Navjivan Hospital

When you travel in an airplane or just come out of the swimming pool, your ears may sometimes block up and even be painful. This is what is known ear barotrauma and is caused by pressure differences inside and outside the ear drum. Severe cases may cause damage to the ear and impede your hearing.

Symptoms of ear barotrauma: Ear barotrauma usually occurs when the Eustachian tube is blocked due to differences in air pressure. The Eustachian tube is a long narrow tube that runs from the middle of your ear to the pharynx or the back of the throat and is thus very important in relevance to the ear, nose and throat. Thus ear barotrauma can also translate to pain in the ear and throat as well.

Some of the symptoms are:

1. Discomfort in the ear, or aggravated pain in extreme cases
2. Dizziness
3. The ears being blocked or full, in severe cases may feel like being underwater
4. Temporary hearing loss
5. Nose bleeding in severe cases
6. Health care providers may see an inward caving or outward bulging in the ear drum. In severe cases, the eardrum may look bruised as well.
7. Some severe cases may even exhibit signs typical of an ear infection along with some of the other symptoms mentioned above.

Precautions and self treatment: There are certain steps you can take to either prevent barotrauma or reduce the symptoms, these are:
yawning or gulping. This is very helpful when air pressure differences are caused in cases of travelling by aircraft.

1. Inhale slowly and then exhale while your mouth is closed and you are holding your nostrils closed by fingers. This will help increase the pressure within the tube to try and open it forcefully.
2. Sucking on candy is another way to prevent barotraumas as you are constantly swallowing and keeping your Eustachian tube from being blocked in the first place.
3. Keep a few chewing gums handy and has similar effects on your ears as it forces the Eustachian tube to remain open despite pressure differences.
4. After diving or swimming, come out of the water slowly.  Scuba divers and deep swimmers need to come up slowly to ensure that the Eustachian tube is given enough time to acclimatize and slowly come back to normal.

Usually, ear barotrauma goes away automatically after sometime and no medications are required. However, if symptoms still persist, it is best to go to a relevant doctor or a health care provider for pain relief and long term solutions.

BPPV or Benign paroxysmal positional vertigo is a major cause of vertigo. This is a condition that gives a sensation of head spin all of a sudden. It also results in dizziness in brief episodes. The severity level can vary from intense to mild. BPPV is triggered with certain changes of the head position. Although BPPV is bothersome, it isn’t serious unless there is a chance of a person falling abruptly because of the head spin. There are ample treatment options available to address this problem.

Symptoms of BPPV
BPPV includes some of the following symptoms:
a. Loss of balance
b. Dizziness
c. Feeling of the surrounding spinning
d. Vomiting and nausea
e. Rhythmic movement of the eye

When to seek medical attention?
If dizziness is accompanied with one of the below-mentioned symptoms, it is time to urgently seek medical attention and get vertigo addressed for good:

1. Hear loss
2. Tingling or numbness
3. Fever accompanies with severe headache
4. Arm or leg weakness
5. Problems with vision
6. Difficulty in walking
7. Becoming unconscious

Causes of BPPV:
If there is on known cause associated with BPPV, the condition is termed as idiopathic BPPV. In most of the cases, though, BPPV is associated with a severe to minor blow to the head. Other causes include an injury to the inner ear, prolonged sitting position in a fixed posture, even migraine pain is at times associated with BPPV.

What are the risk factors?
Benign paroxysmal positional vertigo is likely to occur in the age group of 50 and above, this being said it can happen at any age in case of any injuries. Statistically, it is found that the likelihood of BPPV is more in women than men. Head injury of any sort is by far the most likely reason of BPPV.

What are the tests and diagnosis involved?
A doctor is likely to perform a physical examination followed by a series of tests. Some typical signs that a doctor looks for include the following:
Ability to control eye movement- especially side to side movement

Symptoms of dizziness
In case it is difficult to spot the symptoms, a doctor might suggest video- nystagmography or electronystagmography. It helps to track irregular eye movement. An MRI can also be prescribed to study the cross-sectional images of the body and the head.

Treatments associated with BPPV:
BPPV mostly go away within months or weeks on its own. If however, it still persists, a doctor can suggest Canalith Repositioning- series of small movements that helps to counter BPPV. For extreme cases, a doctor might advise a surgery for blocking the portion of the inner ear that might be causing the problem. It guarantees close to a 100 percent fix to BPPV.

