Whether you pronounce it "TIN-i-tus" or "ti-NIGHT-us," the problem is the same: A ringing or other sound that only you can hear. People who are affected by tinnitus describe the sound they hear in many different ways.

Most say it's a ringing sound, while others describe buzzing, hissing, whistling or roaring. It may be heard in one or both ears. It comes and goes for some people, but is constantly present for others.

The volume of tinnitus can vary; some hear it only in very quiet conditions but for others it is overwhelmingly loud. About 10 to 12 million Americans suffer from tinnitus to the degree that they experience depression, anxiety, difficulty concentrating and sleep problems. Many more have tinnitus that is less disruptive to their lives.

Like many people, I first experienced tinnitus after going to a loud rock concert. Musicians, concert-goers and anyone who listens to the stereo with the sound cranked up high may develop tinnitus, either temporarily or permanently. The same goes for anyone exposed to loud sounds such as gunshots, jackhammers, factory machines, chain saws, power drills, sirens, gas-powered lawn mowers, jet skis and snowmobiles.

A few other things can cause tinnitus: wax build-up in the ear canal, ear infections, jaw misalignment and certain medications (aspirin, aminoglycoside antibiotics, loop diuretics and some chemotherapy drugs).

These causes are treatable, so they should be ruled out before you resign yourself to a life with tinnitus.

Some people find that alcohol, caffeine, nicotine, quinine (found in tonic water), fatigue or stress can make pre-existing tinnitus louder.

There also are a few serious causes of tinnitus that should be considered. Benign tumors of the auditory or facial nerves can cause tinnitus, hearing loss, balance problems and facial paralysis. Certain cardiovascular problems such as abnormalities of veins or arteries, heart murmurs and hypertension can cause a tinnitus that matches the heartbeat.

Head trauma can cause tinnitus, along with headaches, dizziness and memory loss. Not everyone with hearing loss has tinnitus, but about 90 percent of people with tinnitus do have some noise-induced hearing loss.

When is noise too loud and at risk for damaging your hearing and causing tinnitus?

•When the noise causes ear pain (if your instinct is to cover your ears, do it).

•When you have to shout to be heard.

•When your hearing is diminished or if your ears ring right after noise exposure.

Frequent exposure to noise levels over 85 decibels is known to cause hearing damage, but audiologists recognize that some people are sensitive to noise levels considerably less than this. The louder the noise, the shorter the exposure time needed to cause noise-induced hearing loss.

Hearing protection in the form of ear plugs or earmuffs is a great defense against hearing damage. They can reduce the noise levels that reach your ears by 10 to 15 decibels.

If you'll be exposed to very loud noise, wearing ear plugs under your earmuffs can increase the protection. The main problem with hearing protection is that people do not use it properly or consistently enough. Stuffing cotton or tissue paper in your ears is not very helpful.

The American Tinnitus Association - based in Portland - funds research into the causes and treatment of tinnitus. Its Web site at www.ata.org has information for both patients and health care providers. There is no known cure for tinnitus, but there are many different treatments, including sound masking devices, hearing aids, medications, cochlear implants and biofeedback.

It's difficult to predict which ones will be helpful for an individual. The first step is a thorough evaluation by an ear, nose and throat specialist.

For those with severe tinnitus, the OHSU Tinnitus Clinic has had success with Tinnitus Retraining Therapy.

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Kathryn B. Brown is a family nurse practitioner with a master's degree in nursing from OHSU. Is there a health topic you would like to read about? Send your idea to kbbrown@eastoregonian.com. You can find more local health news and information in the Health section at www.eastoregonian.info.

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