tinnitus

Tinnitus is often described as a ringing in the ears. It also can sound like roaring, clicking, hissing, or buzzing. It may be soft or loud, high pitched or low pitched. You might hear it in either one or both ears.

Millions of Americans have tinnitus. People with severe tinnitus may have trouble hearing, working or even sleeping.

Causes of tinnitus include:

• Hearing loss in older people
• Exposure to loud noises
• Ear and sinus infections
• Heart or blood vessel problems
• Meniere's disease
• Brain tumors
• Hormonal changes in women
• Thyroid problems
• Certain medicines

Treatment depends on the cause. Treatments may include hearing aids, sound-masking devices, medicines, and ways to learn how to cope with the noise.

NIH: National Institute on Deafness and Other Communication Disorders

Meniere's disease is a disorder of the inner ear. It can cause severe dizziness, a roaring sound in your ears called tinnitus, hearing loss that comes and goes and the feeling of ear pressure or pain. It usually affects just one ear. It is a common cause of hearing loss.

Attacks of dizziness may come on suddenly or after a short period of tinnitus or muffled hearing. Some people have single attacks of dizziness once in a while. Others may have many attacks close together over several days. Some people with Meniere's disease have "drop attacks" during which the dizziness is so bad they lose their balance and fall.

Scientists don't yet know the cause. They think that it has to do with the fluid levels or the mixing of fluids in the canals of your inner ear. Doctors diagnose it based on a physical exam and your symptoms. A hearing test can check to see how it has affected your hearing.

There is no cure. Treatments include medicines to control dizziness, limiting salt in your diet, and taking water pills. A device that fits into the outer ear and delivers air pulses to the middle ear can help. Severe cases may require surgery.

NIH: National Institute on Deafness and Other Communication Disorders

An ear disorder is any condition that changes or harms the shape or structure of your ear. This can include abnormal ear shapes you're born with, injuries that change your ear's shape, and a growth on or in the ear.

Your ear has three main parts, and each one plays a different role in helping you hear:

• Outer ear. The part you see and the ear canal. It catches sound and sends them to your eardrum.
• Middle ear. When sound reaches your eardrum, it vibrates. These vibrations move through three small bones, called ossicles, that carry them further into your ear.
• Inner ear. Changes vibrations into nerve signals your brain understands as sound. It also helps you keep your balance.

Many conditions may affect your hearing or balance:

• Ear infections, the most common illness in infants and young children
• Tinnitus, a ringing or roaring in your ears
• Meniere's disease, which may be caused by fluid problems in your inner ear
• Ear barotrauma, an ear injury from sudden air or water pressure changes

Some of these conditions can also lead to hearing disorders and deafness.

Ear disorders may be caused by:

• Abnormal ear shapes you're born with, like microtia and anotia, which usually have no known cause. Sometimes they're linked to genes or certain medicines taken during pregnancy.
• Injury from hits, cuts, or bites can damage the ear.
• Growths that form after an injury, piercing, repeated cold water exposure, or years in the sun.
• Infections, like perichondritis, which often start from a cut or piercing.
• Bone growth in the middle ear, called otosclerosis, which can run in families.

Sometimes the only sign of an ear disorder is how your ear looks. Other symptoms may include:

• Changes in the size or shape of your ear
• Swelling, redness, or growths
• Pain or tenderness
• Scarring or changes in skin color
• Cuts or holes in the ear or eardrum
• Slow hearing loss, in some cases

To find out if you have an ear disorder, your health care provider may:

• Do a physical exam
• Look inside your ear with a lighted tool called an otoscope
• Order [imaging tests] to see bones or tissue more clearly
• Test your hearing
• Order a biopsy, to check if a growth is cancer

Sometimes, your provider may refer you to a doctor who specializes in care of the ear, nose, and throat.

Treatment for an ear disorder depends on the cause. Some may be treated with medicine. Others may need surgery to change the shape of the ear or remove a growth. If the disorder affects your hearing, you may need a hearing aid.

Most ear disorders that you are born with can't be prevented. But you can help to prevent some ear disorders by:

• Wearing head protection during sports
• Treating cuts and injuries
• Caring for new piercings
• Protecting your ears from cold water and the sun

Temporomandibular disorders (TMDs) are a group of more than 30 conditions that affect your temporomandibular joints (TMJs). You have two TMJs; one on each side of your jaw. They connect your lower jaw to your skull.

TMDs can cause problems in your jaw joint and your muscles that control jaw movement. These problems can include pain, stiffness, and trouble chewing.

There are three main types of TMDs:

• Disorders of your jaw joints
• Disorders of the muscles you use for chewing
• Headaches from a TMD

Many TMDs last only a short time and go away on their own. However, in some cases they can become chronic (long lasting)

Sometimes an injury to the jaw or TMJ can cause a TMD. But in most cases, the cause is not known.