Benign Paroxysmal Positional Vertigo (BPPV)
Benign Paroxysmal Positional Vertigo (BPPV) is the disorder that causes vertigo, which is the false sensation of head’s spinning. The patient with BPPV may feel minor to severe faintness. BPPV may be caused by the incorrect position of the patient’s head. It is most felt when the patient moves head in either direction, lays down, or gets up from the bed especially in the morning.

BPPV is the disorder of the inner ears in which the crystals of calcium carbonate (known as ear rocks or otoconia) are accumulated and turned into the gel. This gel is then migrated into the semi-circular canals, which are normally filled with fluid. This fluid is generally unaffected by the gravity because of its lightweight.

With the migration, the accumulated gel tends to move down with the effect of gravity and bounces up again with any physical movement of the head and other factors. This results in its interference with the normal fluid movement within the canals that are used for the sensation of head motion.

Because of this interference and fluid movement, the nerves at the canal of the patient’s inner ear are excited and send false signals to the brain related to head rotation. In normal cases, this fluid is rested stationary within the canals. These false signals generate information in the brain that does not match with those sent by the second ear and eyes.

This mismatch of the generated information from multiple sources confuses the brain, which may make you feel spinning. This spinning is medically termed as vertigo, which may last up to a minute from its occurrence. Note that some patients would have a normal feel between every two vertigo invocations.

However, some of them may have a constant feeling of light head spinning sensation between two major spins of vertigo. Note that the dizziness caused by BPPV would not impact the hearing ability of the patient. It would also not make the patient difficult to speak. In case you have any of such additional symptoms, you must discuss with your physician immediately.

The occurrence of BPPV is seen mainly in the adults and is very rare in the children. However, it may impact individuals of any age group. The most cases of this disease are reported in the elderly people. Most of the patients with BPPV may feel the surroundings spinning while getting up from the bed in the morning.

However, the same symptom may also be associated with other disorders such as a migraine, trauma, ear infection, diabetes, intubation caused by lying in bed for a long period, osteoporosis, reduced blood flow, and more. It may also be associated with the incorrect posture of sleep. So, you must consult your doctor immediately when such symptoms arise in your body.

Symptoms of BPPV
The various symptoms of BPPV may include:

-  Dizziness

-  Vertigo in which the patient may feel the surrounding moving or spinning, especially while getting up in the morning

-  Disbalancing while getting up from sitting

-  Continual nausea and vomiting for over several weeks

-  Nystagmus in which the eye movements of the patient appear abnormal

Note that these symptoms may appear or disappear in between. It may happen that the patient is relieved from the symptoms for several months. But those may recur with lesser to severe intensity. Along with the symptoms listed above, some patients may observe the following symptoms in the extreme conditions:

-  Severe and intolerable headache

-  Fever

-  Double vision

-  Vision loss

-  Loss of hearing

-  Difficulty in speaking

-  Weakness in the legs or arms

-  Unconsciousness

-  Difficulty in walking

-  Tingling sensations in the brain, ear or other parts of the body

-  Numbness

Causes of BPPV
Age is a crucial factor that increases your chances of getting BPPV. It is often seen that the individuals of age over 50 years are most likely to get BPPV since the muscles of their inner ear may become weaker at that age. There may also be other causes of BPPV. Some of those are mentioned below:

-  Keeping head in a fixed posture for a long duration either on a dentist chair, salon and more

-  Performing the exercises that require high-speed movements of the head

-  Bike riding on a rough track

-  Various types of disorders of inner ear like Meniere’s disease

-  Resting on the bed for long duration for any reason, like hospitalization, prolonged rest over the weekend, working on a laptop for long while lying on the bed

-  Due to migraine

Prevention from BPPV-
Since BPPV may be caused by multiple reasons including the old age, it is very hard to prevent it completely. However, there are the multiple ways through which you may prevent it from happening to a good extent. Some of those are mentioned below:

-  Avoid doing exercises that may involve frequent and severe head movements.

-  Prevent yourself from any possibility of head injury. Wear a helmet while riding a bicycle, bike, and other sports.

-  Avoid lying on the bed for long hours.

-  Avoid prolonged steady head placement when awake.

