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What does it mean when tinnitus gets louder?

Tinnitus is the perception of noise or ringing in the ears. It is a common condition that affects about 15 to 20 percent of people. For most people, tinnitus is a mild annoyance. But for some, tinnitus can be extremely disruptive to daily life.

What causes tinnitus?

Tinnitus is caused by damage or dysfunction in the auditory system, which includes the outer, middle and inner ear, auditory nerve connections, and auditory centers in the brain. Some common causes of tinnitus include:

  • Noise-induced hearing loss – Exposure to loud noises can damage the tiny hair cells in the inner ear that help transmit sound to the brain. Tinnitus is often associated with some degree of hearing loss.
  • Age-related hearing loss – As people age, the number of functioning hair cells in the inner ear decreases, which can lead to tinnitus.
  • Earwax blockage – Something as simple as a buildup of earwax touching the eardrum can cause tinnitus.
  • Underlying medical conditions – These include high blood pressure, headaches, head or neck trauma, and Meniere’s disease.
  • Medications – Certain medications like aspirin, antibiotics, antidepressants, and diuretics can trigger tinnitus or make existing tinnitus worse.
  • Acoustic neuroma – This non-cancerous tumor that presses on nerves leading from the inner ear to the brain can cause tinnitus.

Why does tinnitus sometimes get louder?

For many people with chronic tinnitus, the volume and intensity can fluctuate over time. There are a number of possible explanations for why tinnitus seems to get louder at times:

  • Changes in background noise – When you are in a quiet environment, like trying to fall asleep in a silent bedroom, you may be more aware of the tinnitus. Less external noise means your brain focuses more on the phantom ear noise.
  • Stress and anxiety – Stress can make tinnitus more noticeable according to many sufferers. Relaxation exercises can help control stress reactions that may be amplifying the tinnitus.
  • Medications – Starting or stopping certain prescription and over-the-counter medications, like aspirin, certain antibiotics, and diuretics, can cause changes in tinnitus.
  • Earwax – Excessive earwax rubbing against the eardrum can increase tinnitus volume. Removing impacted earwax often provides relief.
  • Caffeine, alcohol, nicotine – These stimulants and irritants have been shown to transiently increase the volume of tinnitus in some individuals.
  • Other medical conditions – Diseases that affect hearing, blood flow, hormone levels, and nerve signals such as thyroid disorders, anemia, high blood pressure, migraines, and autoimmune disorders can exacerbate tinnitus symptoms.
  • Age-related hearing loss – Progressive loss of hearing due to aging may contribute to worsening tinnitus over time.
  • Acoustic shock – Exposure to a sudden, loud unexpected sound can trigger fleeting tinnitus and hyperacusis (sensitivity to sound). The tinnitus may initially get louder before gradually going away.
  • Ear injury – Any damage to the structures of the ear can increase the volume of tinnitus, including ear infections and vestibular schwannoma tumor growth.
  • Jaw misalignment – Temporomandibular joint (TMJ) disorders that put pressure on blood vessels and nerves in and around the ear can cause pulsatile tinnitus.

Does louder tinnitus mean hearing loss is getting worse?

Not necessarily. An increase in tinnitus volume does not always reflect progressive inner ear damage or hearing loss. The correlation between tinnitus volume and the degree of hearing loss varies from person to person.

However, sudden loud tinnitus accompanied by hearing loss in one or both ears may signal an acute inner ear injury, such as:

  • Acoustic trauma
  • Ototoxic drug exposure
  • Sudden sensorineural hearing loss
  • Meniere’s disease flare
  • Vestibular schwannoma growth

In these situations, prompt medical evaluation is recommended.

Can tinnitus get louder permanently?

In most cases, intermittent spikes in tinnitus loudness are temporary and the volume reverts back to its regular baseline level. However, some events can lead to a permanent worsening of tinnitus:

  • Acoustic trauma – Exposure to an extremely loud impulse noise, like an explosion, gunshot, or firecracker. The risk of permanent tinnitus increases with the loudness of the noise.
  • Ototoxic drug reaction – Certain antibiotics, cancer medications, diuretics, and quinine medications can be ototoxic, causing damage to the hair cells of the inner ear. This can result in permanent tinnitus and hearing loss.
  • Sudden deafness – Unexplained hearing loss in one or both ears may be accompanied by permanent, loud tinnitus.
  • Meniere’s disease – This chronic inner ear condition can lead to fluctuating hearing loss and severe, long-term tinnitus.
  • Vestibular schwannoma growth – If this noncancerous tumor presses on the cochlear nerve, it can cause single-sided deafness and permanent tinnitus.

The development of permanent, louder tinnitus warrants medical attention. Consulting an audiologist and ENT doctor can help determine the underlying cause and treatment options.

