Tinnitus

Tinnitus is when you hear sounds inside your head that no one else can hear—like ringing, buzzing, or humming. This common problem affects millions of people worldwide and can range from a minor annoyance to a condition that seriously impacts daily life.

Table of contents

• What is tinnitus?
• Symptoms of tinnitus
• What causes tinnitus?
• How common is tinnitus?
• How tinnitus is diagnosed
• Treatment approaches
• Living with tinnitus

What is tinnitus?

Tinnitus is the experience of hearing sound that does not have an external source, so other people cannot hear it^[1][2]. The sounds you hear come from inside your own head or ears, not from your environment.

Tinnitus is not a disease itself. Instead, it is a symptom of several health conditions like ear injuries or age-related hearing loss^[3]. The exact causes of tinnitus are unclear, but most people who have it have some degree of hearing loss^[2].

Most people with tinnitus have what doctors call subjective tinnitus, which means that only you can hear the sounds^[1][2]. In rare cases, the sound pulsates rhythmically, often in time to your heartbeat. In these cases, a doctor may be able to hear the sounds with a stethoscope, and if so, it is considered to be objective tinnitus^[2]. Often, objective tinnitus has an identifiable cause and is treatable^[2].

Symptoms of tinnitus

Tinnitus is most often described as a ringing in the ears, even though no external sound is present^[1]. However, the phantom sound you hear may take many different forms. You may hear phantom sounds in one ear, in both ears, or in your head^[2].

Common types of sounds that people with tinnitus hear include^[1][2]:

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

The sound may be soft or loud and may be low or high pitched^[2]. The noises of tinnitus may vary in pitch from a low roar to a high squeal, and you may hear it in one or both ears^[1]. In some cases, the sound can be so loud it interferes with your ability to concentrate or hear external sound^[1]. Tinnitus may be present all the time, or it may come and go^[1][2].

Sometimes, moving your head, neck, or eyes, or touching certain parts of your body may produce tinnitus symptoms or temporarily change the quality of the perceived sound. This is called somatosensory tinnitus^[2].

In rare cases, tinnitus can occur as a rhythmic pulsing or whooshing sound, often in time with your heartbeat^[1]. This type is called pulsatile tinnitus and is often linked to blood vessel problems^[4][5].

What causes tinnitus?

While the exact causes of tinnitus are not fully understood, experts believe the noises people hear inside the head are the brain’s reaction or way of adapting to some sort of damage in the ear^[4]. When hearing loss occurs, your brain receives less stimulation, but your hearing nerve may still fire at the rate it always has. This can cause you to hear sounds that aren’t really there^[3].

Common causes of tinnitus include^[2][3]:

Age-related hearing loss. Your brain is used to a certain level of sound stimulation. When hearing loss occurs with age, the brain tries to compensate. About 1 in 3 adults over age 65 develop ringing in their ears^[3].

Noise exposure. Many people experience tinnitus after being exposed to loud noise in a workplace setting or at a sporting or entertainment event^[2]. Exposure to loud noises can cause hearing loss and tinnitus. This can happen over time or from a single incident, like an explosion or close-range gunshot^[3].

Ear injuries and trauma. These injuries may affect nerves or areas of your brain that help you hear. People who get tinnitus after an injury usually only have ringing in one ear^[3].

Ear conditions. Earwax blockages or ear infections can cause temporary hearing loss, resulting in ear ringing^[3]. Tinnitus can be a sign of an easily fixed problem, such as wax or a foreign object in the ear canal^[4].

Medications. Certain drugs can cause tinnitus, including some antibiotics, antidepressants, cancer drugs and nonsteroidal anti-inflammatory drugs (NSAIDs)^[3].

Less common causes include^[3][4]:

• Eustachian tube dysfunction
• Ménière’s disease
• Temporomandibular joint (TMJ) disorders
• Vestibular schwannoma (a noncancerous tumor that forms on the vestibular nerve)
• Otosclerosis (abnormal bone growth inside your ears)
• Blood vessel disorders
• Autoimmune diseases like lupus or rheumatoid arthritis
• Neurological disease
• Cardiovascular disease
• Thyroid disease
• Hormonal changes (in women)
• Head injury

People with tinnitus may experience flare-ups after exposure to certain triggers like stress or sleep deprivation^[3].

How common is tinnitus?

Tinnitus is a common problem. It affects about 15% to 20% of people, and is especially common in older adults^[1]. According to research, about 15% of the world’s population has it—including more than 50 million people in the United States^[3]. Anyone can get tinnitus, but it’s most common in people between the ages of 40 and 80^[3].