-  Meditate on a regular basis.

-  Maintain hygiene in your surroundings to avoid the chances of infection in your ears.

-  Have a balanced sleep.

-  Exercise every day.

-  Don’t tip your head back for long hours to watch TV or to talk to your correspondents.

-  Take care of your immune system and adopt the habits that would keep it strong.

-  Avoid frequent head movements in case you are already a patient of BPPV. This may worsen your symptoms.

How BPPV is diagnosed?
If you observe even the mild symptoms of BPPV (mentioned above) for over a week, visit your doctor immediately. The physician would ask the patient several questions related to the symptoms. For instance:

-  When is the dizziness felt most during a day?

-  From how long the symptoms are observed?

-  Do you have a continual temptation of vomiting?

-  How are you normally relieved from the symptoms?

-  For how long at a stretch are the symptoms observed?

-  Do you have any other disease or disorders related to the ears or the brain?

-  Are you a patient of a migraine?

The doctor would also assess the complete medical history of the patient of the past several years. The eye movement of the patient would also be checked for the occurrence of nystagmus. The patient would also be asked to lay down on a table with the head tilted back. This test would help the physician in understanding if the patient has irregular control in eye movement.

It may also be observed if the symptoms occur most with the movement of eyes or head in a particular direction. Post collection of all this information, the physician may also prescribe the patient to undergo an infrared goggle test.

In case the doctor finds it difficult to identify the actual reason for those symptoms, the patient may be prescribed to get one of the following investigations done:

-  Video Nystagmography (VNG) or Electro Nystagmography (ENG) in which the abnormal movement of eyes is detected if any. In the ENG test, electrodes are used and in VNG, small cameras are used to assess if the dizziness is because of some inner ear disease. This is calculated by the measurement of irregular eye movement by placing the patient’s head in multiple positions.

-  Magnetic Resonance Imaging (MRI), in which magnetic fields and radio waves capture multiple images of the patient’s head or other parts of the body from different directions. Such images could be assessed to diagnose the condition of the dizziness and the possible reasons associated with it.

Treatment of BPPV
There are some chances that the symptoms of BPPV may disappear on their own in few weeks to months. However, to get rid of the symptoms sooner, the doctor would provide the treatment for the repositioning of the head movements. This therapy is called as canalith repositioning.

In canalith repositioning, the mispositioned canaliths due to the gel developed from the crystals of calcium carbonate that move from the fluid-filled semi-circular canals of the inner ear, are repositioned. This prevents the nerves of the canal of the patient’s inner ear by sending false signals to the brain related to head rotation. Along with this process, the doctor may also recommend the patient to avoid some particular head position for several weeks to months, which may trigger the symptoms again.

For the first few sessions of canalith repositioning, you are required to visit the therapy centre. Post then, the doctor may teach you the canalith repositioning procedure, which you could practice on your own at home if required. Post such a session, you may be required to take rest for at least 10-15 minutes so that the crystals of calcium carbonate are resettled in the canals of the inner ear.

In some rare situations where the symptoms are extreme and could not be relieved by the canalith repositioning procedure, the patient may be recommended a surgery with which the inner ear’s bone is plugged to prevent the movement of calcium carbonate crystals within the fluid-filled semi-circular canals. This effectively stops the symptoms of dizziness. Such type of surgery is effective with the success rate of around 90%. But in some rare cases, there is the risk of loss of hearing for the patient.

Other than these treatments, there are certain precautions that the patients of BPPV should take. Those are mentioned below:

-  Keep memorising your symptoms and be extra careful about balancing while getting up from your bed. The patients with BPPV are more prone to lose their balance, which may result in them to face injuries.

-  Try to be seated whenever you have a feeling of dizziness. In case you are standing and could not see some nearby seat, just take the support of some wall or any stable object.

-  Keep some lights turned on in your bedroom in the night, so that you would not face many difficulties in getting up in between if required.

-  Keep visiting your doctor periodically unless your symptoms are subsided.

-  Do not lay with the head tilted back, if you are already suffering from the symptoms of BPPV.

-  Avoid laying or sleeping towards the affected side of the head where symptoms are felt the most. Use two pillows while sleeping to ensure this.

-  Even when the symptoms are disappeared, those may recur. Prepare your mindset for that.