Can anything be done for worsening tinnitus?

If tinnitus gets significantly louder and does not improve on its own within a week or so, it is advisable to see an audiologist and ENT specialist. They can help determine if there is an underlying medical condition causing the increase in perceived volume.

Treatment options for worsening tinnitus depend on the cause, but may include:

  • Removing earwax blockages
  • Treating ear infections or sinus congestion with medications
  • Discontinuing possible ototoxic medications
  • Managing underlying conditions like high blood pressure, migraine, or autoimmune disorders
  • Switching or stopping medications that may aggravate tinnitus
  • Avoiding stimulants like caffeine that may amplify tinnitus
  • Using specific medications including antidepressants, anticonvulsants, or lidocaine to provide relief
  • Trying sound therapy devices that play soothing background sounds
  • Undergoing cognitive behavioral therapy to help manage reactions to tinnitus
  • Getting fitted for a hearing aid if tinnitus is accompanied by substantial hearing loss
  • Having surgery to repair a TMJ issue or to remove an acoustic neuroma tumor

The good news is that the vast majority of the time, worsening tinnitus is temporary. Avoiding excessively loud noise exposure can help prevent permanent spikes in tinnitus volume.

When should someone see a doctor for worsening tinnitus?

It is advisable to see a doctor if tinnitus gets substantially louder and does not improve after a week. Red flag symptoms that warrant prompt medical evaluation include:

  • Sudden or rapidly worsening tinnitus
  • Severe tinnitus that disrupts sleep and concentration
  • Tinnitus accompanied by dizziness or balance problems
  • Tinnitus with one-sided or asymmetric hearing loss
  • Tinnitus accompanied by pain or discomfort in the ear

An ENT specialist can look for any structural problems or neurologic dysfunction that may be causing worrisome tinnitus. Audiologic assessment can evaluate hearing sensitivity.

When to seek emergency medical treatment

Rarely, someone with severe tinnitus may require emergency care to address potentially dangerous underlying conditions. Seek emergency treatment if:

  • The tinnitus starts suddenly or reaches a very loud, intolerable level
  • Dizziness, vertigo, vision changes, facial droop, or balance loss accompany the tinnitus
  • You experience chest pain, shortness of breath, weakness, or slurred speech along with tinnitus

These symptoms can indicate the following medical emergencies that require prompt intervention:

  • Acoustic neuroma or other brain tumor causing cranial nerve compression
  • Stroke
  • Head trauma
  • Inner ear hemorrhage
  • Autoimmune inner ear disease
  • Temporomandibular joint artery dissection
  • Multiple sclerosis plaque or flare-up

What is pulsatile tinnitus? Is pulsing tinnitus dangerous?

Pulsatile tinnitus refers to a rushing or roaring sound in the ears that follows a rhythmic pulsing pattern, often in time with the heartbeat. Common causes include:

  • High blood pressure
  • Turbulent blood flow around narrowed arteries
  • Benign intracranial hypertension
  • Glomus tumor that grows on the carotid artery wall
  • Atherosclerotic plaque buildup in arteries
  • Malformed capillaries and veins
  • Volume changes between venous and arterial systems

Pulsatile tinnitus often requires medical investigation to rule out dangerous causes like an aneurysm, arteriovenous malformation, hypertension, or tumor. Urgent care is needed if new-onset pulsatile tinnitus accompanies neurological symptoms.

Table summarizing key points about worsening tinnitus

Cause Mechanism Intervention
Medication use Ototoxic effects damage hair cells in cochlea Stop medication
Earwax impaction Direct pressure on eardrum Remove earwax
TMJ dysfunction Altered blood flow or nerve pressure in ear Dental appliance, physical therapy
Meniere’s disease Inner ear fluid imbalance Low salt diet, diuretics, motion sickness medication
Acoustic neuroma Tumor compresses cranial nerve VIII Surgery to remove tumor
Sudden deafness Viral infection or reduced cochlear blood flow Steroids, antivirals, oxygen therapy

Conclusion

There are many potential reasons why chronic tinnitus may worsen in perceived volume at times. In most cases, the increase in loudness is temporary and will improve spontaneously. However, a distinct deterioration in tinnitus that does not revert back probably warrants medical investigation. An audiologist and otolaryngologist can help determine if there is a treatable underlying cause of the worsening tinnitus.

Pulsatile tinnitus and tinnitus accompanied by one-sided hearing loss or neurological symptoms should always prompt evaluation for underlying vascular, neurologic, or neoplastic conditions. While frustrating, tinnitus itself is not dangerous. By identifying and addressing potential risk factors, the hope is that tinnitus exacerbations can be reduced and controlled.