What Is Tinnitus? Symptoms, Causes And Treatments

Tinnitus is commonly described as “ringing in the ears,” but the phantom sounds take a wide variety of forms and vary in volume from barely perceptible to quite loud. People who experience tinnitus may describe the noises they hear as:

• buzzing
• chirping
• clicking
• hissing
• roaring
• sirens
• whistling
• wind

The sounds may be continuous or sporadic and in one or both ears.

The reasons tinnitus develops are still poorly understood. “There are several different mechanisms involved, but no one knows for sure what they are,” says Richard S. Tyler, Ph.D., professor and director of audiology in the department of otolaryngology and department of communication sciences and disorders at the University of Iowa. “It seems to be hyperactivity in the auditory nerves.”

Research has found, though, that some possible causes of tinnitus may include:

Hearing loss. By far the most common condition connected to tinnitus is age-related hearing loss, known as presbycusis. Presbycusis results from damage to the nerve cells in the inner ear over time and is a type of hearing loss known as sensorineural hearing loss, meaning that it involves the nerves in the inner ear and the brain.

Noise exposure. Loud noise, whether at work or for fun (e.g., concerts, motorcycles), can cause hearing loss and accompanying tinnitus. It’s possible to experience tinnitus as the result of a single loud noise, such as a gunshot or explosion.

Ear injury, infection or blockage. Anything in the middle ear that prevents sound waves from reaching the inner ear—whether that’s ear wax blocking the eardrum, a ruptured eardrum or an infection—can set off tinnitus.

Drugs. There is a long list of over-the-counter and prescription drugs known to have the potential to damage your hearing (called ototoxic drugs) and can trigger tinnitus. These include quinine-based antimalarials, high doses of aspirin, certain types of antibiotics, nonsteroidal anti-inflammatories (NSAIDs), some chemotherapy agents (especially cisplatin) and loop diuretics. If you are taking any of these, make sure your doctor is monitoring the possible effects on your hearing.

The diseases and conditions listed here are either rare in themselves (such as Meniere’s disease) or less likely causes of tinnitus, but since most of them require medical attention in their own right, it’s worth considering them as possible causes of tinnitus as a symptom.

Acoustic neuroma. This rare benign tumor grows on one of the cranial nerves and can cause one-sided hearing loss and tinnitus.

Chronic diseases and conditions. Anemia, autoimmune diseases, hypertension, multiple sclerosis (MS) and thyroid problems are all associated with tinnitus.

Circulatory abnormalities. Known as “objective” tinnitus because it can be heard by an outside observer using a stethoscope, this form of tinnitus is very rare, accounting for fewer than 1% of cases. It’s caused by hearing your own blood circulating, which is known as pulsatile tinnitus, or by other body sounds. When pulsatile tinnitus is one-sided, it warrants immediate medical attention.

Head and neck trauma. Severe injury to the head—including traumatic brain injury (TBI)—or neck can cause changes in auditory processing, blood flow, muscles or nerves that can contribute to the perception of tinnitus.

Meniere’s disease. Tinnitus is just one symptom of this rare inner-ear disorder, which also brings on hearing loss and dizziness or vertigo, and oftentimes, a sensation of fullness in the ears.

Muscle spasms. Spasms in the muscles of the soft palate or middle ear can be responsible for tinnitus.

Otosclerosis. With this middle ear problem, the three small bones that conduct sound deform, potentially leading to hearing loss and tinnitus.

Ramsay Hunt Syndrome. Ramsay Hunt Syndrome is a rare disorder caused by the varicella zoster virus, the same virus responsible for chickenpox in children and shingles in adults. It can trigger tinnitus along with other neurological symptoms.

Temporomandibular joint disorder. The temporomandibular joint (TMJ) connects the lower jaw to the skull. Injuries to or problems with the joint or teeth-grinding (bruxism) can produce tinnitus.