-  While waking up in the morning, lift the head very slowly and sit on the bed for a few minutes before standing up.

-  Avoid bending down for picking up something.

Complications
Although BPPV is not a fatal disease by its own, its symptoms may cause you to face complicated problems if not taken care of or treated on time. It often happens that the patients with BPPV collapse on the floor due to dizziness, which may cause them severe fatal injuries. It is very important for them to bring the practice to their habit of sitting down or holding some stationary object whenever they observe dizziness. Else than that, BPPV may cause the patient to have an uncomfortable feeling. If it lasts for long, the patient may suffer from depression.

Another related complication is associated with the surgery in which the inner ear’s bone is plugged to prevent the movement of calcium carbonate crystals within the fluid-filled semi-circular canals. This surgery is carried out with an attempt to eliminate the symptoms of dizziness caused by BPPV. However, in some rare cases, this surgery may cause loss of hearing.

Myths
Myth #1: Children may not suffer from BPPV

It has been seen that elderly individuals are more likely to be affected by BPPV. However, individuals of any age (including children) may suffer from this disorder. Some children may not be able to express the problems that they would be facing. So, in case your kids collapse by their own on a frequent basis, it is must for you to take them to a paediatrician.

Myth #2: BPPV is caused only by a migraine

A migraine is one of the causes because of which BPPV may occur. However, there are multiple other factors associated with this disorder.

Myth #3: BPPV is always healed by its own

It is not necessary that BPPV is healed by its own every time. If the symptoms are severe, you must get a proper treatment before facing any injury due to the associated dizziness.

Nasal polyps
Nasal polyps are soft and painless benign growths on the lining of the sinuses and nasal passages. Nasal polyps hang down as grapes or teardrops. Polyps can occur in one or both nostrils at a time. They can occur due to allergies, chronic infection, drug sensitivity, some immune disorders, or chronic inflammation because of asthma. You may not experience symptoms if you have small nasal polyps. People with many nasal polyps or larger growths may experience blockage in the nasal passages, breathing problems, frequent infections and loss of sense of smell. Nasal polyps are more prone to adults and males but they can affect any person. Your doctor may prescribe you certain medicines in order to eliminate or shrink nasal polyps. In some cases, surgery is required in order to remove nasal polyps. There is a possibility that nasal polyps can return even after proper treatment.

Symptoms
It is not necessary that you will experience symptoms if you have nasal polyps. Due to polyps, there can be a blockage in the nasal passages leading to chronic congestion. Check out various signs or symptoms of nasal polyps:

-  People with nasal polyps may have a sensation that their nose is blocked.

-  Due to nasal polyps, people may not sense the smell properly.

-  People with nasal polyps may feel a pressure in the face or forehead.

-  Nasal polyps can make you breathe through the mouth.

-  Running nose, nasal stuffiness, and nasal congestion are all the possible signs of nasal polyps.

-  You may suffer from sleep apnea due to nasal polyps. Postnasal drip is a situation in which excess mucus collects in the back of the nose or throat.

-  Snoring can be a symptom of nasal polyps.

-  If you also have a sinus infection with the nasal polyps then you may also suffer from headaches or pain.

Causes-
The causes of polyps are still not known. There is no clarification on the part that why people get chronic inflammation or why inflammation leads to the formation of nasal polyps in some people and not in other people. The chronic inflammation happens in the mucous membrane of the sinuses and nose. As per some evidence, it is clear that people who get nasal polyps have different chemical makers in the fluid-producing lining and a different response of immune system than people who do not get nasal polyps. Nasal polyps can occur to any person at any age. But it has been noticed that they are more prone to middle-aged and young adults. There is a possibility that people can get nasal polyps with no nasal problems in the past. As per scientists, there can be some possible triggers including:

-  Churg-Strauss syndrome

-  Asthma

-  Cystic fibrosis

-  Allergic rhinitis or hay fever

-  Recurring or chronic sinus infections

-  Non-steroidal anti-inflammatory drug sensitivity including aspirin or ibuprofen

How is it diagnosed?
As soon as you discover that you have nasal polyps, you should see a doctor as polyps can lead to various complications. Your doctor conducts a general physical examination and also an exam of your nose. Your doctor will check the polyps with the help of a lighted instrument. Your doctor will do a diagnosis depending on your various answers to queries about the symptoms that you are experiencing. Your doctor may ask you to get various diagnostic tests done in order to confirm the diagnosis:

-  Nasal endoscopy: Your doctor conducts a detailed examination of the sinuses and nose with the help of a narrow tube with an illuminated magnifying lens or small camera, known as a nasal endoscope. The doctor inserts the nasal endoscope into your nostril and then guides it into your nasal passage or nasal cavity.