Surveys estimate that 10 to 25% of adults have tinnitus. Children can also have tinnitus^[2]. For children and adults, tinnitus may improve or even go away over time, but in some cases, it worsens with time^[2]. When tinnitus lasts for three months or longer, it is considered chronic^[2].

According to the American Tinnitus Association, approximately 16 million Americans are living with chronic tinnitus^[15]. Roughly 20 million people have burdensome chronic tinnitus, and 2 million have extreme cases^[4].

How tinnitus is diagnosed

Your doctor will typically diagnose you with tinnitus based on your symptoms alone^[9]. But in order to treat your symptoms, your doctor will also try to identify whether your tinnitus is caused by another, underlying condition. Sometimes a cause can’t be found^[9].

Tinnitus can be difficult to diagnose, because in most cases only the patient can hear the sound or sounds^[4]. To learn more about the ringing in your ears, a healthcare provider (usually an audiologist) will do a physical examination and check your ears for any obvious issues^[3]. They’ll also ask about your medical history and whether you’ve had recent exposure to loud noises^[3].

Common tests used in diagnosing tinnitus include^[9]:

Hearing (audiological) exam. During the test, you’ll sit in a soundproof room wearing earphones that transmit specific sounds into one ear at a time. You’ll indicate when you can hear the sound, and your results will be compared with results considered normal for your age. This can help rule out or identify possible causes of tinnitus^[9]. Each patient with the symptom of tinnitus deserves complete audiologic testing with pure-tone air, bone, and speech discrimination scores^[8].

Movement tests. Your doctor may ask you to move your eyes, clench your jaw, or move your neck, arms and legs. If your tinnitus changes or worsens, it may help identify an underlying disorder that needs treatment^[9].

Imaging tests. Depending on the suspected cause of your tinnitus, you may need imaging tests such as CT or MRI scans^[9]. Imaging should be avoided unless tinnitus is unilateral, pulsatile, associated with asymmetric hearing loss, or with focal neurologic abnormalities^[7]. Pulsatile tinnitus can be seen and/or heard by doctors using special equipment, including magnetic resonance angiography (MRA) or angiography^[4].

Lab tests. Your doctor may draw blood to check for anemia, thyroid problems, heart disease or vitamin deficiencies^[9].

Guidelines recommend that patients should be referred within four weeks for audiologic examination if tinnitus is chronic, bothersome, unilateral, or associated with hearing changes^[7].

Treatment approaches

Tinnitus is only rarely associated with a serious medical problem and is usually not severe enough to interfere with daily life. However, some people find that it affects their mood and their ability to sleep or concentrate. In severe cases, tinnitus can lead to anxiety or depression^[2].

Currently, there is no cure for tinnitus, but there are ways to reduce symptoms^[2]. Healthcare providers can’t cure tinnitus, but they can help manage its impact^[3]. Common approaches include the use of sound therapy devices (including hearing aids), behavioral therapies, and medications^[2].

Tinnitus treatment depends on the cause. Because tinnitus is a symptom of many conditions, providers may be able to treat it by addressing the underlying cause^[3]. Tinnitus is usually caused by an underlying condition, such as age-related hearing loss, an ear injury or a problem with the circulatory system. For many people, tinnitus improves with treatment of the underlying cause or with other treatments that reduce or mask the noise, making tinnitus less noticeable^[1].

Sound therapy and masking devices

Hearing aids. If you have a hearing problem, treating it can make tinnitus less noticeable^[4]. If you have hearing loss, there’s a good chance that hearing aids will both provide some relief for your tinnitus and help you hear better^[14]. Specialists often recommend a cochlear implant hearing aid for people with tinnitus who have serious hearing loss. These small devices are surgically implanted inside the ear, where they can use electrical signals to send external sounds directly to the auditory nerve^[4].

Sound generators and masking devices. This solution can be as simple as keeping a machine on your night table that produces relaxing sounds such as waterfalls or “white noise”^[4][14]. There are also wearable sound generators, or “masking devices,” that fit in your ear that can play soft sounds or music just loud enough to mask the tinnitus noise^[4]. The sound distracts the brain, and tinnitus symptoms become easier to tolerate^[3].

Acoustic neural stimulation. A device the size of your palm works through a pair of headphones to deliver a broadband acoustic signal embedded in music^[4].

Playing music or “white noise” helps distract your brain, so you pay less attention to the tinnitus. It’s especially helpful at night, when it’s quiet and tinnitus can interfere with sleep^[14].

Behavioral therapies

Cognitive behavior therapy. Cognitive behavior therapy is the only treatment that has been shown to improve quality of life in patients with tinnitus^[7]. Patients should be referred to cognitive behavior therapy for chronic, bothersome primary tinnitus^[7].

