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The most common underlying cause of tinnitus is inner ear damage, and the most common underlying cause of inner ear damage is noise. Here is how to reduce or prevent noise-induced tinnitus.
By Barbara Jenkins, Au.D., BCABA
Tinnitus is any sound you hear that is not created by an external source. It can sound like a buzz, high-pitched tone, pulsing, or another sound. It can come on gradually, starting mildly at first, and then increase in intensity and frequency over weeks, months, and even years. You can get tinnitus in an instant. One minute you’re living in a quiet world; in the next your world has been invaded by a constant auditory interloper.  
Tinnitus is a symptom, not a disease. Consequently, there are many causes and many treatments. By far the most common underlying cause of tinnitus is inner ear damage, and the most common underlying cause of inner ear damage is noise. Nearly one-third of all tinnitus cases can be traced back to noise damage.
Unfortunately, noise damage is insidious. As is often the case with skin damage from sun exposure, you may not realize your ears have been damaged for years to come. It’s not uncommon for noise-induced tinnitus to start years after exposure to loud noises.
You may have been told that there is nothing you can do to prevent or reduce tinnitus. Although there are many physicians and audiologists trained in the diagnosis and treatment of hearing loss, there are very few who are specifically trained in tinnitus care.  
I have been treating tinnitus in hospital and clinical settings for more than 20 years, and I opened one of the first tinnitus clinics in the United States. The suggestions below are gleaned from my experience and are what I personally use to prevent my own tinnitus from worsening.
Before Noise Exposure
Noise exposure can both cause and exacerbate tinnitus. Preventing noise-induced tinnitus is relatively easy, but you must plan ahead, especially if you know in advance that you are going to be exposed to loud sounds.
Prepare your ears: A plethora of studies show how utilizing antioxidants and vitamins prior to noise exposure helps the ears recover from noise trauma. In fact, the U.S. Navy uses them to protect sailors exposed to flight deck noise. Two found to be very effective are N-Acetyl-Cysteine (NAC) and Acetyl-L-Carnitine (ALCAR). A 2011 naval study found that NAC protected the cochlea from damage from gun noise, and other studies showed that it may reduce damage even after exposure to loud noise. ALCAR has been shown to do the same.
Getting enough magnesium and vitamins A, E, and C daily has shown significant protective benefits as well. Just as there are certain nutrients known to protect your eyes, there vitamins that have antioxidant capabilities to protect the hair cells of the cochlea. A good natural (non-synthetic) vitamin should help in this regard. No megadoses are necessary; typically the recommended dosage on the bottle is sufficient.
To avoid the risk of harmful interactions, always talk with your primary care doctor before taking any supplements—especially if you have other health issues or are taking any other medications or over-the-counter drugs or supplements.
A healthy ear is a strong ear. And a strong ear is more likely to be able to withstand loud noise.
Protect your ears: Using hearing protection is a no-brainer. (Hearing protection devices for the military are covered in detail in “A Fight for the Long Haul,” page TK.) Make sure to wear your ear protection before the noise exposure starts, not after it has already begun. Sometimes tinnitus begins immediately at the first loud sound, so every second counts.
If you are using earplugs, practice putting them in ahead of time. The small foam-type work well but can be difficult to insert fully and properly, especially if you have smaller ear canals.
During Noise Exposure
At concerts, professional car races, health clubs: Position yourself as far away from the source of sound as possible while still being able to enjoy the atmosphere. Every 15 to 20 minutes, go outside or to a quiet room to give your cochlear hair cells a break. When you are exposed to noise, your inner ear hair cells move in response. With loud noise they can actually become irritated, so that healthy ones may weaken, and weak ones may die. A few minutes of rest may be the difference between ears that are temporarily irritated and those that are permanently damaged.
Using earbuds or headphones with personal music players: First, take the time to adjust the settings on your device so that the maximum volume is reduced at least two levels, or about 6 decibels (dB). This may prevent you from going over a safe level when you aren’t thinking about it. Next, set your music to a level you enjoy, but turn it down just one or two notches. Even a 3 dB drop in volume can reduce damage. Finally, every 15 minutes or so turn down the music significantly or turn it off altogether, giving your ears a few minutes of recovery time.
Using power tools, target shooting, or seeing combat action: If you are serious about protecting your ears, “double up” by using earplugs and earmuffs together. Every decibel of extra protection will help at this volume of noise. One gunshot at ear level near an unprotected ear can produce tinnitus.
Take off your earmuffs if you need to speak with someone, but never remove the earplugs when you are in a highly noisy area. Many of my patients’ tinnitus began when a gun or air compressor went off just after they removed all of their hearing protection. Leave the noisy environment first before removing the last layer of protection.
Damage from this level of noise can be immediate. Take hearing protection seriously. Of course, if you are the victim of an unexpected sudden loud noise, know that there is little you could have done to protect yourself beforehand. (See “Running Toward a Cure,” page TK.) But you can then take steps to help your ears get healthy again and to make sure your tinnitus doesn’t worsen.
After Noise Exposure
The long-standing accepted course of treatment for sudden hearing loss has been steroids (prednisone) taken orally within six weeks of a particular noise event. However, it has come under recent scrutiny because there is lack of evidence that it is successful, and because of the side effect risks.  Another treatment commonly used is steroids injected into the middle ear, but both treatments require further study. Neither treatment has been clinically shown to help with tinnitus due to noise.
Act quickly: Less controversial is the use of the antioxidants mentioned above. If you act quickly enough, the oxidative stress caused by noise damage can be reduced even after the fact. Talk to your primary care doctor about taking NAC and ALCAR right after exposure, and then again for the next few days. Rest as much as possible, and make sure to hydrate.
Let your body heal: While noise may be the primary cause of hearing damage leading to tinnitus, the two things that exacerbate tinnitus more than anything else are stress and fatigue. Do all you can to treat your body well so that your ears can heal as much as possible.
Plan for next time: Use your last experience to help you prepare effectively for your next known exposure. Will custom earplugs work better for you? Should you purchase concert tickets a few rows back? Did you forget to pre-program your iPod at a lower volume?
Every time you depart a loud music concert and your ears are ringing, you have done damage. The tinnitus may be temporary at first, but the more noise you expose yourself to, the more likely you are to experience long-lasting tinnitus in the future.
Avoid noise: If you find your ears are now more sensitive to loud noises, carry earplugs with you—and use them. There are specialized earplugs that still allow you to enjoy the full range of frequencies, such as for hearing or performing live music. Limit time in noisy environments such as crowded bars or open-space restaurants whose decor emphasizes hard surfaces such as glass and steel, and choose more ear-soothing settings for social outings.
Remember that one-third of tinnitus cases are due to noise damage. Almost all of these cases could have been prevented. You can now take preventative measures to protect your ears from tinnitus or prevent your tinnitus from getting worse. No matter what you’ve been told about tinnitus, I’ve never seen a case where there wasn’t something that we could do to help, either before it happened or after.
While you may not be able to stop tinnitus that is a result of other factors, preventing tinnitus due to noise is possible. Be proactive, and be prepared.
Staff writer Barbara Jenkins, Au.D., BCABA, is Colorado’s first board-certified doctor of audiology. She has more than 25 years of hospital and clinical experience in treating patients with hearing loss and tinnitus. Jenkins serves as Colorado’s professional state commissioner for the deaf and hearing impaired, and was awarded the 2010 Leo Doerfler Award for Clinical Excellence by the Academy of Doctors of Audiology. For more information, see
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