-  Imaging studies: Your doctor obtains the images with the help of computerized tomography which helps your doctor to point to the location and size of polyps in deeper regions of the sinuses. It also helps the doctor to find out the range of the inflammation. Other obstructions in the nasal cavity including abnormalities in the structure or different type of noncancerous or cancerous growth can be found out by the doctors with the help of these studies.

-  Allergy tests: Your doctor may ask you to get the epidermis test done in order to find out if allergies are developing due to chronic inflammation. A skin prick test can be conducted in which a few drops of allergens, substances that might be causing an allergy are pricked into the epidermis of your upper back or forearm. The drops of allergens are left on your epidermis for some minutes. Then your doctor observes your epidermis to check the signs or symptoms of allergic reactions. If it not possible to conduct a skin test then your doctor may ask you to get a blood test done that find out specific antibodies to allergens.

-  Test for cystic fibrosis: If it is diagnosed that your child has nasal polyps then your doctor may order you to get the tests done for cystic fibrosis. Cystic fibrosis is an inherited disorder in which the lungs and digestive system damage and it can threaten the life of the affected person. The diagnostic test for cystic fibrosis is a sweat test which is noninvasive that determines if the perspiration of your child is saltier as compared to the sweat of most people.

Prevention
Check out various ways that will help you to get prevention from nasal polyps:

-  If you feel the dry air in your home then you should use a humidifier.

-  You should wash your hands frequently especially after coming from outside or before starting a meal. This helps to reduce the chances of catching a viral or bacterial infection which can lead to a case of inflammation of the nasal passages and sinuses.

-  You should avoid those substances that can create an irritation including chemicals, airborne pollutants, and some allergens. This may help you to reduce the chances of developing nasal polyps.

-  You should manage your allergies and asthma properly. It is important to follow whatever is recommended by your doctor related to allergy and asthma treatment as it will reduce the risk of developing polyps.

-  You should rinse the nasal passages with a saline spray or nasal lavage as it will help you to remove allergens and irritants and make better the flow of mucus.

Treatment
It is a challenge to clear polyps completely. Your doctor will suggest you the best treatment option as per your condition in order to manage your symptoms and treat the factors that can lead to chronic inflammation. The treatment is given so that the size of polyps can be reduced or polyps can be eliminated. Initially, medicines are given to treat the affected person. In certain situations, the doctor may prescribe to go for a surgery. There is a possibility that polyps can recur that is why surgery is not a permanent treatment option.

Medications:
In the treatment of nasal polyps, the doctor generally prescribes medicines in the starting. The medicines help to shrink and remove the polyps even the larger ones. Check out various medicines for the treatment of polyps:

-  Nasal corticosteroids: Your doctor may prescribe nasal corticosteroid spray that will help you to minimize inflammation. By this treatment, polyps can eliminate or shrink. Budesonide (Rhinocort), fluticasone (Veramyst, Flonase), mometasone (Nasonex), flunisolide, ciclesonide (Omnaris), beclomethasone (Beconase AQ), and triamcinolone (Nasacort Allergy 24HR) are some of the nasal corticosteroids.

-  Oral and injectable corticosteroids: Your doctor may recommend you an oral corticosteroid including prednisone if a nasal corticosteroid does not work for you. You can take it alone or in combination with a spray related to the nose. There are some side effects of oral corticosteroids that is why they are taken for a short period. If you have severe nasal polyps then your doctor may recommend injectable corticosteroids.

-  Other medications: To treat the conditions which may contribute to inflammation (chronic) in the sinuses and nasal passages, a doctor may prescribe medication to curb the same. In order to treat allergies, antihistamines are used and to treat a recurring chronic infection, antibiotics are used. Patients with aspirin sensitivity and nasal polyps may get benefit from the treatment of aspirin desensitization.

