Why do I hear ringing sounds in my ears?

Q: I am a 52-year-old man. I have been experiencing ringing in both ears for the past two months.

I consulted an ear, nose and throat (ENT) specialist.

The examination of my inner ears found that there was nothing wrong with them and they were in good condition. The audiometry test showed that my hearing is normal.

In addition, the nasal space was examined and was confirmed clear of any tumour.

Later, I consulted a traditional Chinese medicine (TCM) practitioner, who treated me with acupuncture. I have been taking the prescribed herbs for the past 1 1/2 months.

The ringing in the ears did reduce slightly, but it still persists.

I will be grateful for your advice on what can help me resolve the ear ringing completely.

A: In TCM, tinnitus (a ringing condition in the inner ear) is probably caused by the deficiency in the function of the kidneys, liver, spleen and stomach.

A good flow of qi (energy) and blood is required for good health. The kidneys promote qi and blood to the ears. When the kidneys are dysfunctional - due to ageing, a weak constitution and chronic illnesses - the ears are unable to receive adequate qi and blood from the kidneys.

This will trigger tinnitus, with the ringing getting louder at night. It is accompanied by soreness and aching of the lower back or knees, insomnia and dizziness.

The liver stores blood and controls qi circulation. Insufficient qi and blood to nourish the liver, or negative emotions - such as stress, depression, fear and anxiety - will cause qi to stagnate and create "fire" in the liver.

This "fire" rises to the ears and triggers tinnitus, which becomes louder after emotional upsets. It comes with pain and swelling of the ears, headaches and a dry throat.

The spleen and stomach receive food and convert the nutrients into qi and blood. When both organs are weak, they convert the nutrients into phlegm and "dampness" instead.

When these have accumulated in the body for a prolonged period, they will create blood stasis and "fire", resulting in tinnitus, which is aggravated by fatigue. It comes with a poor appetite, a bloated stomach after meals and loose stool.

When qi and blood are insufficient to nourish one's ears, one hears noises like those made by crickets. This tinnitus reduces after exercise. It comes with dizziness, palpitations and shortness of breath.

With insufficient qi and blood, external disease-causing factors, such as "wind" and "heat", can easily invade the body. They can trigger tinnitus with a blocked nose, sore throat and fever.

External injury to the head or loud noise can damage the ears, and trigger tinnitus with sudden ear pain, hearing loss and headache.

Chinese herbal medicine, acupuncture and cupping therapy can help improve your condition by strengthening the organs and dispelling disease-causing factors.

Cupping involves using fire and cups to create a vacuum on the skin to enhance blood and qi circulation.

Chinese herbs such as processed rehmannia root, barbary wolfberry fruit, Asiatic cornelian cherry fruit and Chinese magnoliavine fruit strengthen the kidneys.

Chinese gentian, Chinese thorowax root, turmeric root-tuber, white peony root, nutgrass galingale rhizome, cape jasmine fruit, finger citron and lophatherum herb strengthen the liver and enhance qi circulation.

Codonopsis root, milkvetch root, largehead atractylodes rhizome and common yam rhizome strengthen the spleen and stomach, and increase the amount of qi in the body.

Chinese angelica, Sichuan lovage rhizome, fleeceflower root and mulberry fruit increase the amount of blood in the body. Hirsute shiny bugleweed herb, motherwort herb, safflower, peach seed and red peony root enhance blood circulation.

Baical skullcap root, thunberg fritillary bulb, Indian bread, dried tangerine peel and bamboo shavings dispel phlegm, "dampness" and "fire".

Avoid alcohol and cold, raw, spicy and deep-fried food. Eat easily digested food such as porridge and green leafy vegetables.

Engage in regular exercise - such as brisk walking, swimming and yoga - and slow down your lifestyle to help enhance qi circulation.

Keep the environment quiet or wear earplugs to reduce your exposure to noise.

Ms Lim Lay Beng
Traditional Chinese medicine practitioner at YS Healthcare TCM Clinic

Doctor says

Doctor says

A ringing in the ears is called tinnitus.

It can be caused by any inflammation of the outer ear, middle ear or the hearing nerve in the inner ear. Inflammation can result from infection of the ears by bacteria and viruses.

One-sided tinnitus (tinnitus in just one ear) is more worrying than tinnitus in both ears. This can be a symptom of a brain tumour in the hearing nerve in the inner ear, which is less likely to occur in both ears at the same time. So for those with one-sided tinnitus, a magnetic resonance imaging scan of the brain should be done to rule out a brain tumour.

Given that you have been examined by an ear, nose and throat specialist and assuming that your outer and middle ears are normal, the next possible explanation would be a problem with the inner ear. However, the hearing test would suggest that the hearing nerve in your inner ear is functioning normally.

Other possible common systemic causes of tinnitus that one would need to consider would include high blood pressure, anaemia, migraines, thyroid disease, high cholesterol, diabetes, some drugs, stress, anxiety and old age.

For instance, high blood pressure raises the blood pressure within the ear. This could be heard as a "pounding" sound in the ears.

High cholesterol and old age result in poorer blood circulation to the ears. Hence, the ears would be oxygen deficient, leading to inner nerve degeneration. This, in turn, can lead to hearing loss and/or tinnitus.

Adopt lifestyle changes to relieve stress, such as exercising regularly. In general, relaxation methods would lower high blood pressure and reduce any resulting tinnitus.

Some types of medication help to improve the blood circulation to the inner ear and the brain. This may help reduce the tinnitus.

Distraction therapy is also useful.

Turn on soft music when the tinnitus is at its worst. Alternatively, some white noise - background noise - has been shown to help too. To create white noise, tune the frequency of the radio between any two stations or use a noisy fan at night.

Dr Kenny Pang
Ear, nose and throat surgeon at Asia Sleep Centre at Paragon

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