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What is tinnitus and what treatments are available?

Tinnitus is commonly described as ringing in the ears, while others may experience different tinnitus sounds. Tinnitus is therefore characterized as perceiving sounds where there isn’t anything producing the sound.

In the majority of cases, tinnitus is a symptom of hearing loss, but there are other causes that are considered when diagnosing the issue, including a blockage in the middle ear, an ear infection, or an underlying health problem.

Although there is not yet a cure for tinnitus, it is possible to get relief. Tinnitus treatments include sound therapy, medication, and behavioral therapy, all of which are aimed at helping you live more comfortably with it.

If you have associated hearing loss, treatment for tinnitus can come in the form of a hearing aid or– a cochlear implant for those with severe or profound hearing loss.

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What is tinnitus?

Tinnitus is when you hear sound in one or both ears without any stimulus. In other words, there is nothing external producing the sound. Around 50 million people in the US – some 15% of the population – experience tinnitus. In the UK, one in eight adults have permanent tinnitus.

You might experience tinnitus in one or both ears, at a high or low pitch, and at different volumes. You may hear it all the time or intermittently. It’s often described as ringing in the ears, but you might perceive it as all kinds of different sounds.

There are two types of tinnitus. By far the most common is known as subjective tinnitus, and it accounts for more than 99% of cases. This type of tinnitus is where you hear the sound but nobody else can.

Objective tinnitus is when other people can hear the sound, too. This is very rare, and happens in less than 1% of cases. It will likely be the person examining you who will also hear the sound.

Tinnitus causes

Tinnitus isn’t a condition or disease on its own, but a symptom of something else. It signals some sort of problem with the auditory system –  which is the body’s system that’s responsible for our sense of hearing and how we understand sounds.

The auditory system includes the ears, the nerve connecting the inner ear to the brain, and parts of the brain that process sound.

model of the inner ear

Most cases of tinnitus – around 90% – are associated with hearing loss of some kind, such as noise-induced hearing loss and age-related hearing loss (presbycusis).

However, it can also be a symptom of a number of underlying health conditions.

Tinnitus causes: underlying health conditions

  • Obstruction in the middle ear (including a wax build-up)
  • Ear or sinus infection
  • Trauma or injury to the head or neck
  • Problem with the temporomandibular joint (where the lower jaw and skull connect)
  • Ototoxic medications (drugs that have an adverse effect on hearing or balance)
  • Conditions of the heart or blood vessels
  • Thyroid problems
  • Meniere’s disease and other vestibular conditions
  • Brain tumor (very rare)
  • Stress and anxiety.

It’s important to highlight that tinnitus is usually mild, temporary, and not linked to any serious underlying problem.

You are more likely to get tinnitus if you have spent a lot of time exposed to loud noise without ear protection. As a result, it tends to disproportionately affect people in certain jobs, such as first responders, construction workers, factory workers, musicians, and people who work in nightclubs and live music venues. Tinnitus is also the primary disability among veterans.

Tinnitus symptoms

Depending on what’s causing your tinnitus, you might experience other symptoms alongside it. But tinnitus itself is a symptom rather than a condition or disease. So, it’s probably more accurate to talk about the different ways people experience tinnitus.

As mentioned above, the sound itself is usually experienced as a ringing noise. But you might hear it as:

  • Buzzing
  • Humming
  • Clicking
  • Hissing
  • Whistling
  • Roaring

People have also described it as sounding like static, the sound of waves sounds, or dialing tones. In a few, very rare cases, people experience the sound as music or signing, which is known as musical tinnitus or musical ear syndrome.

For some people, the tinnitus sound comes in a rhythmic pattern, often in sync with their heartbeat. It might be a throbbing, creaking, thumping sound or sensation. This is called pulsatile tinnitus, but it’s sometimes referred to as vascular, pulse-synchronous, or simply rhythmic tinnitus.

If you have pulsatile tinnitus you might find the sound gets louder and faster as your heart rate increases, and softer when your heart rate slows. That’s because it’s usually caused by an underlying vascular problem –  an issue with the blood vessels and often responds well to treatment.

Pulsatile tinnitus is rare and affects around 5 million people, or 1.5% of the US population, experience this type.

When you perceive the sound continuously, almost continuously, or as overlapping sounds of fluctuating volume, it’s called tonal tinnitus.

How is tinnitus diagnosed?

90% of people with tinnitus have underlying hearing loss. So, it’s very likely that your primary care doctor will refer you to an audiologist for some basic hearing tests.

In the vast majority of cases, tinnitus is subjective. The sound you hear is very real to you, but nobody else can hear it.

As a result, there aren’t any tests to diagnose tinnitus: your doctor will base their diagnosis on how you describe the problem and its impact on your life.

The exception is objective or pulsatile tinnitus. If your doctor can hear the sounds you describe occurring in time with your heartbeat – they might suggest that you have pulsatile tinnitus. This is tested by placing their ear next to your head to listen for any sound, or by examining you with a stethoscope.

If this is the case, they’ll likely refer you to a specialist or send you for more tests to find the underlying cause.