Research suggests that certain factors may play a role in why a TMD starts and whether it will be long lasting:

• Genetics
• Psychological and life stressors
• How someone perceives pain

Anyone can develop a TMD, but it is more common in women than in men. It is most common in women between 35 and 44 years old.

The symptoms of TMDs may include:

• Pain in the chewing muscles and/or jaw joint. This is the most common symptom.
• Pain that spreads to the face or neck.
• Jaw stiffness.
• Limited movement or locking of the jaw.
• Painful clicking or popping in your jaw joint when you open or close your mouth. However, clicking or popping without pain is common and is not a sign of a TMD.
• Tinnitus (ringing in the ears), hearing loss, or dizziness.
• A change in the way the upper and lower teeth fit together.

There is no standard test used to diagnose TMDs, and some other conditions can cause some similar symptoms. This can make TMDs hard to diagnose.

To find out if you have a TMD, your health care provider or dentist:

• Will take a detailed medical history, which includes asking about your symptoms. They will want to know:
  • Where the pain is
  • When you have it
  • What makes it better or worse
  • If it stays in one area or spreads to other parts of your body
  • If you have any other pain conditions such as headache or back pain
• Will examine your head, neck, face, and jaw for:
  • Tenderness
  • Jaw clicking or popping
  • Problems moving your jaw
• May order imaging studies such as an x-ray, MRI, or CT

For many people, the symptoms of TMD are temporary. To help you feel better, your provider or dentist may suggest that you:

• Eat soft foods.
• Apply heat or cold to the face and do some exercises to gently stretch and strengthen your jaw muscles.
• Take over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen.
• Stop clenching your jaw, chewing gum, and biting your nails.

If those do not help, your provider or dentist may suggest other treatments such as:

• Physical therapy
• Self-management and behavioral health approaches, which can include:
  • Cognitive behavioral therapy (CBT), a type of psychotherapy. It can help you identify negative thoughts and change them. It can also teach you coping skills.
  • Biofeedback, which involves using electronic devices to teach you to control certain body functions, such as your heartbeat, blood pressure, and muscle tension. For example, it can detect when you tighten your jaw muscles. You can learn how to recognize when this happens and then relax your muscles.
• Medicines such as:
  • Anti-anxiety medicines
  • Antidepressants
  • Anti-seizure medicines
  • Prescription pain relievers
• An intraoral appliance, which is a device that fits over your teeth. Types of intraoral appliances include oral splints and mouth guards. If you are going to use one, it's important to:
  • Know that there is not a lot of evidence that they improve TMD pain.
  • Make sure that the appliance you have is not designed to permanently change your bite.
  • Let your provider or dentist know if it makes your pain worse.
• Complementary treatments, which are treatments that are used along with mainstream medical care. There is limited evidence showing that they help with TMD symptoms. But some providers and dentists may recommend acupuncture and transcutaneous electrical stimulation (TENS). TENS involves using a device to send a gentle electric current to your nerves or muscles. It may help treat pain by interrupting or blocking the pain signals.

If you are still having severe symptoms from a TMD, your provider or dentist may suggest surgery, including implant surgery, or another procedure.

It's important to be careful, because sometimes surgery or another procedure may not work or may even make your symptoms worse. Before any surgery or other procedure, it is very important to get opinions from more than one provider and to completely understand the risks. If possible, get an opinion from a surgeon who specializes in treating TMDs.

NIH: National Institute of Dental and Craniofacial Research

Military service members and veterans have made sacrifices to our country, and they may face lots of different health issues. Some of the most common health problems they may have include chronic pain, sleep disorders, and mental health disorders.

But they may also face some different health risks than civilians. Serving to protect our country is a special job, and along with it comes some special risks and job hazards. These include different types of injuries and health problems from exposures.

During their service, members are at risk for various injuries. These injuries can happen during training or while in combat. Sometimes the injuries are life-threatening or serious enough to cause disability. Others may not be as serious, but they may be painful and can affect daily life.

Some of the specific types of injuries that service members may face include:

• Sprains and strains, especially in the ankles and knees. These injuries are often caused by exercise and running.
• Back and shoulder injuries, often from lifting and carrying.
• Tinnitus and hearing loss, typically from exposure to noise.
• Head injuries and traumatic brain injuries (TBIs).
• Shrapnel and gunshot wounds.
• Lost limbs.

There may also be a risk of health problems from exposure to environmental hazards, such as contaminated water, chemicals, infections, and burn pits. Sometimes the health problems caused by exposures don't develop until years later.

Some service members experience military sexual trauma (MST). This includes sexual assault and sexual harassment.

