The term “tinnitus” comes from the Latin verb “tinnire,” to ring. Learn the basics.

Tinnitus is defined as the experience of hearing sound without an external, acoustic source. While it is commonly referred to as “ringing in the ears,” tinnitus can also be described as buzzing, hissing, whistling, swooshing, and clicking.

Tinnitus can be an acute (temporary) condition or a chronic (ongoing) health concern. Brief, spontaneous tinnitus, lasting seconds to minutes, is a nearly universal sensation. Acute or temporary tinnitus, lasting minutes to hours, occurs routinely after excessive noise exposure that is sufficiently intense or prolonged to cause temporary injury to the ear. Chronic tinnitus is present more frequently, and is defined as occurring for more than three months.

The U.S. Centers for Disease Control estimates that nearly 15% of the general public—over 50 million Americans—experience some form of tinnitus. Roughly 20 million people struggle with chronic tinnitus, while 2 million have extreme and debilitating cases.

Most patients develop tinnitus as a symptom of hearing loss, caused either by age, long-term hearing damage, or acute trauma to the auditory system. Hearing loss causes less external sound stimuli to reach the brain, and in response, the brain undergoes neuroplastic changes in how it processes different sound frequencies. Tinnitus is the product of these maladaptive neuroplastic changes. Patients with hearing loss and tinnitus may find relief from the use of hearing aids and other sound amplification devices.

Source: American Tinnitus Association; Content is adapted from “Overview: Suffering From Tinnitus,” by Robert A. Dobie, M.D., a chapter in “Tinnitus: Theory and Management,” edited by James B. Snow, Jr., M.D. It appears with permission from Dobie, Snow, and PMPH-USA, the publisher.

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Tinnitus is more common in men, seniors, blue-collar workers, military personnel, and people with common health problems, such as arthritis, hypertension, varicose veins, and arteriosclerosis. All of these associations are probably explained by one simple correlation: The worse your hearing is, the more likely you are to have tinnitus.

Roughly 90 percent of tinnitus cases occur with an underlying hearing loss, regardless to whether the damage is in the inner ear or the middle ear, or what otologic disorder has caused it.

Age-related hearing loss, or presbycusis, can occur whether or not someone has experienced significant noise exposure, ear infections, or any other specific ear disease. Presbycusis continues to progress with age and is usually more severe in men than in women. As a result, as shown in epidemiological surveys, the prevalence of tinnitus is higher in men and increases with age.

These same surveys generally show that the next most important risk factor for hearing loss and tinnitus, after age and gender, is excessive noise exposure. It is generally true that the louder the noise and the longer the exposure, the greater the hearing loss.

People who have regular and prolonged exposure to noise, usually at work (such as military personnel or construction workers), begin to be at risk of permanent hearing loss and tinnitus at levels of about 85 decibels (dB), which is roughly equivalent to the sound of heavy city traffic. At this level, most people would need to speak very loudly or even to shout to converse with someone only at arm’s length away.

Outside of the workplace, one of the most important sources of harmful noise exposure is recreational shooting. But any noise exposure that causes temporary tinnitus or muffled hearing can, if regularly repeated, lead to permanent hearing loss and tinnitus. This includes unsafe listening to personal MP3 players.

There are also many ear disorders other than age-related and noise-induced hearing loss that cause hearing loss and tinnitus. Sensorineural hearing loss can be caused by genetic mutations, by some drugs used to fight infection and cancer, or by head injuries. Conductive hearing loss is often caused by chronic ear infections or otosclerosis, a hereditary middle ear disease.

Content is adapted from “Overview: Suffering From Tinnitus,” by Robert A. Dobie, M.D., a chapter in “Tinnitus: Theory and Management,” edited by James B. Snow, Jr., M.D. It appears with permission from Dobie, Snow, and PMPH-USA, the publisher.

Hearing Health Foundation advises those who think they may have hearing loss, tinnitus, and/or balance concerns to make an appointment with a hearing health professional, such as an audiologist and/or an ear, nose and throat specialist (ENT).

During your evaluation, your doctor or audiologist will examine your ears, head and neck to look for possible causes of tinnitus. Tests include:

  • Hearing (audiological) exam. As part of the test, you’ll sit in a soundproof room wearing earphones through which will be played specific sounds into one ear at a time. You’ll be asked to indicate when you can hear the sound, and your results are compared with results considered typical for your age. This can help rule out or identify possible causes of tinnitus.

    In addition to routine pure tone and speech audiometry, a range of audiological tests can help assess the health and function of your middle ear, inner ear, and auditory pathway. They may include tympanometry, otoacoustic emissions, electrocochleography, auditory brainstem responses, and vestibular evoked myogenic potentials.
     
  • Movement. 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 or other medical causes that need treatment.  

    Medical causes range from simple cerumen (earwax) impaction in the ear canal to complex conditions that involve the inner ear or auditory neural pathways.  

