Tinnitus

Published by Bupa's Health Information Team, April 2010.

This factsheet is for people who have tinnitus, or who would like information about it.

Tinnitus is the perception of a sound in the ear or head that isn't produced by an outside source. There are many different conditions that can produce tinnitus and sometimes it can occur for no known reason.

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About tinnitus

It's quite common to have mild tinnitus, and around one in 10 people are occasionally affected. One in 200 people have tinnitus so badly that it affects their ability to lead a normal life.

Tinnitus is the perception of sounds in the absence of an outside source.

Objective tinnitus can be heard through a stethoscope placed near your ear. This form of tinnitus is often caused by the sound of blood flowing in narrowed arteries in the neck, or the 'murmur' of turbulent blood through a defective heart valve. Problems with your Eustachian tube can also result in objective tinnitus. Subjective tinnitus is more common and is only heard by the person with tinnitus. This type of tinnitus can develop as a result of a number of possible causes including hearing loss, Meniere's disease and acoustic neuroma.

If you experience tinnitus, you should visit your GP.

Symptoms of tinnitus

Tinnitus is the perception of sound which can be high-pitched whistling, buzzing, ringing or hissing. It can also be quite a complex sound, like the roar of an ocean. The sounds may be constant or can come and go. Sometimes the tinnitus beats in time with your heart rate. This is called pulsatile tinnitus.

Whatever the cause of the tinnitus, it's almost always made worse by stress, which can be either physical or psychological. Some people are able to live with their tinnitus quite happily. In others, the tinnitus seriously interferes with their quality of life. The tinnitus can be in one or both ears, or 'in the head'.

Causes of tinnitus

The source of most cases of tinnitus is within the inner ear, which converts sounds to nerve signals; the auditory nerve, which carries these signals to the brain; and the parts of the brain involved in decoding those signals into what we sense as sounds.

Tinnitus is often linked to hearing loss. For this reason it's more common in older people who have age-related hearing loss.

Exposure to loud noise at work may also cause tinnitus. If you work with pneumatic drills or in noisy factories, you may be more at risk of having tinnitus. If you are exposed to such loud noises then it's advisable to wear noise protection headphones.

Other possible causes of tinnitus include:

• Meniere's disease, which results from an increased pressure in the inner ear and also causes deafness and vertigo
• otosclerosis, a condition in which the small bones of the middle ear become stiff and immobile as a result of new bone formation
• ear infections and inflammation
• wax blocking your ear
• middle-ear effusion (the type that is often known as 'glue ear' in children)
• acoustic neuroma, a benign (non-cancerous) tumour of the auditory nerve
• high doses of medicines including aspirin, quinine and some antibiotics, water tablets (diuretics), beta-blockers and chemotherapy drugs
• head injury or whiplash
• general health problems like hypertension
• problems with the joint between your jaws (this is called the temporomandibular joint), which can also lead to pain in the head or face

If you have tinnitus, you're more likely to complain of feeling depressed, irritable, annoyed and have problems with concentration and sleep.

Diagnosis of tinnitus

The type of sound you hear when you have tinnitus doesn't necessarily tell the doctor what the underlying cause might be, or whether the cause is serious or minor. In order to find out the cause of tinnitus, you will need to have some tests.

If you have tinnitus, your GP may refer you to a specialist doctor for some tests. This will usually be an ENT (ear, nose and throat) surgeon or an audio-vestibular physician / neuro-otologist (a doctor who specialises exclusively in hearing and balance problems). He or she will take into account all of your symptoms and may perform blood tests and various tests of your hearing and balance.

If the doctor feels that he or she needs to investigate your inner ear in more detail, you may need to have a magnetic resonance imaging (MRI) scan. If he or she think your tinnitus could be caused by a heart or blood vessel problem, you may need further scans, such as ultrasonography, computed tomography or an angiogram.

Treatment of tinnitus

The treatment you need will depend on what is causing the tinnitus. If you have an underlying problem, such as an ear infection, acoustic neuroma or Meniere's disease, this may need specific treatment. However, sometimes there is no treatment available.

Self-help

There are some simple things you can try yourself that may help with your tinnitus. These include:

• keep your stress levels down
• take regular exercise
• make time to relax and try special techniques such as meditation
• keep a low level of background noise, such as a fan, radio or TV
• join a local support group

Medicines

There are no medicines which have been shown to effectively treat tinnitus itself. However, your GP may be able to prescribe you medicines to treat an underlying cause, if there is one. For example, if your tinnitus is caused by an ear infection, your doctor may prescribe antibiotics. If it's found to be caused by Meniere's disease, he or she may prescribe betahistine, which can help to reduce the frequency and severity of your attacks.

Depression or anxiety can make tinnitus more of a problem and treatment of these conditions may help bring some relief. People with some long-term, painful conditions sometimes get relief by taking low doses of antidepressants such as amitriptyline. This may also help sometimes if you have tinnitus.

Hearing aids

If you have impaired hearing, wearing a hearing aid can help mask the tinnitus by making external sounds seem louder.

If your have good hearing, you may be given noise generators as part of tinnitus - retraining treatment. These produce background noise, such as 'white noise' or sounds of nature, just below the sound of your tinnitus. The devices can be part of a hearing aid, worn like a personal stereo, or stand alone like a radio.

Tinnitus-retraining therapy combines periods of listening to low levels of specially created sounds with counselling sessions. The counselling aims to encourage you to disconnect the experience of the sounds from the negative feelings they produce. A full programme of tinnitus retraining takes about one and a half years to complete.

Positive thinking

The attitude you have towards your tinnitus is crucial. People with a positive attitude find it more manageable. Having a trusting relationship with your doctor, who takes your concerns seriously, and is willing to try several approaches to treatment if necessary, will help you to feel that you are making some progress.

Cognitive behavioural therapy (CBT) is an approach that can be used in treating tinnitus. CBT is a combination of cognitive therapy, which examines unwanted thoughts, attitudes, and beliefs (called cognitive processes) and behavioural therapy, which focuses on behaviour in response to those thoughts.

If you have long-term (chronic) tinnitus, you may be also be encouraged not to listen for your tinnitus and, instead, to try and concentrate and direct your attention to other things.

Surgery

If your tinnitus is caused by a benign tumour (acoustic neuroma), your doctor may recommend having surgery to remove the tumour.

Complementary therapy

Because conventional medicine has not found any reliable treatments for tinnitus, complementary therapies are popular. Any therapy that promotes relaxation and a sense of wellbeing may be useful in relieving tinnitus or the distress it causes.

Techniques include yoga, the Alexander technique, meditation, reflexology, hypnosis, acupuncture and massage. Ask your doctor for advice on these therapies. He or she may be able to recommend a qualified practitioner.

The herbal remedy ginkgo biloba is promoted as a cure for tinnitus but good-quality scientific studies have shown it does not work any better than a placebo.

Other treatments

A range of other treatments, including dietary supplements, electromagnetic stimulation and medicines (including anti-epileptics such as gabapentin (Neurontin) and anti-sickness drugs) have been tried, but their effectiveness hasn't been proven.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.