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Hearing Loss and Dementia

Hearing Loss Linked to Accelerated Brain Tissue Loss

Release Date: January 22, 2014

Although the brain becomes smaller with age, the shrinkage seems to be fast-tracked in older adults with hearing loss, according to the results of a study by researchers from Johns Hopkins and the National Institute on Aging. The findings add to a growing list of health consequences associated with hearing loss, including increased risk of dementia, falls, hospitalizations, and diminished physical and mental health overall.

For the study, Frank Lin, M.D., Ph.D., and his colleagues used information from the ongoing Baltimore Longitudinal Study of Aging to compare brain changes over time between adults with normal hearing and adults with impaired hearing. The Baltimore Longitudinal Study of Aging was started in 1958 by the National Institute on Aging to track various health factors in thousands of men and women.

Previous research from other studies had linked hearing loss with marked differences in brain structure compared to those with normal hearing, both in humans and animals. In particular, structures that process information from sound tended to be smaller in size in people and animals with impaired hearing. Lin, an assistant professor at the Johns Hopkins University schools of medicine and public health, says it was unknown, however, whether these brain structural differences occurred before or after hearing loss.

As part of the Baltimore Longitudinal Study of Aging, 126 participants underwent yearly magnetic resonance imaging (MRI) to track brain changes for up to 10 years. Each also had complete physicals at the time of the first MRI in 1994, including hearing tests. At the starting point, 75 had normal hearing, and 51 had impaired hearing, with at least a 25-decibel loss.

After analyzing their MRIs over the following years, Lin and his colleagues, reporting in an upcoming issue of Neuroimage, say those participants whose hearing was already impaired at the start of the sub-study had accelerated rates of brain atrophy compared to those with normal hearing. Overall, the scientists report, those with impaired hearing lost more than an additional cubic centimeter of brain tissue each year compared with those with normal hearing. Those with impaired hearing also had significantly more shrinkage in particular regions, including the superior, middle and inferior temporal gyri, brain structures responsible for processing sound and speech.

That structures responsible for sound and speech are affected in those with hearing loss wasn’t a surprise, says Lin – shrinkage in those areas might simply be a consequence of an “impoverished” auditory cortex, which could become atrophied from lack of stimulation. However, he adds, these structures don’t work in isolation, and their responsibilities don’t end at sorting out sounds and language. The middle and inferior temporal gyri, for example, also play roles in memory and sensory integration and have been shown to be involved in the early stages of mild cognitive impairment and Alzheimer’s disease.

“Our results suggest that hearing loss could be another ‘hit’ on the brain in many ways,” Lin explains.

The study also gives some urgency to treating hearing loss rather than ignoring it. “If you want to address hearing loss well,” Lin says, “you want to do it sooner rather than later. If hearing loss is potentially contributing to these differences we’re seeing on MRI, you want to treat it before these brain structural changes take place.”

Lin and his colleagues say they plan to eventually examine whether treating hearing loss early can reduce the risk of associated health problems.

The research was supported by the intramural research program of the National Institute on Aging, the National Institutes of Health’s National Institute on Deafness and other Communication Disorders (K23DC011279), a Triological Society/American College of Surgeons Clinical Scientist Development Award and the Eleanor Schwartz Charitable Foundation.

Susan Resnick, Ph.D., of the National Institute on Aging was the study’s senior investigator. Michael A. Kraut, M.D., Ph.D., of Johns Hopkins; and Luigi Ferrucci, M.D., Ph.D., and Yang An, M.S., both of the National Institute on Aging, also contributed to this research.

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Hearing Loss and Dementia

Incident Dementia


Earlier studies have suggested that hearing loss, which is prevalent in more than 30% of adults >60 years, may be a risk factor for dementia, but this hypothesis has never been investigated prospectively.


To determine if hearing loss is associated with incident all-cause dementia and Alzheimer’s disease (AD).


During a median follow-up of 11.9 years, 58 cases of incident all-cause dementia were diagnosed of which 37 cases were AD. The risk of incident all-cause dementia increased log-linearly with the severity of baseline hearing loss (1.27 per 10 db loss, 95% CI: 1.06 – 1.50). Compared to normal hearing, the hazard ratio for incident all-cause dementia was 1.89 for mild hearing loss (95% CI: 1.00 – 3.58), 3.00 for moderate hearing loss (95% CI: 1.43 – 6.30), and 4.94 for severe hearing loss (95% CI: 1.09 – 22.4). The risk of incident AD also increased with baseline hearing loss but with a wider confidence interval (1.20 per 10 dB of hearing loss, 95% CI: 0.94 – 1.53).


