Tinnitus causes and treatment

Tinnitus sounds include:

• ringing
• buzzing
• humming
• whooshing
• hissing
• throbbing

You can get tinnitus in one ear or both ears. Read our chapter on tinnitus causes.

Tinnitus is a common condition that people of all ages can get, including young children. 30% of people will experience tinnitus at some point in their lives and 1 in 10 people suffer from persistent tinnitus. People with hearing loss or other problems with their ears are more susceptible to tinnitus but the condition also affects people with normal hearing.

Read our chapter on tinnitus in children for parents.

Is your tinnitus getting worse? You should speak to your GP if you believe your tinnitus is getting worse, you get tinnitus regularly or if it’s affecting your sleep or concentration.

You should also see your GP if your tinnitus is only on one side or a lot louder on one side than the other. They may need to do some tests if this is the case to make sure nothing else is going on.

Pulsatile tinnitus is a rhythmical sound that usually matches up with your heartbeat or pulse. The condition is caused by blood circulation in or around your ears. Pulsatile tinnitus can be a result of high blood pressure or high pressure in your head, swollen arteries, atherosclerosis, turbulent blood flow, head or neck tumours or abnormal capillaries.

Pulsatile tinnitus is usually not serious and may be treated with medication and lifestyle changes depending on the underlying cause. However, pulsatile tinnitus can sometimes be an indication of more serious problems. If you are experiencing pulsatile tinnitus, you should visit your GP.

For more information about pulsatile tinnitus, the British Tinnitus Association have a useful resource.

At your appointment, your GP might look into your ears to see if your tinnitus is caused by an ear infection or earwax build-up. Your GP might also be able to check if you have any hearing loss. If appropriate, your GP will refer you to a specialist to get tested further and possibly receive treatment for your tinnitus.

Often, people want to know how to stop tinnitus with an over-the-counter cure. However, there is no catch-all tinnitus cure. Sometimes, if there is an obvious cause for your tinnitus your GP can advise you on treatment, but often they may simply advise you on how to manage the symptoms to get back your quality of life.

Possible tinnitus treatment includes:

• Correcting hearing loss
• Tinnitus retraining therapy
• Counselling
• Cognitive behavioural therapy (CBT)

Tinnitus is often worse if you have hearing loss as your ears need to strain to listen. Even if you have only a small degree of hearing loss, correcting this could improve your tinnitus. This is because correcting any amount of hearing loss means that the parts of your brain which are responsible for hearing do not have to work as hard, and therefore pay less attention to tinnitus. Correcting hearing loss can also help to override the sounds of tinnitus as previously unheard sounds become audible.

Your GP may refer you to a specialist who will be able to test your hearing ability and recommend treatment appropriate to you. This might be having a hearing aid fitted or in some cases undergoing a surgical procedure.

This uses sound therapy to help tune out tinnitus noise, making you less aware of it by retraining your brain. Tinnitus retraining therapy is widely available privately but is only available on the NHS for people who suffer from persistent or severe tinnitus.

Tinnitus counselling often helps people learn about their tinnitus and how to cope with the condition and the associated stress and strain it can put on you. Working with a healthcare professional such as a hearing therapist or audiologist, you can better understand your tinnitus, find out how to cope with it and improve your quality of life.

Cognitive behavioural therapy (CBT) is a therapy that looks at how our thoughts and feelings affect the way we are able to cope with life. A CBT therapist can help you change the way you cope with tinnitus and continue to enjoy your life despite it. A meta-analysis of studies into CBT and tinnitus concluded that CBT is an effective way of treating tinnitus.

Tinnitus home remedies include:

• using a tinnitus app
• listening to white noise
• listening to calming music
• meditation or yoga
• exercise
• earwax removal

Tinnitus symptoms can be eased with sound therapy. This distracts the brain from the tinnitus and helps you focus on other noise instead. Some people use a tinnitus app to help cope with their tinnitus. Apps such as Relax Melodies, Tinnitus Balance App and StopTinnitus are available for both iOS and Android and offer sounds such as white noise, whale sounds, wind chimes and rainfall to help you to relax and cope with tinnitus.

