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Tinnitus


Expert reviewer, Mr Anil Banerjee, Ear, Nose and Throat Consultant
Next review due August 2021

Tinnitus is when you hear sound that isn’t caused by an outside source. People often describe it as a ringing or buzzing in their ears. Many different conditions can cause tinnitus, but sometimes it can occur without any obvious cause.

About one in six people have tinnitus occasionally, but it is usually mild. One in 50 people have severe tinnitus.

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About tinnitus

There are two types of tinnitus. Subjective tinnitus means that only you can hear the sound. This is the most common type of tinnitus. It is usually caused by a problem with your inner ear or the nerves involved with hearing.

Objective tinnitus means that you can hear the sound, but sometimes so can a doctor if they listen through a stethoscope placed near your ear. Only one in 100 cases of tinnitus is this type. It is usually caused by a physical problem that produces sound in or near the ear (for example, a pulse in a blood vessel).

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 may be continuous or it may come and go. Objective tinnitus (that a doctor examining you may hear) is usually a vibration, clicking or beating sound. It may be in time with your heartbeat.

You may notice tinnitus more when it’s quiet, so it can seem worse when you’re in bed. It may also be worse when you are feeling stressed.

Sometimes, people with tinnitus have other symptoms such as dizziness, problems with balance, jaw pain or facial weakness. Severe tinnitus can be very distressing and some people develop depression.

If you think you have tinnitus, contact your GP.

Diagnosis of tinnitus

The aim of diagnosis is to find the underlying cause of your tinnitus.

Your GP will ask about your symptoms and medical and family history. They may ask you about possible causes such as how often you have been exposed to noisy environments or if you’ve taken certain medicines.

Your GP may examine your head and neck. They will also look inside your ears with a special instrument called an auriscope, and may refer you to an audiologist to do hearing tests.

Tinnitus can be caused by a wide range of conditions (see our section, Causes of tinnitus). 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
  • a CT scan (similar to 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)
  • a psychological assessment

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Self-help

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

  • Relaxation will help, so your doctor may advise you on some relaxation techniques.
  • further blood tests
  • 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 to see if this works for you.
  • For some people, recorded sounds such as rain, the sea or birdsong may help. Again, there is not strong evidence but it could be something to experiment with. You can buy CDs with nature sounds, download sound effects from websites or use an app on your phone.
  • Loud noise can make your tinnitus worse and may damage your hearing. Avoid very loud sounds such as listening to music on high volume or using power tools without ear-defenders.
  • If you are taking certain medicines known to cause tinnitus, your doctor will advise you to stop taking them.
  • For some people, certain substances can make the tinnitus worse (for example, caffeine, alcohol, sugar, artificial sweeteners, food colouring or tobacco). It may be worth cutting these out in turn to see if that helps.
  • Exercise will help to improve your overall health and well-being and will also help you to sleep.
  • Contact an organisation providing information and support for people with tinnitus. You may find ideas that help you. Some organisations run support groups where you can share suggestions and experiences. There is a list in our helpful websites section.

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

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 an underlying cause. Some of these are outlined in this section.

Sound generators

If you have good hearing, your doctor may suggest a sound generator. These used to be called masking devices. There are two main types. One is a portable machine that produces calming sounds. The other fits to your ear like a hearing aid and produces a constant low-level noise or tone, sometimes called white noise, masking (covering up) the tinnitus. This may also help your brain get used to the tinnitus. Some people find that sound generators interfere with their hearing while they’re using them.

Hearing aids

If you have tinnitus because of a problem with your hearing, your doctor may suggest 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.

Tinnitus retraining therapy

A doctor may refer you for tinnitus retraining therapy. This is an approach that combines using 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 sound generator (see above) or similar equipment. The device will provide low-level noise 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.

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. As many as eight out of 10 people have some improvement in their tinnitus with this type of treatment.