    Common auditory conditions that can lead to tinnitus include otitis media (a middle ear infection); otosclerosis (an abnormal bone growth in the middle ear); sudden sensorineural hearing loss (sudden deafness); Ménière’s disease; noise-induced hearing loss; and presbycusis (age-related hearing loss). Rarely, tinnitus is caused by acoustic neuroma (a benign, slow-growing tumor on the auditory nerve), and some brain diseases that involve the auditory system.Vascular system disorders in the head and neck area can cause tinnitus that pulses in time with the heartbeat. Head and neck injuries including whiplash are frequently associated with tinnitus. Severe temporomandibular (jaw) joint disorders can sometimes result in tinnitus. Tinnitus can also occur with systemic diseases such as severe anemia, hypertension, hypothyroidism, and syphilis.
     
  • Imaging tests. Depending on the suspected cause of your tinnitus, you may need imaging tests such as CT or MRI scans.

The sounds you hear can help your doctor identify a possible underlying cause.

  • Clicking. Muscle contractions in and around your ear can cause sharp clicking sounds that you hear in bursts. They may last from several seconds to a few minutes.
  • Rushing or humming. Usually vascular in origin, you may notice sound fluctuations when you exercise or change positions, such as when you lie down or stand up.
  • Heartbeat. Blood vessel problems, such as high blood pressure, an aneurysm or a tumor, and blockage of the ear canal or eustachian tube can amplify the sound of your heartbeat in your ears (pulsatile tinnitus).
  • Low-pitched ringing. Conditions that can cause low-pitched ringing in one ear include Meniere’s disease. Tinnitus may become very loud before an attack of vertigo — a sense that you or your surroundings are spinning or moving.
  • High-pitched ringing. Exposure to a very loud noise or a blow to the ear can cause a high-pitched ringing or buzzing that usually goes away after a few hours. However, if there’s hearing loss as well, tinnitus may be permanent. Long-term noise exposure, age-related hearing loss or medications can cause a continuous, high-pitched ringing in both ears. Acoustic neuroma can cause continuous, high-pitched ringing in one ear.
  • Other sounds. Stiff inner ear bones (otosclerosis) can cause low-pitched tinnitus that may be continuous or may come and go. Earwax, foreign bodies or hairs in the ear canal can rub against the eardrum, causing a variety of sounds.

In many cases, the cause of tinnitus is never found. Your doctor can discuss with you steps you can take to reduce the severity of your tinnitus or to help you cope better with the noise.

Rule Out Other Conditions

To treat tinnitus, your doctor may try to identify any underlying condition that may be associated with your symptoms. If tinnitus is due to another health condition, your doctor may be able to take steps that could reduce the noise. Examples include:

  • Earwax removal. Removing impacted earwax can decrease tinnitus symptoms.
  • Treating a blood vessel condition. Underlying vascular conditions may require medication, surgery or another treatment to address the problem.
  • Changing your medication. If a medication you’re taking appears to be the cause of tinnitus, your doctor may recommend stopping or reducing the drug, or switching to a different medication.

Counseling & Sound Therapy

For many people, a combination of counseling and sound therapy can provide tinnitus relief.

  • Tinnitus Activities Treatment (TAT): Includes counseling of the whole person, and considers individual differences and needs. TAT utilizes a picture-based approach facilitates engagement of the patient, and provides thorough and structured counseling. The patient is also engaged through the inclusion of homework and activities to demonstrate understanding and facilitate progress. The following four areas are evaluated:
    • Sleep: The patient learns about the sleep cycle and how certain habits can affect sleep. Effective strategies to use before and during sleep are taught, and the use of background sounds and relaxation exercises are discussed.
    • Hearing: Most people with tinnitus also have an underlying hearing loss. The patient is taught strategies to improve hearing and communication and, when appropriate, the use of hearing aids is considered.
    • Emotions: The patient is asked to describe fears and concerns about how tinnitus is affecting his or her life and health. Patients are taught that they can change their reactions to their tinnitus.
    • Concentration: Patients are asked to identify situations when tinnitus interferes with concentration. They practice doing activities that require different levels of attention and, in some situations, use background sounds to help.
       
  • Cognitive behavioral therapy (CBT): This method of counseling has been used for depression, anxiety, post-traumatic stress disorder, and other conditions. It focuses on restructuring the negative reactions toward and regaining control over the condition. In addition to relaxation techniques, it teaches that while you can’t change the tinnitus, you can change your attitude toward it and in this way better manage it.
     
  • Tinnitus Retraining Therapy (TRT): This therapy aims to achieve habituation to your tinnitus. This means you are no longer aware of your tinnitus except when you focus on it, and even when you do notice the tinnitus, it does not bother you. It is combined with low-level, broadband sound generators.

