Information About Tinnitus: General Information and Prevalence
Kimberly Langer-Roedel, M.S.--F.A.A.A.
Clinical Audiology Consultant
The EAR Foundation of Arizona
Tinnitus can be defined as ringing in the ears, or other head noises that occur independent
from an external noise source (Yost, 1994). Studies conducted by the National Center for
Health Statistics estimate that 32% of the general population is affected by tinnitus. The
prevalence of tinnitus increases to 70% to 85% of the hearing impaired population. This
indicates that over 80% of the patients who have tinnitus, also have some degree of hearing
loss. Of the individuals who suffer from tinnitus, both hearing impaired and not, roughly
75 percent aren’t seriously bothered by their tinnitus. However, 25 percent of tinnitus
sufferers are bothered enough by their tinnitus to seek medical attention. This relates to
approximately 1 million tinnitus sufferers who say that their condition seriously disrupts
their lives.
Types Of Tinnitus
Tinnitus can be classified into two categories, objective and subjective forms. The
objective form of tinnitus is less prevalent than subjective tinnitus, and its causes are
simpler to ascertain. Objective tinnitus is noise in the ears that can be heard by an observer
as well as by the sufferer with special listening devices. These noises are usually caused by
inner ear structural defects such as hair cell damage. Objective tinnitus can also be caused
by vascular anomalies or repetitive muscle contractions of the muscles in the middle ear.
Objective tinnitus sufferers may hear rhythmic rushing noise caused by their own pulse,
due to the close proximity of an artery to the middle ear space. This is called pulsatile
tinnitus. Any structure from the ear canal to the brain can be involved or produce objective
tinnitus, or other sensations of noise. This type of tinnitus can usually be medically
treated, thus relieving the sufferer of tinnitus, or at least assessing a structure that is likely
the cause of the objective tinnitus.
Subjective tinnitus is more common, and is much less understood that the objective form
of tinnitus. Subjective tinnitus is a phenomenon in which the sufferer hears noise in the
head or ears, which cannot be heard by an outside observer (Hazell, 1987). Subjective
tinnitus may be constant and unrelenting, or it may change with respect to frequency or
intensity. Subjective tinnitus may be in one or in both ears, and may also come and go.
Some tinnitus sufferers report that their tinnitus sounds like a high pitched background
squeal, very similar to that emitted by some computer monitors, fluorescent lights and

television sets. Some tinnitus sufferers report that their tinnitus sounds like chirping
crickets, hissing steam, bells, breaking glass or even chainsaws (Yost, 1994). The
perceptions of the volume, frequency, and handicap caused by tinnitus seem to vary
greatly with each sufferer. There is no general agreement about the definition of tinnitus, a
classification system for tinnitus or the mechanism of tinnitus production or perception
(Goldstein & Shulman, 1999).
Etiology (Causes) of Subjective Tinnitus
Tinnitus is a multifaceted disorder that can affect an individual's hearing, health, emotion,
and lifestyle (Kuk, Tyler, Russell & Jordan, 1990). For 43% of tinnitus sufferers there is
no known cause for their suffering (McFadden, 1982). For other sufferers, tinnitus may
be caused in part to noise exposure. Many sufferers who are afflicted with tinnitus have
been exposed to loud noise and also suffer from noise induced hearing loss (Kuk, Tyler,
Russell & Jordan. 1990). Repeated exposure to noise such as firearms, artillery, aircraft,
lawn mowers, movie theaters, loud music, heavy construction equipment, etc. can cause
noise induced hearing loss. A study of 4000 San Francisco Bay rock musicians, performed
by the Hearing Education and Awareness for Rockers (H.E.A.R.) organization, indicated
that nearly 50% of those surveyed indicated the presence of tinnitus. At the Nazareth
College of Rochester, it was found that significantly more music majors than non-music
majors had some form of tinnitus. This increased prevalence of tinnitus among those who
are routinely exposed to loud levels of sound indicates that tinnitus may be related to noise
exposure, as well as to noise induced hearing loss. It is estimated that 24% of tinnitus
sufferers can attribute their tinnitus to noise exposure and noise induced hearing loss
(McFadden, 1982; Vernon, Johnson, Schleuning & Mitchell, 1980).
Another of the many potential causes of tinnitus is cerumen (debris) accumulation in the
ear canal. The sufferer’s physician can easily ascertain this cause of tinnitus during an
otoscopic examination. If there is excessive cerumen or debris this problem can be
remedied by using manual removal, irrigation, suction or cerumenilytics to remove the
accumulated debris (Kitahara, 1988). If the tinnitus was caused exclusively by wax
accumulation, the removal of the accumulation should completely eradicate the tinnitus.
A more serious cause of tinnitus is acoustic neuroma. Acoustic neuromas are small, slow
growing benign tumors that press against or invade the auditory nerve (Clark & Yanick,
1984). If the sufferer's tinnitus is unilateral in nature, an acoustic neuroma must first be
ruled out as the cause of the tinnitus. The undiagnosed acoustic tumor can eventually
interfere with the sufferer's hearing mechanism resulting in hearing impairment or more
severe health problems.
Ototoxic drugs are also a common cause of tinnitus. Some analgesics, antiarhythmics,
antidepressants, antiemetics, antihistamines, anti-inflammatory agents, anti-ulcer agents,