In addition to apps, special tinnitus masker devices can be used to help relieve tinnitus. These devices are based on white noise machines and work by adding noise to mask the sound of tinnitus. It’s worth noting that there is not currently any strong evidence to suggest that white noise for tinnitus improves the condition, it simply helps you cope with it.

It’s not always clear what causes tinnitus as it could be a number of different factors. Tinnitus is often linked with:

• Exposure to loud noise
• Age-related hearing loss (presbycusis)
• Ear bone stiffening (otosclerosis)
• Earwax build-up or blockage
• Ear infection

Other tinnitus causes may include:

• Ménière’s disease
• Mental health conditions such as depression and anxiety
• Conditions such as high blood pressure, diabetes, thyroid disorders or multiple sclerosis
• Certain medications. Tinnitus can be a side effect of medications including antibiotics, chemotherapy medicines, and aspirin.
• Head injuries

It’s not always possible to prevent tinnitus. However, there are some things that you can do to reduce your chances of getting the condition:

• Use ear defenders or ear plugs in settings where the noise levels are too loud.
• Don’t stand close to speakers. If you are going to a music festival or club, try not to stand too close to the speakers as the sound will be louder.
• Use headphones safely. If you listen to music using headphones, keep the noise level to a safe volume.
• Reduce stress and anxiety. This can sometimes cause tinnitus or make existing tinnitus worse.

The intensity of sound is measured in decibels dB. When sound levels rise above 85 dB, it is considered unsafe without the use of hearing protection. If you work in a noisy environment above 85 dB, you should be provided with hearing protection. These rules do not apply to social noise so you need to make sure that you protect your ears to prevent tinnitus and other problems.

The following shows some examples of different sounds above 85 dB and their maximum exposure time. These sounds cannot always be prevented but you should be aware of how they can damage your ears.

See the Plug’em campaign from the British Tinnitus Association for tips on how loud is too loud.

Researchers have shown in a 2015 study that many people experience tinnitus after significant stress or anxiety. Find out how you can reduce stress and anxiety to improve tinnitus.

Most people with tinnitus do not experience any adverse effects when flying. There are some things you can do to help your tinnitus during a flight:

• Avoid using ear plugs. These can make your tinnitus worse as they block out background noise, making your tinnitus more pronounced. They also make it harder for your ears to cope with the change in pressure at altitude and descent.
• Swallow and yawn. This helps to open the Eustachian tube, allowing air to enter your middle ear.
• Stay awake during take-off and descent. Your Eustachian tube doesn’t adjust as well when you are asleep so staying awake can help make your flight more comfortable.
• Take advantage of in-flight entertainment. Watching movies and listening to music can help to take your focus away from tinnitus.

For more tips for a comfortable flight, the British Tinnitus Association have a useful resource on their website.

Wearing ear protection in loud environments is essential because once your ears become permanently damaged, hearing cannot be fixed. Tinnitus from loud sounds is preventable and wearing ear protection is one of the best ways of reducing noise levels.

Pros

• Cheap
• Fits everyone
• Available to buy at most pharmacies
• If fitted properly, they can achieve attenuation up to 30dB(A)

Cons

• Not suitable for listening to music with or listening to people in noisy settings as they block your ears
• Need to be put in correctly to get a proper fit
• Loss of sound clarity in mid and high frequencies

Prices start from around £1 a box and can be bought on the high street.

Often, people with tinnitus worry if it will go away or if it can be cured. Sometimes tinnitus is a temporary condition and it will go away on its own over time. However, this is not always the case as tinnitus can be permanent for some people. Many people with long-term tinnitus find that they adjust to the sound over time and there are many ways of coping with the condition to improve quality of life.

The term tinnitus habituation is used to describe a state of mind when someone with tinnitus no longer has a negative response to their tinnitus. This means that someone with tinnitus has adjusted to the noise and is able to continue their day-to-day activities unaffected by tinnitus, despite it still being present.

