• buzzing sounds tend to be vascular in origin, influenced by changes in position or level of physical activity
• a heartbeat is heard when there is a vascular problem, high blood pressure or an aneurysm, but also when the Eustachian tube is blocked
• muffled ringing - in Meniere's disease, may become louder in dizziness
• high-pitched tones - after exposure to too much noise, after an ear injury, a blow to the ear
• in older age there is also continuous ringing in both ears
• constant whistling in one ear may be due to acoustic neuroma
• low tones that come in and get muffled tend to be in otosclerosis
• different tones can also be produced by earwax, foreign bodies and friction of tiny hairs in the ear canal

This is a subjective and individual perception.

The table lists subjective and objective tinnitus

You ask:
Can whistling in the ears be from the cervical spine?
Yes, it can.
Often occurs with a blockage in the neck. An example is cervicobrachial syndrome.

It is also important to determine whether the tinnitus is related to temporomandibular joint disorder, cervical spine disorder (TMJ), or whether it occurred during sports activity or rehabilitation.

In addition to tinnitus, it is possible that other difficulties may be associated:

• Dizziness
• feeling of pressure in the ears and lying down
• ear pain
• headache
• neck pain
• hearing impairment
• discharge from the ear
• visual disturbance
• nausea and sickness - feeling like vomiting
• anxiety, fear

Tinnitus can have several causes

The source of an ear murmur can be a vascular or muscular problem, but it can also come from other surrounding structures.

Alternatively, another disease may be to blame. In most cases, however, its origin is unknown.

Summary of the main causes:

• diseases of the inner, middle or outer ear
• disorders of the auditory nerve and auditory pathways
• damage to the central nervous system - the brain
• otosclerosis, where changes occur in the bone structure of the ear
• perceptual hearing loss
• inflammation in the ear, otitis media, i.e. inflammation of the middle or inner ear (labyrinth)
• blockage by earwax, water - often with ear plugging, sebaceous plug, cerumen
• trauma to the head and neck
• exposure to loud noise - above 60 dB or more, especially at work and for long periods of time
  • acoustic sound trauma - exposure to noise, explosion, loud music, saw, industrial machinery
  • barotrauma - exposure to pressure, explosion, gunshot, diving
• Meniere's disease - disease of the auditory-balance system, resulting in dizziness with tinnitus
• disorders of the balance system, vestibular syndrome
• problems with the cervical spine or temporomandibular joint
• Eustachian tube disorder
• medications such as antibiotics, chemotherapy drugs, non-steroidal anti-inflammatory drugs, diuretics, quinine, antidepressants, high-dose acylpyrine, etc.
• acoustic neurobenignant nerve tumour or also vestibular Schwann
• rhinitis, sinusitis, flu
• Atherosclerosis
• high blood pressure
• low blood pressure
• ischaemic heart disease
• stroke
• metabolic diseases and thyroid disorders
• Lyme disease
• head and neck tumours
• turbulent blood flow in the carotid artery, vein
• capillary (small vessel) disorders and arteriovenous malformations
• psychiatric disorders, depression, anxiety, insomnia
• decayed teeth and tooth decay

Possible triggers and risk factors include exposure to loud noise, for example at a concert. This type of tinnitus is usually not permanent and passes quickly.

When pressure is applied, the eardrum may rupture.

The likelihood of tinnitus also increases with age, especially in men.

Smoking, drugs and coffee increase the risk of developing it.

In addition to other diseases, there are diseases of the cardiovascular system, such as insufficient blood circulation, high blood pressure or too low blood pressure.

It often happens that people, in addition to feeling faint or dizzy, hear intense whistling or humming in the ears. Subsequently, a short-term disorder of consciousness (syncope, collapse) may occur.

Stress and psychological strain are important triggers, especially if prolonged. Tinnitus can occur when tired.

Tinnitus itself is an unpleasant life complication and significantly reduces the quality of life.

In the case of intense and prolonged whistling, those affected may also experience:

• fatigue and exhaustion
• stress
• sensitivity to sounds - hyperacusis, i.e. sensitivity to sounds at normal volume
• ear and head pain
• sleep disturbances, inability to fall asleep, waking from sleep
• impaired concentration
• memory impairment
• anxiety to depression
• irritability and nervousness

Prevention is important

While tinnitus cannot be prevented in every case, it is a good idea to reduce some of the negative factors.

An example is the use of hearing protection, especially in places where there is increased noise. It is also advisable to reduce the volume when listening to music. Loud music through headphones is particularly dangerous.

Elimination of noise as number 1, followed by appropriate and sufficient hygiene.

It is necessary to maintain general health and good not only physical but also mental condition.

If you have a disease that could be related to tinnitus, sufficient treatment is important.

What is the treatment and what helps? How to relieve tinnitus?

It is important to know the cause and to discover whether it is an objective form or whether the whistling has a source in another disease.

In this case, treatment is targeted according to the diagnosis.

The diagnosis is made by an ENT doctor, who performs a hearing test using various methods. Laboratory tests such as blood tests, CT scans, MRI scans and even an angio or sonogram are added. The cervical spine and temporomandibular joint are also evaluated.

The treatment has several methods, from pharmacological (drugs to improve blood circulation, ginkgo biloba or other herbs) to removal of earwax, treatment of blood vessels, changes in medication for other diseases, various hearing aids to suppress noise, masking devices and others.

Examples of treatments include:

• ear surgery - tympanoplasty, which involves reconstruction of a ruptured eardrum.
• Noise generator - generates noise and thus helps to perceive tinnitus to a lesser extent
• treatment of the underlying disease
• relaxing music
• antidepressants

It is important to avoid stress.

Read also:

• The most common causes of tinnitus? Find them here in one place
• Will herbs help with tinnitus or just professional treatment?