Being in combat and being separated from your family can be stressful. So can readjusting to civilian life after the military. All of this stress can put service members and veterans at risk for mental health problems, including:

• Depression
• Post-traumatic stress disorder (PTSD)
• Anxiety
• Alcohol and drug use disorders

There is also a risk of suicide. Veterans who are in crisis can get help from the Veteran's Crisis line by:

• Calling 988 and then pressing 1
• Texting to 838255
• Chatting with them online

There are health care services especially for service members and veterans through:

• TRICARE, which is the Department of Defense's health care program. It has insurance plans and other services for uniformed service members, retirees, and their families around the world.
• The Veterans Health Administration, which is part of the Department of Veterans Affairs (VA). It provides medical and social support services to eligible veterans.
• The VA 's expanded health care and benefits for veterans exposed to burn pits, Agent Orange, and other toxic substances.

To better understand and treat the health needs of veterans in the future, the VA created the Million Veteran Program (MVP). This research program is looking at how genes, lifestyle, military experiences, and exposures affect health and wellness in veterans.

Dizziness and vertigo are not the same thing, but they are often mixed up.

• Dizziness can make you feel lightheaded, woozy or unsteady on your feet.
• Vertigo is the feeling that you or the room is spinning even when nothing is moving.

These feelings may get worse when you walk, stand up, or move your head, and they can make you lose your balance. You may also have nausea, vomiting, sweating, trouble walking, or ringing in your ears.

Dizziness and vertigo can happen to anyone, but they are more common as you get older. As people age, they may have more health conditions and take more medicines, which increases the chance of dizziness.

Common causes of dizziness and vertigo may include:

• A sudden drop in blood pressure
• Dehydration
• Getting up too quickly
• Certain medicines
• Inner ear problems, such as Meniere's disease, or benign paroxysmal positional vertigo (BPPV), the most common cause of vertigo
• Motion sickness
• Migraines
• A head injury or ear surgery

Sometimes dizziness or vertigo is a symptom of another condition.

Your provider will ask about your medicines and symptoms and may do a physical exam. They may check your hearing, balance, and how you walk.

You may need an imaging test if your provider thinks you may have had a stroke or if you've had a head injury.

Dizziness often gets better on its own, but if it keeps happening, your provider can help you find the cause and the right treatment. Treatment depends on the cause and may include balance exercises and medicines.

Get emergency help right away if you have sudden or severe dizziness or vertigo along with vision problems, slurred speech or weakness. These may be signs of a more serious condition.

NIH: National Institutes of Health

It's frustrating to be unable to hear well enough to enjoy talking with friends or family. Hearing disorders make it hard, but not impossible, to hear. They can often be helped. Deafness can keep you from hearing sound at all.

What causes hearing loss? Some possibilities are:

• Heredity
• Diseases such as ear infections and meningitis
• Trauma
• Certain medicines
• Long-term exposure to loud noise
• Aging

There are two main types of hearing loss. One happens when your inner ear or auditory nerve is damaged. This type is usually permanent. The other kind happens when sound waves cannot reach your inner ear. Earwax buildup, fluid, or a punctured eardrum can cause it. Treatment or surgery can often reverse this kind of hearing loss.

Untreated, hearing problems can get worse. If you have trouble hearing, you can get help. Possible treatments include hearing aids, cochlear implants, special training, certain medicines, and surgery.

NIH: National Institute on Deafness and Other Communication Disorders

Von Hippel-Lindau syndrome (VHL), also known as Von Hippel-Lindau disease, is a rare condition that causes tumors and cysts (fluid-filled sacs) to grow in your body. They can grow in your:

• Brain
• Spinal cord
• Eyes
• Inner ears
• Kidneys
• Pancreas
• Adrenal glands
• Organs involved in having children

The tumors are usually benign (non-cancerous) and may not cause problems. People with VHL syndrome often develop hemangioblastomas, a benign growth made up of many blood vessels. If these get too large and press on the brain or spinal cord, they may cause problems with things like vision or hearing.

Some tumors, such as those in the kidney and pancreas, can become cancerous.

VHL is a genetic disease. It is caused by a change (variant) in the VHL gene. Most people with VHL inherit the gene change, which means that it is passed down from parent to child. In some people, there is no family history of VHL, and the gene changes on its own.

The symptoms of VHL depend on the size and location of the tumors. Some people have no symptoms for many years. Some specific symptoms may include:

• Headaches
• Problems with balance and walking
• Dizziness
• Weakness of the limbs
• Vision problems
• Hearing loss or ringing in the ears
• High blood pressure

Finding and treating VHL early is important. Your health care provider may suspect that you have VHL if you have certain types of cysts and tumors. There is a genetic test for VHL. If you have it, you will need other tests, including imaging tests and eye exams, to look for tumors and cysts.

Treatment can vary from person to person and will depend on the location and size of the tumors and cysts. Treatments may include:

• Medicines that may help slow the growth of certain tumors
• Radiation therapy
• Surgery

Typically, the goal is to treat growths when they are small, before they can cause permanent damage. But certain tumors may not be treated until symptoms begin to develop.

Regular checkups by a health care team familiar with VHL will allow for careful monitoring and early treatment.

NIH: National Institute of Neurological Disorders and Stroke