Tinnitus Retraining Therapy. Similar in concept to acoustic therapy, tinnitus retraining therapy utilizes a portable sound generator that produces soft patterned tones to help desensitize the brain to the sounds of tinnitus^[11]. Tinnitus Retraining Therapy can be very effective, but it can take upwards of 12-24 months to experience long-lasting relief^[15].

Mindfulness programs. A program called Mindfulness Based Tinnitus Stress Reduction builds skills in deep breathing, yoga, relaxation, and meditation to help a person to deal with tinnitus. Mindfulness programs have been shown to reduce depression and anxiety and improve quality of life^[4][14].

Counseling. Counseling, sleep and stress management techniques can help people cope with tinnitus^[11].

Other treatment approaches

Medications. Melatonin, antidepressants, and cognitive training may help with sleep disturbance, mood disorders, and cognitive impairments, respectively^[7].

Surgery. If you have an acoustic neuroma and suffer from tinnitus, the tinnitus may be resolved through a surgical removal of the acoustic neuroma^[11].

Steroid Injections. Meniere’s disease has a triad of symptoms (hearing loss, tinnitus, vertigo) that fluctuate due to increased fluid pressures in the ear organs. Fluctuation of hearing and resulting tinnitus can be treated with a series of injections of Dexamethasone (a potent steroid) with an 85 percent chance of reduction in tinnitus symptoms^[11].

Living with tinnitus

While there’s currently no cure for tinnitus, you can manage your tinnitus in a number of ways. Changes to your daily life and surroundings may make it easier to live with tinnitus^[21].

What to avoid

Complete silence. Believe it or not, silence can make tinnitus worse. If you have hearing devices that provide sound therapy, then you already understand how background noise can help alleviate tinnitus^[15]. Tinnitus may bother you more when it’s quiet^[21].

Triggers. Learn what makes tinnitus worse for you. Some people report that certain foods, drinks, or drugs can make their symptoms worse. Not everyone is affected the same way, so try to avoid triggers one at a time and keep a written log^[21]. Some possible triggers include drinks with caffeine such as cola, coffee, tea, and energy drinks; alcohol; aspirin; and salt^[21].

Smoking. Smoking can make tinnitus worse in two ways. It harms blood flow to the sensitive nerve cells that control your hearing. It also acts as a stimulant in your body, which can make the ringing in your ears sound louder^[21].

Very loud noises. Loud noises can exacerbate your tinnitus. Always make sure you’re protecting your hearing when you’re around excessive noise^[15]. Keep music at 60% of full volume or lower when using earbuds. Wear ear plugs at concerts, loud restaurants, or other loud events. Use ear plugs or earmuffs when cutting the grass, using power tools, or using snow or leaf blowers. Always use ear protection in a noisy workplace^[21]. Avoidance of noise exposure may help prevent the development or progression of tinnitus^[7].

Lifestyle strategies

Add soothing sounds. Try playing soft music in the background, listening to the radio, or turning on a fan. You can also try a white-noise machine^[21].

Manage stress. Stress and anxiety can make your tinnitus worse^[15][14]. Try to minimize the effects as much as possible using techniques like deep breathing, mindfulness, meditation or yoga, all of which can help you relax and treat your tinnitus. Plan time to relax every day^[21].

Exercise regularly. Regular physical activity can reduce the frequency and intensity of tinnitus, and the distress it causes, in some people. Higher levels of physical activity can improve overall health and the quality of your sleep, both of which can help you cope with tinnitus^[14]. Exercise at least three to five times a week. Exercise can lower stress, improve your sleep, and fight depression^[21].

Get enough sleep. Fatigue often makes symptoms worse, turning a soft hum into a loud roar. Set aside 7 to 9 hours for sleep at night. Go to bed and get up at the same time every day. Develop a bedtime routine, such as taking a relaxing warm bath right before bedtime^[21].

Monitor your diet. Some people report a correlation between their diet and tinnitus symptoms. Though the science hasn’t been solidified, there is a chance that consuming alcohol, nicotine, caffeine and high-sugar foods might worsen tinnitus symptoms^[17].

Visit an audiologist. The most important thing you must do if you’re experiencing tinnitus is to meet with an audiologist right away. Meeting with an audiologist can immediately help you feel better about your tinnitus—knowing that there is someone who understands and will be helping with your symptoms^[15].

Be patient. While visiting an audiologist is an important first step, the journey doesn’t end there. It’s important to be patient with your tinnitus treatment plan. Don’t give up on your tinnitus treatment if you don’t find your symptoms reduced right away. Remember that tinnitus originates in the brain, and it takes time to retrain your brain^[15].

Tinnitus is no longer running my life. Many people with tinnitus have been able to find relief and return to living a normal life^[19].