Hearing loss is independently associated with incident all-cause dementia. Whether hearing loss is a marker for early stage dementia or is actually a modifiable risk factor for dementia deserves further study.


In this study we found that hearing loss was independently associated with incident all-cause dementia after adjustment for sex, age, race, education, diabetes, smoking, and hypertension, and our findings were robust to multiple sensitivity analyses. The risk of all-cause dementia increased log-linearly with hearing loss severity, and for individuals >60 years in our cohort, over one-third of the risk of incident all-cause dementia was associated with hearing loss.

Our findings contribute significantly to the discussion in the literature on whether hearing loss is a risk factor for dementia. Previous studies suggested that individuals with hearing loss are more likely to have a diagnosis of dementia 5;6 and poorer cognitive function 15. Supporting this hypothesis, smaller prospective studies have observed that hearing loss is associated with accelerated cognitive decline in individuals with prevalent dementia 16;17. Although, a prospective study of cognitively-normal elderly volunteers failed to find any meaningful association between hearing loss at study entry and later cognitive function, the results of this study are questionable because of the short (5-year) follow-up and a 50% dropout rate 18. In our study, hearing loss, a condition that is highly prevalent in older adults and often remains untreated 19, was strongly and prospectively associated with incident dementia.

A number of mechanisms may be theoretically implicated in the observed association between hearing loss and incident dementia. There may be an over-diagnosis of dementia in individuals affected by hearing loss, or vice versa an over-diagnosis of hearing loss in individuals with cognitive impairment at baseline. An over-diagnosis of dementia in our study is unlikely because the diagnostic protocol for incident dementia relied on a consensus conference that examined information from multiple sources. We also conducted sensitivity analyses censoring individuals diagnosed with dementia during a 6-year washout period from baseline that did not affect our results. In such an analysis, individuals would already have had several “normal” cognitive exams with hearing loss before being diagnosed with dementia, likely making the dementia diagnosis not confounded by poor communication. Hearing loss (short of profound deafness) also minimally impairs face-to-face communication in quiet environments (i.e. during cognitive testing) particularly in the setting of testing by experienced examiners who are accustomed to working with older adults 20.

An over-diagnosis of hearing loss is also unlikely since there is no evidence that mild cognitive impairment would affect the reliability of audiometric testing. Behaviorally, pure-tone audiometry has been performed even in children as young as 5 years. We also excluded any individuals with recognized cognitive impairment at baseline (mild cognitive impairment or Blessed > 3), and our results were robust to models controlling for baseline Blessed scores.

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Hearing Loss and Diabetes

How do diabetes and hearing loss relate?

Diabetes and hearing loss are two of America’s most widespread health concerns. Nearly 30 million people in the U.S. have diabetes, and an estimated 34.5 million have some type of hearing loss. Those are large groups of people, and it appears there is a lot of overlap between the two.

A recent study found that hearing loss is twice as common in people with diabetes as it is in those who don’t have the disease. Also, of the 86 million adults in the U.S. who have prediabetes, the rate of hearing loss is 30 percent higher than in those with normal blood glucose.

Right now we don’t know how diabetes is related to hearing loss. It’s possible that the high blood glucose levels associated with diabetes cause damage to the small blood vessels in the inner ear, similar to the way in which diabetes can damage the eyes and the kidneys. But more research needs to be done to discover why people with diabetes have a higher rate of hearing loss.

Since it can happen slowly, the symptoms of hearing loss can often be hard to notice. In fact, family members and friends sometimes notice the hearing loss before the person experiencing it.

Signs of Hearing Loss

  • Frequently asking others to repeat themselves.
  • Trouble following conversations that involve more than two people.
  • Thinking that others are mumbling.
  • Problems hearing in noisy places such as busy restaurants.
  • Trouble hearing the voices of women and small children.
  • Turning up the TV or radio volume too loud for others who are nearby.

What should I do if I suspect a hearing loss?

Talk to your primary care doctor. You may then want to seek help from hearing specialist like: an audiologist, a licensed hearing aid dispenser or a doctor who specializes in hearing problems. From a full hearing exam, you’ll learn more about your hearing loss. You will also be told what can be done to treat it.

  • Last Reviewed: September 30, 2013
  • Last Edited: June 10, 2014

– See more at:

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Hearing Loss and Diabetes

Hearing Loss Is Common in People with Diabetes

Hearing loss is about twice as common in adults with diabetes compared to those who do not have the disease, according to a new study funded by the National Institutes of Health (NIH).