Surgery:
If medications are not effective in eliminating or shrinking polyps then the doctor may ask you to go for endoscopic surgery. This will help in solving the problems related to sinuses and removing nasal polyps. In the surgery, the surgeon inserts a tiny tube with a camera or magnifying lens into the nostrils and guides the tube into the sinus cavities. Some instruments are used to eliminate nasal polyps and other obstacles that block the fluids from the sinuses. The affected person can be discharged on the same day of the surgery. Your doctor may recommend the patient to use the nasal spray after the surgery in order to prevent polyps from recurring. Saltwater (saline) rinse may also be prescribed by the doctor to catalyze the process of healing after the surgery.

Complications:
Complications occur due to nasal polyps because it restricts the normal airflow, fluid drainage and also because of the degenerative inflammation that underlies their development. The major complications of nasal polyps generally include the following:

-  Obstructive sleep apnea: In this chronic condition you usually stop and begin to breathe frequently during the time you sleep.

-  Asthma flare-ups: The serious and chronic rhinosinusitis can cause and even worsen the condition of asthma.

-  Sinus infections: It has been observed that you are more likely to get sinus infections if you suffer from the disease nasal polyps. These sinus infections occur very frequently and sometimes, they can also become serious or chronic.

-  Disfigured structure of the face: Nasal polyps can alter the shape or structure of the face which consequently causes the condition of double vision. Often if the patient has cystic fibrosis, he or she can have eyes which are set wider apart than they are normally.

-  Complications due to surgery: When nasal polyps are treated, especially by surgery, they can cause severe nosebleeds. Along with that, surgery in case of nasal polyps can also cause infections. If the treatment with nasal steroids sprays or oral corticosteroids is continued, it can reduce your ability to fight off and counteract sinus infections.

Conclusion:
Noncancerous, soft, painless growths which may form on one’s sinuses or nasal passages are known as nasal polyps. They may look like teardrops or hanging grapes. Due to allergies, asthma, drug sensitivity, recurring infection or some immune disorders may result from chronic inflammation.

People generally do not experience symptoms when they have small nasal polyps. Nasal polyps may lead to breathing problems, frequent infections blockage in the nasal passages, and loss of sense of smell. Men are more prone to nasal polyps than women. Polyps can happen to a person of any age.

Tinnitus (tin-ih-tus) is the perception of noise or ringing in the ears. A common problem, tinnitus affects about 1 in 5 people. Tinnitus isn't a condition itself — it's a symptom of an underlying condition, such as age-related hearing loss, ear injury or a circulatory system disorder.

Although bothersome, tinnitus usually isn't a sign ofv something serious. Although it can worsen with age, for many people, tinnitus can improve with treatment. Treating an identified underlying cause sometimes helps. Other treatments reduce or mask the noise, making tinnitus less noticeable.

Symptoms
Tinnitus involves the annoying sensation of hearing sound when no external sound is present. Tinnitus symptoms include these types of phantom noises in your ears:

• Ringing
• Buzzing
• Roaring
• Clicking
• Hissing

The phantom noise may vary in pitch from a low roar to a high squeal, and you may hear it in one or both ears. In some cases, the sound can be so loud it can interfere with your ability to concentrate or hear actual sound. Tinnitus may be present all the time, or it may come and go.

There are two kinds of tinnitus.

1. Subjective tinnitus is tinnitus only you can hear. This is the most common type of tinnitus. It can be caused by ear problems in your outer, middle or inner ear. It also can be caused by problems with the hearing (auditory) nerves or the part of your brain that interprets nerve signals as sound (auditory pathways).
2. Objective tinnitus is tinnitus your doctor can hear when he or she does an examination. This rare type of tinnitus may be caused by a blood vessel problem, a middle ear bone condition or muscle contractions.

You develop tinnitus after an upper respiratory infection, such as a cold, and your tinnitus doesn't improve within a week.
See your doctor as soon as possible if:

Causes- 
A number of health conditions can cause or worsen tinnitus. In many cases, an exact cause is never found.

A common cause of tinnitus is inner ear cell damage. Tiny, delicate hairs in your inner ear move in relation to the pressure of sound waves. This triggers ear cells to release an electrical signal through a nerve from your ear (auditory nerve) to your brain. Your brain interprets these signals as sound. If the hairs inside your inner ear are bent or broken, they can" leak" random electrical impulses to your brain, causing tinnitus.Other causes of tinnitus include other ear problems, chronic health conditions, and injuries or conditions that affect the nerves in your ear or the hearing center in your brain.