After having tinnitus for a long time or particularly loud tinnitus, some people feel that tinnitus habituation is not possible for them and wonder if tinnitus habituation is real. It’s important to remember that people habituate or adapt to various stimuli on a daily basis, such as the noise of traffic and the feel of clothes on our bodies. Over time, many people find tinnitus habituation success naturally but this isn’t always the case.

Many people with tinnitus will habituate naturally. They find that they pay less attention to the sounds of tinnitus and its negative effects wane over time. Others progress towards tinnitus habituation by using therapy and sound to aid the management of their tinnitus.

It is common for children to experience tinnitus. A 2012 study found that as many as 37% of 6 to 12-year-olds with normal hearing experienced tinnitus and 59% of children with hearing problems experienced the condition.

Many parents find it difficult to determine if their child has tinnitus. The best way to tell if your child has tinnitus is to ask them about it. Younger children may be able to explain the noises they hear by describing them using terms they are familiar with such as ‘buzzing’ or ‘choo choo’.

Tinnitus affects children in different ways. Many children just need a simple explanation for the sounds they are hearing but others will be more distressed by their tinnitus. Sometimes, children can feel isolated by tinnitus because they are unable to explain what they are hearing.

It can be a concern for many parents that bringing up the subject of tinnitus with their children will make them more aware of it or make them feel anxious about it. However, clinical experts have found that talking to children about tinnitus helps to reassure them and address any concerns that they might have.

In most cases, children are not distressed by tinnitus and it does not negatively impact their performance at school. However, sometimes tinnitus can be troubling for your child and this is when it should be discussed with them. You should ask your child about tinnitus if they experience any of the following:

• Difficulties sleeping. Tinnitus can sometimes be the cause of children not being able to sleep.
• Difficulties in concentration. If your child is struggling to concentrate at home or in class, it might be tinnitus.
• Avoiding noise. If your child is distressed in noisy environments, it might be due to their tinnitus.
• Avoiding quietness. Likewise, if your child avoids quiet environments or seems distressed when quiet, it could be down to tinnitus.
• Feelings of frustration, anger, fear or helplessness.
• Feeling ‘full’ in their ears.

Many physical changes occur to the body after becoming pregnant. These changes can interfere with the way the inner ear works by converting sound vibrations into electrical impulses which are sent to the brain. It is the disruption to this sensitive process which leads to a perception of tinnitus.

Tinnitus is often associated with high blood pressure and might be an early indication of a more serious problem such as gestational hypertension or pre-eclampsia. These are serious complications of pregnancy so a first-time or worsening of pre-existing tinnitus should be reported to your GP or midwife.

Dr Abby Hyams grew up in Manchester and did her medical training in Bristol. She has been a GP for over ten years, many of them as a partner in an NHS practice in Hemel Hempstead. Dr Hyams loves being a GP because the wide spectrum of people she encounters every day.

Professor Antony Narula is an otorhinolaryngologist (ENT surgeon). He practices general ENT and specialises in children with ear, nose and throat disorders and hearing problems. Antony was head of department at St Mary’s Hospital Paddington, Charing Cross Hospital, Hammersmith Hospital, and Leicester Royal Infirmary until he took early retirement in 2014 to concentrate on his medical charity work and private practice.

Notably, Antony was Past President of ENT UK and a Past President of British Society for Otology, The Association of Otolaryngologists and Young Consultant Otolaryngologists. He was also an Honorary Consultant at Chelsea & Westminster and Royal Brompton Hospitals. Recently Antony co-founded The Global Tracheostomy Collaborative, an organisation committed to improving care for all children and adults with tracheostomies.

Dr Sufian Ali is a Medicspot GP based in the West of Scotland, having attended Aberdeen Medical School and completed his GP training in Glasgow. He has enjoyed working in a number of specialties including paediatrics, psychiatry and emergency medicine; while also working in a variety of settings.

This article is for general information only and should not be used for the diagnosis or treatment of medical conditions. Medic Spot Limited has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. In the event of an emergency, please call 999 for immediate assistance.