Tinnitus

Tinnitus (pronounced tin-NITE-us or tin-uh-tus) means hearing sound that isn’t caused by an outside source. People describe it as ringing, hissing, clicking or buzzing in their ears. Many different conditions can cause tinnitus. But sometimes there is no obvious cause. About one in seven people have tinnitus occasionally.

About tinnitus

Many of us have had ringing in the ears after hearing a loud bang or being at a concert with very loud music. This is temporary tinnitus and generally goes away soon afterwards. But tinnitus can also be a longer-term condition.

There are two types of tinnitus. Subjective tinnitus means that only you can hear the sound. Often the cause is unknown, but it can be caused by a problem with your inner ear or the nerves involved with hearing.

Objective tinnitus means others can hear the sound you’re hearing, including your doctor. It is usually caused by a physical problem that produces sound in or near the ear (for example, a pulse in a blood vessel). It can be pulsatile (in time with your heartbeat) or sometimes can be a repeated clicking noise. Your doctor may call this pulsatile tinnitus.

Subjective tinnitus is the more common type. Only 1 in 100 tinnitus cases will be objective tinnitus. Anyone can develop tinnitus. It’s more common as we get older. But it can start at any age, including in childhood. Tinnitus is more common in adults and children who have hearing problems.

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. You may have it in one or both ears.

Tinnitus symptoms may be continuous or it may come and go. Objective tinnitus (that your doctor can also hear) is usually a humming, clicking or beating sound. It may be in time with your heartbeat (pulsatile).

Tinnitus may be worse when you are feeling stressed, and can cause problems with sleeping.

Sometimes, people with tinnitus have other symptoms such as:

• hearing loss
• dizziness
• problems with balance
• jaw pain
• sensitivity to loud noise (hyperacusis)

Severe tinnitus can be very distressing, and some people develop depression. If you think you have tinnitus, contact your GP.

Causes of tinnitus

What causes tinnitus is not always clear. It can be linked to hearing loss. Tinnitus may also be linked to conditions including:

• age-related hearing loss
• noise-induced hearing loss, caused by exposure to loud sounds
• a build-up of earwax in your ear
• reactions to medicines such as aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), certain antibiotics, diuretics, beta-blockers and chemotherapy
• Ménière’s disease – a rare ear condition that causes vertigo, hearing loss, tinnitus and a feeling of pressure in the ear
• otosclerosis – a rare condition affecting a bone inside your ear
• head or neck injuries
• ear infections
• diabetes or thyroid problems
• psychological problems such as anxiety or depression
• problems with your nervous system (for example, multiple sclerosis)
• non-cancerous growths such as acoustic neuroma

Objective tinnitus (where your doctor can also hear the sounds) may be caused by:

• problems with your veins or circulation
• muscle spasms in the middle ear
• problems with your jaw joint and surrounding muscles

Tinnitus can also be related to other conditions though these are less common. Because it has so many possible causes, it’s important to contact your GP if you have tinnitus. They can make sure it is properly investigated.

Diagnosis of tinnitus

Your GP will ask about your symptoms, and your medical and family history. They may ask about possible tinnitus causes – for example, how often you’ve been exposed to noisy environments and certain medicines you’ve taken.

Your GP may examine your head and neck. They will also look inside your ears with an instrument called an otoscope. This is to check for earwax build-up, infection or other abnormalities. They may ask you to see an audiologist for hearing tests.

If necessary, there may be further tests you will need to have, which can be:

• further hearing tests
• blood tests
• a CT scan (like an X-ray but producing a detailed series of cross-sections of your body)
• an MRI scan (using magnets, radio waves and computers to produce a detailed image of the inside of your body)
• an assessment by a mental health management team

Self-help

If you have tinnitus, your GP can advise you on tinnitus treatment. They’ll also suggest some self-help measures for tinnitus. Here are some things you could try.

• Tinnitus can worsen with stress so relaxation techniques may help.
• A low level of background noise may help to reduce awareness of your tinnitus. Try leaving a window open or having a fan or the radio on.
• Recorded sounds such as rain, the sea or birdsong may help. You can buy CDs with nature sounds, download sound effects from websites or use an app on your phone.
• Loud noise can make tinnitus worse and further damage your hearing. Avoid very loud sounds such as listening to music on high volume or using power tools without ear-defenders.
• You may need to stop taking medicines known to cause tinnitus – your doctor will advise you.
• For some people, certain foods or drinks can make tinnitus worse. Some doctors advise reducing salt, caffeine, alcohol, sugar, artificial sweeteners or food colouring.
• Exercise regularly, for example walking or swimming.

Treatment of tinnitus

There is no tinnitus cure. You may have treatment for an underlying cause, such as for impacted earwax. But it’s more likely you’ll have treatment to help manage symptoms.

For many people, tinnitus improves slowly over time. This is because you learn to get used to your tinnitus so it has less impact on your life. Doctors call this ‘habituation’. Some of the following treatments can help with habituation.

Sound therapy

Your doctor may suggest sound therapy. Sound therapy involves using a portable device, for example by your bedside at night, that produces calming sounds. During the day you can wear a device in your ear like a hearing aid that produces a constant low-level noise or tone. Tinnitus sound therapy may help mask your tinnitus or distract you from it.

Hearing aids

If you have hearing loss, your doctor may suggest a hearing aid. This makes external sounds louder, so you’re less aware of the tinnitus. Hearing aids help to relieve around half of all cases of tinnitus related to hearing loss.

Cognitive behavioural therapy (CBT)

You may find it helpful to have tinnitus counselling, where you speak to a specialist who explains what tinnitus is and how it develops. You can talk to them about ways to cope with your tinnitus.

Tinnitus can cause anxiety, disrupt your life or stop you doing the things you enjoy. Your doctor may suggest cognitive behavioural therapy (CBT). The aim of CBT is to help you think differently about the condition and achieve a more positive attitude. Many people find CBT helps their symptoms and improves their quality of life.

Surgery

Surgery is not done for tinnitus itself. But it may be used to treat any underlying condition, for example if there is a physical problem such as a growth near your ear.

Complementary therapies

Complementary therapies are not part of conventional medical treatment. Some that have been used for tinnitus include:

• hypnosis
• acupuncture
• herbal remedies
• supplements
• dietary changes

There is little or no scientific evidence that these approaches work.

Acupuncture involves putting very fine needles into your skin at specific points. Make sure you use a qualified practitioner. Some supplements can have side-effects or interfere with other medicines. Check with your doctor before starting to take them.

Some people with tinnitus say that cutting out caffeine, alcohol or added salt helps reduce their tinnitus. But there’s not enough strong evidence to support doing this. If you want to see if this helps, speak to your GP or a dietitian first.

Medicines

There aren’t any specific medicines for tinnitus. But tinnitus can be worsened by depression or anxiety, which can be treated with medicines. So your doctor may prescribe an antidepressant if they think that will help.