Tinnitus

Causes

• Hearing Loss:
  • Age-related hearing loss (presbycusis): As people age, hearing often declines, and tinnitus can be a symptom of this.
  • Noise-induced hearing loss: Exposure to loud noise (e.g., from machinery, concerts, firearms, headphones) can damage the hair cells in the inner ear, leading to hearing loss and tinnitus.
• Ear Conditions:
• • Earwax blockage: Accumulation of earwax can block the ear canal and cause tinnitus.
  • Otosclerosis: Abnormal bone growth in the middle ear that affects hearing.
  • Ménière's disease: An inner ear disorder that causes episodes of vertigo, tinnitus, hearing loss, and a feeling of fullness in the ear.
  • Eustachian tube dysfunction: Problems with the tube connecting the middle ear to the back of the nose.
• Vascular Disorders: Conditions affecting blood vessels can cause pulsatile tinnitus (a rhythmic sound that often beats with your pulse).
• • Atherosclerosis (narrowing of arteries)
  • High blood pressure (hypertension)
  • Turbulent blood flow (e.g., from narrowed blood vessels near the ear)
  • Arteriovenous malformations (abnormal connections between arteries and veins)
• Medications: Many medications can cause or worsen tinnitus (ototoxic drugs).
• • Aspirin (in high doses)
  • NSAIDs (e.g., ibuprofen, naproxen)
  • Certain antibiotics (e.g., aminoglycosides)
  • Certain diuretics (loop diuretics)
  • Some antidepressant medications
  • Certain chemotherapy drugs
• Temporomandibular Joint (TMJ) Disorders: Problems with the joint connecting the jawbone to the skull.
• Head or Neck Injuries: Trauma to the head or neck can affect nerves, blood flow, or muscles, leading to tinnitus.
• Acoustic Neuroma: A non-cancerous tumor on the nerve that connects the ear to the brain.
• Chronic Stress or Anxiety: Can worsen the perception of tinnitus.

Symptoms

• Type of sound: Ringing, buzzing, humming, hissing, clicking, roaring, whistling, or whooshing.
• Pitch: High-pitched or low-pitched.
• Volume: From barely noticeable to extremely loud.
• Location: In one ear, both ears, or in the head.
• Pattern: Intermittent or constant.

Diagnosis

• Medical History and Physical Exam: The doctor will ask detailed questions about the nature of your tinnitus, your medical history (including noise exposure, medications, and any underlying conditions), and perform a physical exam, including checking your ears, head, and neck.
• Hearing Test (Audiometry): To assess for any hearing loss, as hearing loss is often associated with tinnitus.
• Blood Tests: To rule out underlying medical conditions (e.g., thyroid problems, diabetes, vitamin deficiencies, vascular issues).
• Imaging Tests: If a specific underlying cause like a tumor, vascular problem, or TMJ disorder is suspected.
  • MRI (Magnetic Resonance Imaging)
  • CT scan (Computed Tomography)
  • MRA (Magnetic Resonance Angiography) or CTA (CT Angiography) to examine blood vessels.
• Pulsatile Tinnitus Evaluation: If you experience pulsatile tinnitus, the doctor may listen to your neck (carotid artery) and abdomen (aorta) with a stethoscope to detect any vascular sounds.

Treatment

• Treating the Underlying Cause:
  • Removing earwax blockage.
  • Managing high blood pressure or other vascular conditions.
  • Adjusting or discontinuing ototoxic medications (under medical supervision).
  • Treating TMJ disorders.
  • Addressing hearing loss (e.g., with hearing aids, which can also mask tinnitus).

• Sound Therapy/Masking: Introducing external sounds to distract from or cover the tinnitus.
  • White noise machines: Can provide background sound for sleep or concentration.
  • Tinnitus maskers: Small electronic devices worn in the ear that generate a low-level sound.
  • Hearing aids: Can amplify ambient sounds, making tinnitus less noticeable for those with hearing loss.
  • Tinnitus apps: Mobile apps offer various sound therapy options.
• Cognitive Behavioral Therapy (CBT): A type of therapy that helps individuals change their reactions and thoughts about tinnitus, reducing its impact on quality of life and emotional distress.
• Tinnitus Retraining Therapy (TRT): Combines sound therapy with counseling to help the brain habituate to the tinnitus sound, so it becomes less noticeable and bothersome.
• Medications: No medication specifically cures tinnitus, but some may help manage associated symptoms or underlying conditions.
  • Anti-anxiety medications or antidepressants may be prescribed for severe distress, anxiety, or depression related to tinnitus.
  • Specific medications for Ménière's disease.

• Lifestyle Management:
  • Avoid loud noise exposure: Use ear protection (earplugs, earmuffs) in noisy environments.
  • Manage stress: Stress can worsen tinnitus perception. Techniques like meditation, yoga, and exercise can help.
  • Limit caffeine, alcohol, and nicotine: These can sometimes exacerbate tinnitus.
  • Ensure adequate sleep.

Living With Tinnitus

Most tinnitus never goes away entirely, but for most people it becomes something the brain files as unimportant and stops noticing, and that is a realistic goal. Below is what changes the odds, and the few patterns that need investigation first.

The patterns that need testing first

Tinnitus in one ear only, especially with hearing loss on that side, is imaged to exclude an acoustic neuroma. A rhythmic sound in time with the pulse is evaluated for a vascular cause. Tinnitus that arrives with sudden hearing loss is an emergency, because steroids given within days can recover hearing that is lost for good if treatment waits; our sudden hearing loss article explains why. Tinnitus with episodes of spinning and ear fullness points toward Meniere's disease.

Hearing aids are the most effective single treatment

When hearing loss is present, which it is in most people with tinnitus, a hearing aid restores the sound the brain was missing and reduces tinnitus in the majority who use one, often more than any masking device. Age-related hearing loss is also a modifiable risk factor for dementia, which our hearing loss and dementia article covers.

Habituation: how the brain learns to ignore it

Tinnitus is loudest in silence and in anxiety, so a fan or low background sound at night, and treating the insomnia and anxiety that amplify it, do more than any pill. Cognitive behavioral therapy has the best evidence of any treatment for reducing distress, and it works whether or not the sound changes. Improvement is measured in months, not weeks. Ginkgo, zinc, and other supplements have not shown benefit in trials, and B12 helps only when it was deficient.

Medications and noise you control

High-dose aspirin, NSAIDs, loop diuretics such as furosemide, and some antibiotics can cause or worsen tinnitus, and a medication review is part of every evaluation. Boat engines, power tools, lawn equipment, firearms, and concerts add hearing damage that makes tinnitus louder and permanent; foam earplugs or earmuffs for each of those are the one prevention that clearly works. Jaw clenching and TMJ problems drive some tinnitus and respond to treating the jaw.

What tinnitus is not

Tinnitus itself does not damage hearing, does not mean a tumor in the vast majority of cases, and does not progress to deafness; the fear that it will is much of what keeps it loud. Our ear, nose, and throat team arranges audiology and imaging when needed, and our why tinnitus happens article goes deeper. NIDCD and the American Academy of Otolaryngology publish patient guidance.

If tinnitus is in one ear only, came on suddenly, or is keeping you from sleep, schedule a visit.