“Hearing loss may be an under-recognized complication of diabetes. As diabetes becomes more common, the disease may become a more significant contributor to hearing loss,” said senior author Catherine Cowie, Ph.D., of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), who suggested that people with diabetes should consider having their hearing tested. “Our study found a strong and consistent link between hearing impairment and diabetes using a number of different outcomes.”

The researchers discovered the higher rate of hearing loss in those with diabetes after analyzing the results of hearing tests given to a nationally representative sample of adults in the United States. The test measured participants’ ability to hear low, middle, and high frequency sounds in both ears. The link between diabetes and hearing loss was evident across all frequencies, with a stronger association in the high frequency range. Mild or greater hearing impairment of low- or mid-frequency sounds in the worse ear was about 21 percent in 399 adults with diabetes compared to about 9 percent in 4,741 adults without diabetes. For high frequency sounds, mild or greater hearing impairment in the worse ear was 54 percent in those with diabetes compared to 32 percent in those who did not have the disease.

Adults with pre-diabetes, whose blood glucose is higher than normal but not high enough for a diabetes diagnosis, had a 30 percent higher rate of hearing loss compared to those with normal blood sugar tested after an overnight fast.

The study, published early online June 17, 2008, in the Annals of Internal Medicine, was conducted by researchers from the NIDDK, the National Institute on Deafness and Other Communication Disorders (NIDCD), components of the NIH, and Social & Scientific Systems, Inc., which provides support on public health topics to NIH and other government agencies.

The researchers analyzed data from hearing tests administered from 1999 to 2004 to participants in the National Health and Nutrition Examination Survey (NHANES) conducted by the National Center for Health Statistics, part of the Centers for Disease Control and Prevention (CDC). Half of the 11,405 survey participants aged 20 to 69 were randomly assigned to have their hearing tested, and nearly 90 percent of them completed the hearing exam and the diabetes questionnaire. The hearing test, called pure tone audiometry, measures hearing sensitivity across a range of sound frequencies.

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Hearing Loss and Depression

Hearing Loss and Depression in Older Adults

To the Editor

Hearing loss (HL) is a common, but underappreciated health issue affecting older adults. The functional consequences of HL for older adults are now surfacing in epidemiological studies demonstrating that HL may be independently associated with depression1 and loneliness.2 Compared to other medical co-morbidities, HL is more strongly associated with the development of depression in older adults.1 Whether hearing rehabilitative treatment may mitigate the possible effects of HL on depression remains unclear. We investigated the association of HL and hearing aid use with major depressive disorder (MDD)in a nationally representative study of older patients.


We analyzed data from the 2005–2006 and 2009–2010 two-year cycles of the National Health and Nutrition Examination Survey (NHANES), an epidemiological study designed to assess the health, functional, and nutritional status of the civilian, non-institutionalized United States population. During these survey cycles, audiometry was performed in adults aged 70 years and older. Participants were also administered the patient health questionnaire (PHQ-9),3 a self-reported depression assessment instrument based on Diagnostic and Statistical Manual IV signs and symptoms of MDD. Our analytic cohort consists of 1029 adults aged 70 through 79 years who completed audiometric testing as well as the PHQ-9.

Hearing was defined by the speech-frequency pure tone average of hearing thresholds at 0.5, 1, 2, and 4 kHz in the better hearing ear. Participants were classified as having MDD or any depressive symptoms if either of the initial questions addressing depressed mood was answered as “more than half the days” or “nearly every day” and the PHQ-9 score was ≥ 10 or ≥ 5, respectively. Scores ≥ 10 have an 88% sensitivity/specificity for MDD, while scores ≥ 5 represent mild depression.4

Data were analyzed using stepwise multivariate logistic models to investigate the association of HL as a continuous variable (per 25 dB) and hearing aid use with MDD and any depressive symptoms, adjusting for demographic characteristics and cardiovascular risk factors. Hearing aid use was defined as wearing a hearing aid at least 5 hours a week in the twelve months prior to the interview. All significance tests were two-sided with a type I error rate of 0.05.All analyses were performed using SAS version 9.3.


At baseline, 602 (58.5%) participants had a >25 dB HL, 38 (3.9%) participants met criteria for MDD, and 71 (7.4%) participants met criteria for having any depressive symptoms. Greater HL (per 25 dB) was not significantly associated with an increased odds of MDD (OR=1.63, 95% CI: 0.66, 4.98), or any depressive symptoms (OR=1.58, 95% CI: 0.77, 3.25). Hearing aid use was associated with reduced odds of MDD (OR=0.35, 95% CI: 0.14–0.90) and any depressive symptoms (OR= 0.33, 95% CI: 0.14, 0.77) in the fully adjusted model (Table 2).