Common causes of tinnitus
In many people, tinnitus is caused by one of these conditions:

• Age-related hearing loss. For many people, hearing worsens with age, usually starting around age 60. Hearing loss can cause tinnitus. The medical term for this type of hearing loss is presbycusis.
• Exposure to loud noise. Loud noises, such as those from heavy equipment, chain saws and firearms, are common sources of noise-related hearing loss. Portable music devices, such as mp3 players or ipods, also can cause noise-related hearing loss if played loudly for long periods. Tinnitus caused by short-term exposure, such as attending a loud concert, usually goes away; long-term exposure to loud sound can cause permanent damage.
• Earwax blockage. Earwax protects your ear canal by trapping dirt and slowing the growth of bacteria. When too much earwax accumulates, it becomes too hard to wash away naturally, causing hearing loss or irritation of the eardrum, which can lead to tinnitus.
• Ear bone changes. Stiffening of the bones in your middle ear (otosclerosis) may affect your hearing and cause tinnitus. This condition, caused by abnormal bone growth, tends to run in families.

Other causes of tinnitus
Some causes of tinnitus are less common, including:

1. Meniere's disease- Tinnitus can be an early indicator of meniere's disease, an inner ear disorder that may be caused by abnormal inner ear fluid pressure.
2. Tmj disorders- Problems with the temporomandibular joint, the joint on each side of your head in front of your ears, where your lower jawbone meets your skull, can cause tinnitus.
3. Head injuries or neck injuries- Head or neck trauma can affect the inner ear, hearing nerves or brain function linked to hearing. Such injuries generally cause tinnitus in only one ear.
4. Acoustic neuroma- This noncancerous (benign) tumor develops on the cranial nerve that runs from your brain to your inner ear and controls balance and hearing. Also called vestibular schwannoma, this condition generally causes tinnitus in only one ear.
5. Blood vessel disorders linked to tinnitus- In rare cases, tinnitus is caused by a blood vessel disorder. This type of tinnitus is called pulsatile tinnitus. Causes include:
6. Atherosclerosis- With age and buildup of cholesterol and other deposits, major blood vessels close to your middle and inner ear lose some of their elasticity — the ability to flex or expand slightly with each heartbeat. That causes blood flow to become more forceful, making it easier for your ear to detect the beats. You can generally hear this type of tinnitus in both ears.
7. Head and neck tumors- A tumor that presses on blood vessels in your head or neck (vascular neoplasm) can cause tinnitus and other symptoms.
8. High blood pressure- Hypertension and factors that increase blood pressure, such as stress, alcohol and caffeine, can make tinnitus more noticeable.
9. Turbulent blood flow- Narrowing or kinking in a neck artery (carotid artery) or vein in your neck (jugular vein) can cause turbulent, irregular blood flow, leading to tinnitus.
10. Malformation of capillaries- A condition called arteriovenous malformation (avm), abnormal connections between arteries and veins, can result in tinnitus. This type of tinnitus generally occurs in only one ear.

Medications that can cause tinnitus
A number of medications may cause or worsen tinnitus. Generally, the higher the dose of these medications, the worse tinnitus becomes. Often the unwanted noise disappears when you stop using these drugs. Medications known to cause or worsen tinnitus include:

• Antibiotics
• Cancer medications,
• Water pills (diuretics), 
• Quinine medications used for malaria or other health conditions
• Certain antidepressants may worsen tinnitus
• Aspirin taken in uncommonly high doses (usually 12 or more a day)

Risk factors
Anyone can experience tinnitus, but these factors may increase your risk:

• Loud noise exposure- Prolonged exposure to loud noise can damage the tiny sensory hair cells in your ear that transmit sound to your brain. People who work in noisy environments — such as factory and construction workers, musicians, and soldiers — are particularly at risk.
• Age- As you age, the number of functioning nerve fibers in your ears declines, possibly causing hearing problems often associated with tinnitus.
• Gender- Men are more likely to experience tinnitus.
• Smoking- Smokers have a higher risk of developing tinnitus.
• Cardiovascular problems- Conditions that affect your blood flow, such as high blood pressure or narrowed arteries (atherosclerosis), can increase your risk of tinnitus.