Subjective tinnitus questions a doctor may ask:

  • What type of sound do you hear, how loudly and how often?
  • Is there any pattern in your experience of tinnitus (like if you tend to get it more at night, or under certain conditions)?
  • Do you have any other symptoms?
  • How does your tinnitus is affecting your day-to-day life?

They will examine your ears to check for any visible blockages, like ear wax. To see whether they can identify a trigger, they’ll also examine your head and neck, and ask you to turn your head or clench your jaw..

Your doctor might also perform the following tests to evaluate your tinnitus, all of which can be helpful when deciding what treatment or management techniques are likely to work:

  • Sound matching – where your doctor plays common tinnitus sounds back to you at different pitches.
  • Minimum masking level – a test to see how much white noise it takes to counteract or ‘mask’ your tinnitus.
  • Loudness discomfort level – a measurement of the maximum volume you can tolerate before an external sound becomes uncomfortable.

loudness discomfort level hearing test

Tinnitus treatment

There is currently no tinnitus cure, but there are some things you can try to bring tinnitus relief. Whether or not a particular treatment works for you will depend on the underlying cause.

Since the overwhelming majority of tinnitus cases are caused by hearing loss of some kind, one of the most common treatments for tinnitus is a hearing aid.

Hearing aids amplify the external noise your ears pick up, helping to mask the sounds of tinnitus. By making external sounds louder, it can also increase auditory stimulation in your brain.

Other treatments for tinnitus include:

Sound therapy

This involves using external noise to change how you perceive the tinnitus sound, or how you react to it.

Cognitive behavioral therapy (CBT)

This is aimed at helping you to cope if your tinnitus is affecting your mental health, or making you distressed. This type of therapy has been shown to reduce depression and anxiety related to tinnitus as well as improve your quality of life.

Other forms of psychological therapy techniques can also be used to treat tinnitus, such as mindfulness-based cognitive therapy (MBCT) or acceptance on commitment therapy (ACT).

Medication

Like with CBT, some antidepressant or anti-anxiety medications can help to relieve the mental health effects of your tinnitus. There are currently no FDA-approved drugs to treat tinnitus directly.

Neurostimulation

This uses small electric shocks to stimulate the brain. This is quite a new treatment option, so there isn’t much evidence as to whether it is effective or who might benefit from it. Researchers are looking at different ways to stimulate areas of the brain involved in tinnitus and it’s showing promise.

Relaxation training

This can be helpful in cases where people find that stress makes their tinnitus worse.

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You might need to try different treatments and therapy to find one that helps provide relief for your tinnitus. While most people find their tinnitus mild and bearable, some people struggle with it and find it really interferes with their lives.

There may be some simple lifestyle changes you can make. For example, if stress is a trigger for your tinnitus, it’s a good idea to eliminate as much stress as possible, maybe trying relaxation techniques, gentle exercise, or meditation.

A healthy, balanced diet and regular physical activity can have multiple benefits for your overall health, which may also reduce the impact that tinnitus has on your life.

However, there is no strong evidence that any specific foods or drinks – or eliminating them from your diet – have any effect on tinnitus.

If you find that certain foods or drinks worsen your tinnitus, it’s likely to be an idiosyncratic reaction (i.e., one that’s individual to you).

An exception is if your tinnitus is caused by Meniere’s disease. There is some evidence, albeit limited, of a link between Meniere’s symptom and diet – especially salt intake.

If you find your tinnitus is worse in quiet environments and, as a result, find it difficult to sleep, avoiding caffeine and alcohol in the hours before bedtime may help you sleep better.

There are plenty of reports on the internet of a link between certain dietary supplements and improved tinnitus – especially magnesium, zinc and vitamin B12. Research is ongoing in this area, and even though they are safe, there is insufficient evidence that any of these supplements actually work.

Note

Don’t forget – if your hearing is starting to bother you, or is gradually getting worse, it’s always worth speaking to a professional. We can connect you with a local audiologist to get you the help you need. Fill in our quick form and we’ll do the rest.

Written by:
Allie Anderson is a health writer and editor with many years of experience creating accurate, evidence-based content for consumer and professional audiences. Allie is passionate about making medical information as accessible as possible, empowering people to make informed choices about their health and well-being. Allie holds a first-class honours degree in Linguistics from University College London, a Russell Group institution that’s ranked in the top 10 universities globally. She trained as a journalist with the UK’s NCTJ (National Council for the Training of Journalists) and after working as a news reporter for local newspapers and B2B titles, began writing about health. Published in medical journals, peer-reviewed magazines for healthcare professionals and a broad range of consumer titles, Allie has covered all manner of health and medical topics throughout her career, most recently focusing on hearing health and hearing loss. Allie has conducted in-depth research into the mechanisms underpinning hearing and has developed an understanding of the nuanced impact hearing loss can have on individuals and their loved ones.
Reviewed by:
Audiologist Ana Paula de Lima Rodrigues (Audiology and Speech Therapy BSc) is extremely passionate about providing exceptional care, advice and support for people with hearing loss. Ana trained at the University of Vale do Itajai in Brazil in 2001 and currently works in London where she is registered with The Health and Care Professions Council (HCPC).
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