There is no cure for tinnitus itself, but if it’s being caused by an underlying medical problem like an ear infection, treating that may help alleviate it. Likewise, if it’s being caused by medications, reducing or changing them in consultation with your doctor may help.

“For most people, the first six to nine months of tinnitus is the worst,” says Dr. Tyler. “And that’s a reasonable reaction: Tinnitus gets in the way of enjoying life. It can also affect hearing, concentration and sleep.” Dr. Tyler says that patients’ emotional reactions to tinnitus vary greatly depending on their existing challenges in everyday life, from intense distress to mild annoyance. Over time, he says, most people become more accepting of the condition.

If the tinnitus persists, especially if it’s interfering with your ability to sleep or concentrate, you may want to consider some of the following options:

Acupuncture. Research has found that this holistic health treatment can be effective for neurological tinnitus. However, just as each person responds individually to symptoms, so do people’s experiences with obtaining relief from acupuncture.

Medications. There are no prescription drugs that alleviate tinnitus symptoms, but doctors may prescribe anti-anxiety drugs or antidepressants for people who are experiencing intense anxiety or persistent depression due to their intrusive tinnitus symptoms.

Relaxation techniques. Because stress and anxiety—sometimes caused by the tinnitus itself—can worsen tinnitus symptoms, methods that lessen psychological distress can help. These include biofeedback, hypnotherapy, mindfulness-based stress reduction (MBSR), socializing with friends and family or engaging in favorite hobbies and sports.

Psychotherapy. There are a variety of psychotherapeutic practices that teach you how to gain better control over—and therefore acceptance—of tinnitus. These include: acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), progressive tinnitus management (PTM), tinnitus activities treatment (TAT) and tinnitus retraining treatment (TRT).

Vagus nerve stimulation (VNS). A relatively new implant-device therapy approved for the treatment of epilepsy and chronic depression, VNS is being studied as a way to reduce tinnitus symptoms. At this point, the results aren’t sufficient to say it helps. There are other therapies that use implanted electrical devices as well: deep brain stimulation, repetitive transcranial magnetic stimulation, and transcranial direct current stimulation. The newest form of stimulation is known as bimodal neuromodulation and is delivered through the tongue. All are still experimental at this point and none are accepted as effective treatments yet.

Hearing Aids for Tinnitus

The first step in evaluating someone with tinnitus is usually a full hearing assessment to identify the degree and type of hearing loss. Then, an audiologist or other medical professional will work with you to identify the pitch and volume of your particular tinnitus sound.

If your degree of hearing loss suggests you’d benefit from wearing hearing aids, you can choose the type that includes what’s known as pitch masking. Using a masking tone that matches the pitch and intensity of your particular tinnitus sound, the goal is to produce residual inhibition, which means that you either no longer hear or barely hear the bothersome sound.

(Note: All product details are accurate as of publication and are subject to change.)

Even if you don’t need hearing aids, you may benefit from using sound therapy via headphones or environmental sound machines to mask your tinnitus and help you habituate to it.

Sources

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Ramsay Hunt Syndrome. National Organization for Rare Disorders. Accessed 5/30/2021.

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Treatment Options. American Tinnitus Association. Accessed 5/30/2021

General Wellness. American Tinnitus Association. Accessed 6/3/2021

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Sereda M, Xia J, Scutt P, Hilton MP, Refaie MP, Hoare DJ. Ginkgo Biloba for Tinnitus. Cochrane Database Systematic Review. 2019(12):CD013514.

Drug Therapies. American Tinnitus Association. Accessed 5/30/2021

Experimental Therapies. American Tinnitus Association. Accessed 6/3/2021

Conlon B, Langguth B, Hamilton C, Hughes S, Meade E, O’Connor C, et. al. Bimodal neuromodulation combining sound and tongue stimulation reduces tinnitus symptoms in a large randomized clinical study. Science Translational Medicine. 2020:Vol.12,Issue564,eabb2830

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