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Tinnitus

Tinnitus is when you hear sound that isn’t caused by an outside source. There are many different conditions that can cause tinnitus and sometimes it can occur without an obvious cause.

Mild tinnitus is common, affecting about one in 10 people.

There are two types of tinnitus.

  • Subjective tinnitus – Only you can hear the sound. This is the most common type of tinnitus and is usually linked to problems affecting your hearing (auditory) system.
  • Objective tinnitus – You can hear the sound, and sometimes so can a doctor if they listen through a stethoscope placed near your ear. This type of tinnitus is very rare. It is usually caused by a physical problem that produces sound in or near the ear, for example, problems with blood vessels.
Image showing the outer, middle and inner ear

Details

  • Symptoms Symptoms of tinnitus

    Tinnitus is when you hear sound that isn’t caused by an outside source. It can be whistling, buzzing, ringing, hissing, humming or roaring. It can affect one or both of your ears.

    Subjective tinnitus (that only you can hear) usually has a continuous tone. Objective tinnitus (that a doctor examining you may hear) is usually a vibration, clicking or beating sound.

    These sounds may be constant or can come and go. If the sounds are constant, you may notice them more in quiet environments, so it can seem worse when you’re in bed.

    If you think you have tinnitus, contact your GP.

    Bupa Health Assessment: Hearing test

    If you are concerned about hearing loss, Bupa can help you get a diagnosis.

  • Diagnosis Diagnosis of tinnitus

    The aim of diagnosis will be to work out what the underlying cause of your tinnitus is.

    Your GP will ask about your symptoms and medical and family history. They may ask how often you are exposed to noisy environments and if you’ve taken certain medicines.

    Your GP may examine your head, neck and torso. They may also look inside your ears with a special instrument called an auriscope. Occasionally, they may carry out a hearing test to see if the tinnitus is related to a hearing problem. They may do a blood test.

    Depending on their observations, your GP may refer you to a specialist. This is most likely to be a doctor specialising in conditions of the ears, nose and throat (ENT). In some cases, they may refer you to a health professional specialising in hearing and balance problems (audiologist), or a doctor specialising in the brain and nervous system (neurologist).

    A wide range of conditions can cause tinnitus (see ‘Causes of tinnitus’ section). This means there are many different tests that a doctor may carry out to help determine the cause. You may need to have:

    • further hearing tests
    • further blood tests
    • scans
      • X-ray (using radiation to produce images of the inside of your body)
      • CT (similar to X-ray but producing a more detailed image)
      • ultrasound (using sound waves to produce images of the inside of your body)
      • MRI (using magnets, radio waves and computers to produce a detailed image of the inside of your body)
    • a psychological assessment
  • Treatment Treatment of tinnitus

    For most people, tinnitus improves slowly over time. This is because your brain learns to get used to your tinnitus and it doesn’t have such an impact on your life any more.

    There are no treatments that have been shown to directly cure tinnitus. A doctor may prescribe a treatment to address the underlying cause of your tinnitus. Some of these are outlined in this section.

    Self-help

    If you have tinnitus, you will probably play a big part in managing the condition. Your doctor may suggest some simple things to try that may help manage your symptoms of tinnitus and improve your quality of life.

    • Relaxation will help, so your doctor may advise you on some relaxation techniques.
    • For some people, a low level of background noise may help to reduce the perception of tinnitus, though there is not strong evidence for this. You could try leaving a window open, or having a fan or the radio on, and see if this works for you.
    • For some people, recorded relaxation sounds, such as rain, the sea or birdsong may work in the same way. Again, there is not strong evidence but it could be something to experiment with.
    • Being exposed to loud noise can make your tinnitus worse and may lead to hearing damage. It is best to avoid very loud sounds, such as listening to music on high volume, or using power tools.
    • If you are taking certain medicines known to cause tinnitus, your doctor will advise you to stop taking them.
    • You may find that it helps to improve your overall health, by getting regular physical activity and enjoying a healthy diet.

    Remember that if you are experiencing tinnitus, the first thing you should do is contact your GP.

    Medicines

    Depression or anxiety may make your tinnitus worse. Treating these conditions may help ease your symptoms and help you manage them better. If your tinnitus is associated with depression or anxiety, your doctor may prescribe you an antidepressant.

    Hearing aids

    If you have tinnitus because of a problem with your hearing, your doctor may give you a hearing aid. This will make external sounds louder, helping to decrease your awareness of the tinnitus. Hearing aids help to relieve tinnitus in around half of all cases where the problem relates to hearing loss.