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 helps you identify anything you might be doing that is making the condition worse. CBT doesn’t help reduce the loudness of the sounds you hear. But it can help you to cope with it, deal with any negative feelings and change how you think about tinnitus. So it may help to improve your quality of life.

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 such as a growth near your ear, surgery may help.

Complementary therapies

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

In some situations, your doctor may suggest that you try hypnosis, acupuncture or herbal remedies to promote relaxation and relieve the stress or anxiety that tinnitus may cause.

Acupuncture is a therapy that involves inserting needles into your skin at certain points. There are a range of other complementary therapies that may work for you. Some herbal remedies can have side-effects or interfere with other medication you are taking, so do check with your doctor.

Medicines

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

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
  • noise-induced hearing loss (caused by being exposed to loud sounds)
  • a build-up of earwax in your ear (this can also cause other hearing difficulties)
  • reactions to medicines, including aspirin and non-steroidal anti-inflammatory drugs (NSAIDs), certain antibiotics, diuretics, beta-blockers and chemotherapy drugs
  • 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 the nervous system (for example, multiple sclerosis)
  • non-cancerous growths such as acoustic neuroma
  • problems with the veins or circulation
  • problems with the 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.

Living with tinnitus

Tinnitus affects people in different ways. This is partly to do with how serious it is. For some people, it can be very distressing – particularly if it is very bad. Fortunately, most cases are relatively mild. Even mild tinnitus is likely to be distressing at first, but most people find they cope better as time goes on.

Tinnitus can have a social and a psychological impact on you. You may interact less with friends and family because you find it difficult to hear or concentrate. Often people find it difficult to sleep, particularly when they first develop tinnitus. It is also relatively common for people to have anxiety or depression linked to tinnitus.

Do try and stay positive. It’s unlikely that your tinnitus can be cured, but there are things that can be done, and it is essential to see your GP. It may be helpful to talk to other people who are affected by tinnitus. You can find support groups online (see our section on helpful websites).

Frequently asked questions

  • Everyone experiences tinnitus in different ways. It causes problems sleeping in around one in 20 cases, but there are things you can try to help yourself get a good night’s sleep.

    If you feel stressed or anxious about tinnitus, you’re more likely to suffer from insomnia. Treatments such as sound therapy and CBT can help (for more information, see our section, Treatment of tinnitus).

    Other more general advice for overcoming difficulty in sleeping may also help you to get a good night's sleep.

    • Reduce your caffeine and alcohol intake, especially in the hours before bedtime.
    • Have a regular bedtime and a routine that you know helps you relax before you go to bed.
    • Keep your bedroom for sleeping. Watching TV, working or playing on your phone will stimulate your brain and make it more difficult to sleep.

    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.

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

    As with adults, children who have hearing loss may be more likely to have tinnitus. Two-thirds of children with tinnitus also have hearing problems.

    Children may be less likely to say they have tinnitus unless they’re questioned about it. It's important that you talk to your child to get an idea of how they are coping and their feelings towards tinnitus. In fact, most children with tinnitus are not bothered by it. If your child does find it upsetting, always be supportive and reassure your child that they are not alone.

    If you think your child has tinnitus, see your child’s GP. They may refer your child to a paediatric ENT specialist for further tests. Therapy and support are available for your child if they are diagnosed with tinnitus and they are bothered or distressed by it. If your child is not bothered by their tinnitus, you may just need reassurance about their condition.

  • 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 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 and become short-tempered
    • anxious about what the underlying cause may be
    • frustrated at the constant sound
    • worn out by battling with tinnitus or losing sleep
    • 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 (for example, listening to music or the radio) may keep you awake. If this happens, you could ask your partner to use headphones or pillow speakers.


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Related information

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  • Reviewed by by Marcella McEvoy, Specialist Health Editor, and Liz Woolf, Freelance Health Editor, Bupa Health Content Team, August 2018
    Expert reviewer, Mr Anil Banerjee, Ear, Nose and Throat Consultant
    Next review due August 2021



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