Sound therapy, or acoustic therapy, works by making the perception of the tinnitus less noticeable in relation to background sound that is delivered through the sound therapy device. The devices can be wearable or be placed on a tabletop. Many different sounds are available:

  • Noise: Broadband noise is most widely used, most likely because it is easy to ignore. Sounding like radio static, it includes a wide range of frequencies. (Frequency refers to the number of vibrations per second; its perceptual equivalent is pitch.) This is believed to activate a large area of auditory cortex in the brain, possibly making this type of sound more effective.
     
  • Music: Studies have found music to be effective for encouraging relaxation and reducing anxiety. Music can also help distract you from your tinnitus. Most clinicians use mild, moderate-tempo, instrumental music rather than fast-tempo music or music with vocalists, which can feel more stimulating than calming.
     
  • Modulated tones: Amplitude and frequency can be varied, resulting in softly pulsing tones. Some patients find this a more effective, acceptable, and relaxing sound.
     
  • Notched sounds: “Notched” sounds refer to sound with a portion of the spectrum removed, or filtered out. Some approaches remove some frequencies from the frequency of the patient’s particular tinnitus pitch. Other strategies remove frequencies around the patient’s pitch match frequency.
     
  • White noise machines: These devices, which produce simulated environmental sounds such as falling rain or ocean waves, are often an effective treatment for tinnitus. You may want to try a white noise machine with pillow speakers to help you sleep. Fans, humidifiers, dehumidifiers and air conditioners in the bedroom also may help cover the internal noise at night.
     
  • Hearing aids: These can be especially helpful if you have and underlying hearing loss well as tinnitus.
     
  • Masking devices: Worn in the ear and similar to hearing aids, these devices produce a continuous, low-level white noise that suppresses tinnitus symptoms.
     
  • Tinnitus retraining: A wearable device delivers individually programmed tonal music to mask the specific frequencies of the tinnitus you experience. Over time, this technique may accustom you to the tinnitus, thereby helping you not to focus on it. Counseling is often a component of tinnitus retraining.

Medications

Some medications have shown to provide relief to tinnitus suffers and may help reduce the severity of symptoms or complications. Learn more about how Hearing Health Foundation’s Hearing Restoration is working toward finding better therapies and cures for hearing loss and tinnitus, here.

Possible medications include:

  • Tricyclic antidepressants, such as amitriptyline and nortriptyline, have been used with some success. However, these medications are generally used for only severe tinnitus, as they can cause troublesome side effects, including dry mouth, blurred vision, constipation and heart problems.
     
  • Alprazolam (Niravam, Xanax)may help reduce tinnitus symptoms, but side effects can include drowsiness and nausea. It can also become habit-forming.

Alternative medicine

There’s little scientific evidence that alternative medicine treatments work for tinnitus. However, some alternative therapies that have been tried for tinnitus include:

  • Acupuncture
  • Hypnosis
  • Ginkgo biloba
  • Zinc supplements
  • B vitamins

Neuromodulation using transcranial magnetic stimulation (TMS) is a painless, noninvasive therapy that has been successful in reducing tinnitus symptoms for some people. Currently, TMS is utilized more commonly in Europe and in some trials in the U.S. It is still to be determined which patients might benefit from such treatments.

Fortunately, most people with chronic tinnitus are not too bothered by it. Many people never seek medical attention for their tinnitus, and many who see a doctor only want to know that their tinnitus is not a harbinger of serious disease or impending deafness.

On the other hand, many patients (tinnitus “sufferers”) say that it is annoying, intrusive, upsetting, and distracting to their daily life

Members of a small tinnitus self-help group were asked to list difficulties they have had as a result of the tinnitus. Among the 72 who responded, the most frequently reported problems were:

  • Getting to sleep (57%)
  • Persistence of tinnitus (49%)
  • Understanding speech (38%)
  • Despair, frustration, or depression (36%
  • Annoyance, irritation, or inability to relax (35%)
  • Poor concentration or confusion (33%)

The persistence of the tinnitus seems to be key. Many state that their tinnitus is not particularly unpleasant except for the fact that, like a dripping faucet, it will not go away. Concerns that the tinnitus is a sign of something serious can make it difficult for some people to ignore their tinnitus, leading to problems with sleep, concentration, and emotion.

The hearing difficulties tinnitus sufferers report are considered to be attributable to their hearing loss rather than to the tinnitus itself.

Many tinnitus sufferers complain of difficulty tolerating external sounds of even moderate intensity, a condition called hyperacusis.

Why do some people with tinnitus become tinnitus sufferers, while others do not? Psychological factors present before the onset of tinnitus may be very important. Many, patients with really bothersome tinnitus are found to have a major depressive disorder. About half of depressed tinnitus patients reported previous episodes of depression, before they ever noticed their tinnitus.

Content is adapted from “Overview: Suffering From Tinnitus,” by Robert A. Dobie, M.D., a chapter in “Tinnitus: Theory and Management,” edited by James B. Snow, Jr., M.D. It appears with permission from Dobie, Snow, and PMPH-USA, the publisher.