    Masking devices

    If you have good hearing, your doctor may give you a masking device, also called a noise generator. This usually fits to your ear like a hearing aid and produces a constant low-level noise or tone, masking (covering up) the tinnitus. It is thought that this also helps with the process of your brain getting used to the tinnitus. Some people find that masking devices cause problems with hearing while they’re using them.

    Tinnitus retraining therapy

    A doctor may refer you for tinnitus retraining therapy. This is an approach that combines the use of sound therapy with counselling sessions. The aim is to help with the process of your brain getting used to the tinnitus.

    Sound therapy involves using a masking device (see above) or similar equipment. The device will provide low-level noise or tone for a set amount of time each day.

    The counselling aims to increase your awareness and understanding of tinnitus and the negative feelings you associate with it. It may also help you deal with any stress you’re having. More research is needed, but evidence suggests tinnitus retraining – where you have counselling and sound therapy together – may be a more effective approach than sound therapy on its own.

    How often you attend sessions will depend on how bad your tinnitus is. Tinnitus retraining therapy usually takes one or two years to work properly. It has been shown to have positive results for most people.

    Cognitive behavioural therapy (CBT)

    If your tinnitus is causing anxiety, disrupting your life or stopping you doing the things you enjoy, your doctor may refer you for cognitive behavioural therapy (CBT). The aim of CBT is to help you think differently about the condition and achieve a more positive attitude. It also addresses any aspects of your behaviour that might be making the condition worse. Research suggests that it doesn’t help reduce the loudness of the sounds you hear. CBT can, however, help teach you coping techniques to deal with any negative feelings and change how you think about tinnitus. It may help to improve your quality of life and it has a positive effect on how you cope with tinnitus.

    Surgery

    For most people, there is no form of surgery that will help with tinnitus. However, if your tinnitus is caused by a physical problem, for example, a growth near your ear, a surgeon may recommend having the growth removed.

    Complementary therapies

    Complementary therapies sit outside of conventional medicine, and there is little or no scientific evidence that they are effective. However, there is no harm associated with most of them and some people find them effective.

    In some situations, your doctor may recommend complementary therapies to promote relaxation, to relieve the stress that tinnitus may cause. One option is acupuncture, a therapy that involves inserting needles into your skin at certain points. Your doctor may also advise you on some relaxation techniques, to help ease any anxiety associated with your tinnitus.

    There are a range of other complementary therapies that may work for you.

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  • Causes Causes of tinnitus

    Tinnitus is often linked to hearing loss. In fact, two-thirds of people with tinnitus have some kind of hearing loss. This includes people with the following conditions.

    • Age-related hearing loss. You are more likely to have hearing difficulties as you get older.
    • Noise-induced hearing loss. This is when your hearing is damaged by being exposed to loud sounds.
    • Ménière’s disease. This is a rare ear condition that causes vertigo, hearing loss, tinnitus and a feeling of pressure in the ear.
    • Impacted wax. A build-up of earwax in your ear can cause hearing difficulties.
    • Otosclerosis. This is a rare condition affecting a bone inside your ear.

    Tinnitus can also be related to other conditions, though these are less common.

    • Reaction to medicines. Taking high doses of certain medicines, such as aspirin and non-steroidal anti-inflammatory drugs (NSAIDs), certain antibiotics, diuretics, beta-blockers and chemotherapy drugs, can cause tinnitus.
    • Head or neck injuries. These may or may not also cause hearing loss.
    • Others:
      • ear infections
      • diabetes or thyroid problems
      • psychological problems, such as anxiety or depression
      • problems with the brain or nervous system, such as multiple sclerosis
      • problems with the heart or circulation
      • problems with the jaw joint and surrounding muscles

    Because it has so many possible causes, it’s important to contact your GP if you’re experiencing tinnitus. They can ensure that the cause is investigated properly.

  • Living with tinnitus Living with tinnitus

    If you have tinnitus, it can affect your quality of life. Tinnitus affects people in different ways, but the consequences tend to be social and psychological. You may interact less with friends and family, and could experience insomnia, anxiety or depression.

    It may be helpful to talk to other people who are affected by tinnitus. You can find support groups online (see our Further information).

  • FAQ: Can tinnitus affect my sleep? Can tinnitus affect my sleep?

    Everyone experiences tinnitus in different ways. Tinnitus causes sleep deprivation in around 1 in 20 cases, but there are things you can try to help yourself get a good night’s sleep. People with tinnitus often have some difficulty sleeping.

    If you feel stressed or anxious about tinnitus, you’re more likely to suffer from insomnia.

    If you have trouble sleeping, there are things you can do to get a good night's sleep.

    • Reduce your caffeine and alcohol intake, especially before bedtime.
    • Have a regular bedtime and a routine that you know helps you relax before bed.
    • Make sure your sleeping environment is comfortable.