Complications
Tinnitus can significantly affect quality of life. Although it affects people differently, if you have tinnitus, you also may experience:

• Fatigue
• Stress
• Sleep problems
• Trouble concentrating
• Memory problems
• Depression
• Anxiety and irritability

Treating these linked conditions may not affect tinnitus directly, but it can help you feel better.

Prevention
In many cases, tinnitus is the result of something that can't be prevented. However, some precautions can help prevent certain kinds of tinnitus.

Use hearing protection. Over time, exposure to loud noise can damage the nerves in the ears, causing hearing loss and tinnitus. If you use chain saws, are a musician, work in an industry that uses loud machinery or use firearms (especially pistols or shotguns), always wear over-the-ear hearing protection.
Turn down the volume. Long-term exposure to amplified music with no ear protection or listening to music at very high volume through headphones can cause hearing loss and tinnitus.
Take care of your cardiovascular health. Regular exercise, eating right and taking other steps to keep your blood vessels healthy can help prevent tinnitus linked to blood vessel disorders.

Homeopathic remedies
1. Calcarea carbonica- When this remedy is indicated, tinnitus may be experienced alone or with vertigo. The person may have hearing problems, or cracking and pulsing sensations in the ears. People who need this remedy are usually chilly, easily fatigued, crave sweets, and feel overwhelmed and anxious when unwell.

2.Chininum sulphuricum- Buzzing, ringing, and roaring sounds that are loud enough to impair the person's hearing suggest a need for this remedy. The person may also have a tendency toward chills and vertigo, during which the tinnitus is often worse.

3. Graphites- This remedy may be beneficial to a person who has tinnitus with associated deafness. Hissing and clicking sounds are often heard in the ears (or even louder sounds like gunshots). People who need this remedy may also have a tendency toward constipation, poor concentration, and cracking skin eruptions.

4. Lycopodium- A humming and roaring in the ears, along with impairment of hearing, suggest the use of this remedy. Sounds may also seem to echo in the ears. People needing lycopodium often have a tendency toward ear infections with discharge, as well as chronic digestive problems or urinary tract complaints.

5. Carbo vegetabilis- This remedy may be useful if ringing in the ears occurs during flu or other conditions involving vertigo and nausea. The symptoms may be worst in the evening and at night. The person may feel cold and faint, but usually has a craving for fresh and moving air. Carbo vegetabilis is also helpful when an illness has been prolonged or recovery is slow.

6. China (also called cinchona officinalis)- This remedy is often helpful to people who feel touchy, weak, and nervous with sensitivity to noise and tinnitus. It is often indicated after fluids have been lost through vomiting, diarrhea, heavy sweating, and surgery or other conditions involving blood loss.

7. Cimicifuga- People likely to respond to this remedy are very sensitive to noise, along with tinnitus, and often have pain and muscle tension in the neck and back. They are usually energetic, nervous, and talkative, but become depressed or fearful when not feeling well. Headaches and problems during menstrual periods are often seen in people who need this remedy.

8. Coffea cruda- This remedy may be helpful to an excitable, nervous person with tinnitus accompanied by extremely sensitive hearing and a buzzing feeling in the back of the head. People who need this remedy often have insomnia from mental overstimulation.

9. Kali carbonicum- Tinnitus with ringing or roaring, accompanied by cracking noises and itching in the ears, may be relieved with this remedy. Vertigo experienced on turning is another indication. People who need this remedy are often quite conservative, with a rigid code of ethics. They tend to feel anxiety in the region of the stomach.

10. Natrum salicylicum- This remedy may be beneficial if ringing in the ears is like a low, dull hum. Loss of hearing related to bone conduction, as well as nerve interference and vertigo, may be involved. Natrum salicylicum is a useful remedy when tinnitus and tiredness occur after influenza or along with meniere's disease.

11. Salicylicum acidum- This remedy is indicated for tinnitus with very loud roaring or ringing sounds, which may be accompanied by deafness or vertigo. The problem may have begun with flu, or occur in a person with meniere's disease. Salicylicum acidum may also be helpful if tinnitus has been caused by too much aspirin.

"Don’t use any homeopathic remedies without any prescription."