Hearing & Tinnitus

Hearing loss can develop slowly over years or appear suddenly. Where the problem sits determines the type:

• Conductive hearing loss. Sound is blocked before it reaches the inner ear, for example by earwax, fluid from an ear infection, or a problem in the eardrum or middle ear. Many of these causes can be treated directly.
• Sensorineural hearing loss. The inner ear or the hearing nerve is affected. Common causes include aging and exposure to loud noise. Head injuries and certain medications can also affect hearing.

Sudden hearing loss is a medical emergency. If you lose hearing in one or both ears over a few hours or days, often noticed on waking, with or without a “pop,” ear fullness, ringing, or vertigo, seek medical care right away. Early evaluation matters.

Tinnitus is hearing a sound that has no outside source, so other people cannot hear it. It is often described as ringing, but it can also sound like buzzing, roaring, hissing, humming, or clicking. It may be heard in one ear, both ears, or in the head, and it may come and go or be constant.

Tinnitus is a symptom rather than a disease. It has been linked to:

• Noise exposure and hearing loss, which are the most common associations
• Certain medications, especially at high doses
• Earwax or an ear infection blocking the ear canal
• Head or neck injuries, which can affect the ear, the hearing nerve, or the parts of the brain that process sound
• Ménière’s disease, jaw joint problems, and, less often, blood vessel conditions or tumors

Some people develop tinnitus with no identifiable cause. Tinnitus that pulses in time with the heartbeat should be evaluated, because it sometimes has a specific cause that can be found and treated.

For many people tinnitus is not severe, but it can affect sleep, concentration, and mood. That impact is part of the evaluation too.

The evaluation starts with your history: when the hearing change or tinnitus began, what it sounds like, whether it affects one side or both, noise exposure, injuries, and your medications. Dr. Kayem then examines the ears, head, and neck.

A hearing test measures how well you hear across different pitches and helps separate conductive from sensorineural hearing loss. Depending on the findings, imaging may be ordered, particularly when tinnitus pulses or hearing loss affects one ear more than the other.

Treatment depends on the cause:

• Removing earwax or treating an ear infection when either is responsible
• Hearing aids for hearing loss, which can also make tinnitus less noticeable
• Sound therapy devices that provide soft background sound
• Talk therapy approaches, including cognitive behavioral therapy, that help reduce the impact of tinnitus on daily life
• Treatment of an underlying condition identified during the evaluation

There is currently no medication approved specifically to cure tinnitus, and supplements marketed as cures have not been shown to work. Dr. Kayem will discuss which options fit your situation.

Tinnitus and hearing changes can occur together with balance problems. See Balance Problems and Vertigo.