    When you’re in bed there are things you can do that may distract you from the tinnitus.

    • Listen to tranquil music or keep a window open.
    • Do breathing exercises to help you relax and fall asleep.
  • FAQ: Can children have tinnitus? Can children have tinnitus?

    People of all ages can be troubled by tinnitus, including children. The exact numbers aren’t clear, but it’s thought that around one in 10 children may have tinnitus.

    As with adults, children who have hearing loss may be more likely to also experience tinnitus. Children may be less likely to say they have tinnitus unless they’re questioned about it.

    If you think your child has tinnitus, see your child's GP. If necessary, they will refer your child to a specialist doctor for further tests.

    Therapy and support are available for your child if they are diagnosed with tinnitus. It's important that you talk to your child to get an idea of how they are coping and their feelings towards tinnitus. Always be supportive and reassure your child that they are not alone.

  • FAQ: Supporting your partner How can I help my partner with their tinnitus?

    If your partner has tinnitus, first of all you should encourage them to contact their GP.

    You can also help your partner emotionally. Everyone with tinnitus is affected differently. Some people find tinnitus easy to manage, while others find it very distressing. It's important to talk to your partner to get an idea of how they are coping with the symptoms so you can understand what they’re going through.

    Your partner may feel a range of different emotions in response to tinnitus. If you understand these feelings, you can provide support. For example, they may feel:

    • irritated or angry about having tinnitus
    • anxious about what the underlying cause may be
    • frustrated at the constant sound
    • stressed because it interferes with their daily life

    Your partner may have difficulty sleeping because of their tinnitus. This can cause problems for you if they’re restless and keep you awake at night as well. Some techniques may help them sleep, such as listening to music or the radio, but may also keep you awake. You could ask your partner to use headphones or pillow speakers.

  • Other helpful websites Other helpful websites

    Further information

    Sources

    • Tinnitus. NICE Clinical Knowledge Summaries. cks.nice.org.uk, revised April 2010
    • Tinnitus. The MSD Manuals. www.msdmanuals.com, reviewed September 2013
    • Ear, nose and throat. Oxford Handbook of General Practice (4th ed. online). Oxford Medicine Online. www.oxfordmedicine.com, published March 2014
    • Tinnitus explained. British Tinnitus Association. www.tinnitus.org.uk, updated July 2011
    • Tinnitus. PatientPlus. www.patient.info/patientplus, last reviewed February 2013
    • Tinnitus. Medscape. www.emedicine.medscape.com, updated June 2015
    • Treatment. British Tinnitus Association. www.tinnitus.org.uk, updated February 2015
    • I think I have tinnitus. Action on Hearing Loss. www.actiononhearingloss.org.uk, accessed 18 March 2016
    • Map of Medicine. Tinnitus. International View. London: Map of Medicine; 2012 (Issue 2)
    • Tinnitus. BMJ Best Practice. bestpractice.bmj.com, updated January 2016
    • Self help for tinnitus. British Tinnitus Association. www.tinnitus.org.uk, revised September 2012
    • Martinez-Devesa P, Perera R, Theodoulou M, Waddell A. Cognitive behavioural therapy for tinnitus. Cochrane Database of Systematic Reviews 2010, Issue 9. Art. No.: CD005233. DOI: 10.1002/14651858.CD005233.pub3
    • Hesser H, Weise C, Westin VZ, Andersson G. A systematic review and meta-analysis of randomized controlled trials of cognitive-behavioral therapy for tinnitus distress. Clin Psychol Rev. 2011 Jun; 31(4):545–53. doi: 10.1016/j.cpr.2010.12.006
    • Tinnitus – causes and therapies. Action on Hearing Loss. www.actiononhearingloss.org.uk, published August 2015
    • Presbycusis. PatientPlus. www.patient.info/patientplus, last reviewed February 2015
    • Ménière's disease. NICE Clinical Knowledge Summaries. cks.nice.org.uk, revised September 2012
    • Otosclerosis. The MSD Manuals. www.msdmanuals.com, reviewed December 2015
    • Insomnia. NICE Clinical Knowledge Summaries. cks.nice.org.uk, revised April 2015
    • Relaxation. British Tinnitus Association. www.tinnitus.org.uk, revised February 2013
    • Tinnitus in Children - Practice Guidance. British Society of Audiology. www.thebsa.org.uk, March 2015
    • How to help friends and family with tinnitus. Action on Hearing Loss. www.actiononhearingloss.org.uk, published August 2015
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    Reviewed by Nick Ridgman, Lead Health Editor, Bupa Health Content Team, May 2016
    Peer reviewed by Mr Anil Banerjee, Ear, Nose and Throat Surgeon
    Next review due May 2019

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