View Table 2

Table 2

Stepwise Logistic Regression Models of the Odds of Major Depressive Disorder or Any Depressive Symptoms per 25 dB of Hearing Lossb and hearing aid use


Our results demonstrate that hearing aid use is significantly associated with a reduced odds of MDD and any depressive symptoms, consistent with prior studies.5,6,7,8 Two small single arm prospective studies showed reductions in depressive symptoms within 3 months of hearing aid use.7,8 Similar results have been demonstrated in the Blue Mountains Study in which hearing aid use was associated with a reduced odds (OR =0.32) of having depressive symptoms.5 Prospective longitudinal studies in nursing home participants have shown similar reductions in depressive symptoms (OR= 0.30)6 and improvement in mental health in ambulatory patients with hearing aid use.8 The strength of our study is the utilization of the PHQ-9 to evaluate for depressive symptomatology and also MDD. Furthermore, our results are based on a generalizable cohort of older adults.

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Hearing Loss and Depression

Negative consequences of uncorrected hearing loss: A review


Hearing loss gives rise to a number of disabilities. Problems in recognizing speech, especially in difficult environments, give rise to the largest number of complaints. Other kinds of disabilities may concern the reduced ability to detect, identify and localize sounds quickly and reliably. Such sounds may be warning or alarm signals, as well as music and birds singing. The communicative disability affects both hearing-impaired people and other people in their environment—family members, fellow workers, etc. Hearing-impaired people are not always aware of all the consequences of the impairment; they do not always know what they are missing. Several studies have shown that uncorrected hearing loss gives rise to poorer quality of life, related to isolation, reduced social activity, and a feeling of being excluded,leading to an increased prevalence of symptoms of depression.

These findings indicate the importance of early identification of hearing loss and offers of rehabilitative support, where the fitting of hearing aids is usually an important component. Several studies also point to a significant correlation between hearing loss and loss of cognitive functions. Most of these studies show such a correlation without being able to show whether the hearing loss caused the reduction in cognitive performance or if both the hearing loss and the cognitive decline are parts of a common, general age-related degeneration. A couple of these studies, however, indicate that the uncorrected hearing loss may be the cause of cognitive decline. Whichever alternative is true, the correlation should be seen as a clear indication for early hearing aid fitting for those needing it. Monaural hearing aid fitting in subjects with bilateral hearing loss may give rise to a reduced ability to recognize speech presented to the unaided ear, the so-called late-onset auditory deprivation effect. This functional decline is reversible in some but not all subjects after fitting of a hearing aid also on the previously unaided ear.

Disability and Handicap

Hearing loss is an often underestimated disturbance of a sensory function. It has been shown to negatively affect physical,cognitive, behavioral and social functions, as well as general quality of life, and is clearly related to depression and dementia.It is estimated that approximately 10% of the population in many Western countries suffer from a hearing loss of a such a degree that it affects ordinary daily life. The prevalence of hearing loss is strongly related to age (Davis, 1995; Rosenhalletal, 1999). A lesion in the auditory sense organ can give rise to various forms of impairment, most commonly hearing loss, tinnitus, or hyperacusis. In this review, the focus is on hearing loss and the possibilities of overcoming at least some of its effects by means of hearing aids.The kind of lesion that dominates in the developed countries is the sensorineural lesion, primarily involving the cochlea, with loss of hair cell function. This kind of lesion gives rise to both quantitative and qualitative effects, both attenuation and distortion (Plomp, 1978).

A hearing loss gives rise to disabilities of various kinds, e.g.loss of ability to detect sounds, to recognize speech, especially in adverse conditions, and to localize sound sources. In response to questions about problems in understanding speech in back-ground noise or reverberation, young normal-hearing people typically answer ‘rarely’ (Cox, 1996), while people with slight-to-moderate hearing loss, on average, answer ‘often’ (Cox & Alexander, 1995). In order for hearing-impaired people to pickup as much as possible of the acoustical world, they have to concentrate much more than normal-hearing people. The fatigue caused by this extra concentration is an additional component among the consequences of uncorrected hearing loss. The reduced ability to detect sounds may affect sounds such as those of doorbells or telephones, traffic sounds that may signal immediate danger, and sounds of importance for quality of life, such as music or bird song.

Disability may in turn give rise to handicap or, in other terminology, affect the hearing-impaired person’s participation in interactions with other people. Increasing difficulties in recognizing the spoken messages of others, having to ask for repetition too often, and still not being sure about having understood correctly, often lead to withdrawal from social activities, rejection of invitations to parties, and no more visits to theaters, cinemas, churches, lectures, etc. This, in turn, leads to reduced intellectual and cultural stimulation, and an increasingly passive and isolated social citizen.

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Hearing Loss and Tinnitus

Causes of Tinnitus

By Mayo Clinic Staff

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:

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.

TMJ disorders. Problems with the temperomandibular joint, the joint on each side of your head in front of your ears, where your lower jawbone meets your skull, can cause tinnitus.

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.

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.

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:

Head and neck tumors. A tumor that presses on blood vessels in your head or neck (vascular neoplasm) can cause tinnitus and other symptoms.

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.

High blood pressure. Hypertension and factors that increase blood pressure, such as stress, alcohol and caffeine, can make tinnitus more noticeable.

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Hearing Loss and Tinnitus

What is Tinnitus

Over 50 million Americans have experienced tinnitus or head noises, which is the perception of sound without an external source being present. About one in five people with tinnitus have bothersome tinnitus, which distresses them and negatively affects their quality of life and/or functional health status. Those individuals with persistent and bothersome tinnitus will often seek medical care. Tinnitus may be an intermittent or continuous sound in one or both ears. Its pitch can go from a low roar to a high squeal or whine or it can have many sounds. Persistent tinnitus is tinnitus that lasts more than six months. Prior to any treatment, it is important to undergo a thorough examination and evaluation by your otolaryngologist (ENT doctor) and audiologist. An essential part of the treatment will be your understanding of tinnitus and its causes.

What Causes Tinnitus?

Tinnitus is commonly defined as hearing a sound in the absence of external sounds. Tinnitus is not a disease in itself but a common symptom, and because it involves the perception of sound or sounds, it is commonly associated with the hearing system. In fact, various parts of the hearing system, including the inner ear, are often responsible for this symptom. At times, it is relatively easy to associate the symptom of tinnitus with specific problems affecting the hearing system; at other times, the connection is less clear. Most tinnitus is primary tinnitus, where no cause can be identified aside from hearing loss. Secondary tinnitus is associated with a specific underlying cause that may be treatable. Your doctor will help you distinguish whether your tinnitus is primary or secondary.

Most of the time, the tinnitus is subjective—that is, the tinnitus is heard only by the individual. Rarely, tinnitus is “objective,” meaning that the examiner can actually listen and hear the sounds the patient hears.

Tinnitus may be caused by different parts of the hearing system. The outer ear (pinna and ear canal) may be involved. Excessive ear wax, especially if the wax touches the ear drum, causing pressure and changing how the ear drum vibrates, can result in tinnitus.

Middle ear problems that cause hearing problems can also cause tinnitus. These include common entities such as middle ear infection and uncommon ones such as otosclerosis, which hardens the tiny ear bones or ossicles. Another, rare, cause of tinnitus from the middle ear that does not result in hearing loss is muscle spasms of one of the two tiny muscles in the ear. In this case, the tinnitus can be intermittent and at times, the examiner can also hear the sounds.

Most subjective tinnitus associated with the hearing system originates in the inner ear. Damage and loss of the tiny sensory hair cells in the inner ear (that can be caused by different factors such as noise damage, medications, and age) may be commonly associated with the presence of tinnitus.

One of the preventable causes of tinnitus is excessive noise exposure. In some instances of noise exposure, tinnitus can be noticed even before hearing loss develops, so it should be considered a warning sign and an indication of the need for hearing protection in noisy environments. Medications can also damage inner ear hair cells and cause tinnitus. These include both non-prescription medications such as aspirin and acetaminophen, when taken in high doses, and prescription medication including certain diuretics and antibiotics. As we age, the incidence of tinnitus increases.

Tinnitus may also originate from lesions on or in the vicinity of the hearing portion of the brain. These include a variety of uncommon disorders including vestibular schwannoma (acoustic neuroma) and damage from head trauma.

A special category is tinnitus that sounds like one’s heartbeat or pulse, also known as pulsatile tinnitus. Infrequently, pulsatile tinnitus may signal the presence of cardiovascular disease or a vascular tumor in the head and neck or the ear. If experiencing this type of tinnitus, it is advisable to consult a physician as soon as possible for evaluation.

There are a number of non-auditory conditions and lifestyle factors that are associated with tinnitus. Medical conditions such as temporomandibular joint arthralgia (TMJ), depression, anxiety, insomnia, and muscular stress and fatigue may cause tinnitus, or can contribute to worsening of existing tinnitus.

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