Tinnitus: Treatments for Ringing in the Ears
Tinnitus can be distressing, potentially leading to anxiety and depression. For some people with tinnitus, simply learning about the condition can reduce symptoms. Sound therapy and hearing aids can also be effective treatments.
This article will describe tinnitus and related symptoms, what is known about the cause of tinnitus, and tinnitus triggers. It will also discuss treatment options and the outlook for someone with tinnitus.
In simple terms, the definition of tinnitus is the perception of noise inside the head in the absence of actual sound you can hear. Tinnitus derives from the Latin verb “to ring.” People with tinnitus perceive sounds that might mimic buzzing, roaring, or clicking.
Tinnitus is a common condition. According to the Centers for Disease Control and Prevention (CDC), a 2014 survey showed that 11% of the United States population, including adults and children, report ringing in the ears. Research estimates that 90% of people with tinnitus also have significant hearing loss, but they may not be aware of it.
Tinnitus can have a gradual onset or occur abruptly. It is a common occurrence that can range in severity from being a nuisance to being a symptom of a medical emergency that should be evaluated immediately.
A rhythmic sound, one that may be described as accompanying the heartbeat, is also cause for concern. The term for this is pulsatile tinnitus. Seek prompt medical care for this type of tinnitus, for tinnitus that does not go away, or tinnitus that comes and goes.
There are three types of tinnitus:
- Subjective tinnitus: More than 99% of people with tinnitus have this type. Only the person with tinnitus can perceive the noise.
- Objective: High blood pressure or muscle spasms can cause audible noises that can be heard through a stethoscope or other sensitive devices.
- Pulsatile tinnitus: This is a rhythmic rushing or roaring sound that may result from blood vessels near the ears. The rhythm is usually the same as your heartbeat.
The sound volume can be very low or high, and it may occur in one or both ears. You may barely be aware of your tinnitus, or it may distract you from your daily routines.
How do you know if you have tinnitus?
Symptoms of tinnitus include sensing sounds that mimic:
Contact a healthcare professional if you hear sounds that others around you do not. A simple hearing test and physical exam can help identify a potential problem.
Symptoms you may experience along with tinnitus
Conditions that cause tinnitus may also cause other symptoms, including:
- discharge or drainage from the ear
- ear pain or fullness
- malaise or lethargy
- discoloration of the ear with warmth or swelling
Symptoms that might indicate a life threatening condition
In some cases, tinnitus can be a sign of a serious condition, especially if it occurs following a head injury. Seek immediate medical care (call 911) for any of these symptoms:
- confusion or loss of consciousness for even a brief moment
- dizziness or vertigo
- memory loss
- nausea, with or without vomiting
- severe bleeding
The lining of the ear canal contains tiny hairs that sense movement and vibration. Typically, the auditory nerve conveys this information as electrical impulses to the brain, which the brain interprets as sound. This part of the brain is the auditory cortex.
Tinnitus can occur when one or more parts of this process are not functioning as they should. The problem can be with the ear, the auditory nerve, or the brain, which may misinterpret nerve signals as sound. Researchers continue to study the exact cause of tinnitus and where it starts.
Tinnitus can be a symptom of many different underlying conditions, summarized by the American Academy of Family Physicians, a 2021 update on tinnitus in the Journal of Clinical Neurology, and other research.
Conditions that can lead to tinnitus
Tinnitus can be a symptom of the following conditions:
- exposure to loud noises, the most common trigger
- age-related hearing loss
- ear wax buildup
- ear infection
- eardrum damage
- sinus infection
- blood vessel disorders
- autoimmune conditions
- Meniere’s disease
- otosclerosis, the hardening of the bones in the ear
- damage to the eighth cranial nerve, such as from acoustic neuroma, a noncancerous tumor
- tensor tympani myoclonus, a rare form of pulsatile tinnitus
Short-term vs. long lasting tinnitus can be due to different conditions. For example, an ear infection may cause transient tinnitus, but age-related hearing loss could cause long lasting or even permanent tinnitus.
The table below, listing possible causes of tinnitus in one ear vs. both ears, is adapted from Han, B.I., et al. (2021):
|Tinnitus in one ear||Tinnitus in both ears|
|chronic noise exposure||chronic noise exposure|
|ear or sinus infection||medication side effect|
|head injury, stroke, tumor||head injury|
|high blood pressure||high blood pressure|
|blood vessel conditions||blood vessel conditions|
|Eustachian tube contraction||Eustachian tube contraction|
Medications that can cause tinnitus
Certain drugs may lead to tinnitus as a side effect, including:
- antimalarial drugs
- aspirin (high doses)
- cancer medications
Serious or life threatening causes of tinnitus
In rare cases, tinnitus may be due to serious or potentially life threatening conditions, including:
- brain tumor
- head injury
- intracranial vascular abnormality
A number of factors increase the risk of developing tinnitus. Not all people with risk factors will get tinnitus. Risk factors for tinnitus include:
- being age 65 years or older
- being exposed to loud noise
- hearing loss attributed to age
- having a history of high blood pressure, heart disease, or high cholesterol levels
- experiencing stress
- using medications such as antibiotics, high-dose aspirin, cancer medications, or antimalarial drugs
Reducing your risk of tinnitus
Some risk factors for tinnitus are out of your control, such as age. However, you can take certain steps to reduce your risk of tinnitus, including:
- changing medications (in consultation with your doctor) that are linked with tinnitus
- reducing your exposure to loud noise
- seeing your healthcare professional for diagnosis and treatment of any underlying disorders
Your doctor can diagnose tinnitus based on the symptoms you describe, but they may also run tests to try to diagnose an underlying cause, which may be treatable.
A healthcare professional will ask you for a medical history and examine your ears, head, and neck. Tests to help determine the cause of tinnitus include:
- Hearing test: This is also known as an audiological test. An audiologist will send specific sounds to you through headphones while you are in a soundproof booth. They will tell you how to indicate when you hear a sound.
- Changes in position: Your doctor may ask you to move your eyes, arms, legs, or neck, or clench your jaw. If these movements affect your tinnitus, it may point to an underlying condition.
- Imaging tests: Your doctor may order a CT scan or an MRI.
- Blood tests: Lab tests can detect anemia, heart disease, or nutritional deficiencies that may contribute to tinnitus.
Your doctor will also ask you to describe the sounds you hear. Different types of sounds may indicate certain conditions:
- High-pitched ringing: This is the most common form of tinnitus. It can occur due to hearing loss or sustained exposure to loud noises. Many medications can also cause tinnitus, including nonsteroidal anti-inflammatory drugs (aspirin, ibuprofen, naproxen), antidepressants, and high blood pressure medications.
- Clicking: This sound can indicate muscle contractions near your ear that can result in tinnitus.
- Pulsing or roaring sounds: These sounds are typical of pulsatile tinnitus. They are usually due to blood pressure changes or high blood pressure, which may increase when you stand up or exercise.
- Low-pitched ringing: This can be due to a blockage in the ear canal, Meniere’s disease, or otosclerosis, when the bones of the inner ear become rigid.
According to the 2021 update on tinnitus, anyone with tinnitus may benefit from learning more about the condition and the outlook. Education may be the only treatment necessary for people with mild tinnitus. It can reduce stress, a known trigger of tinnitus episodes. Cognitive behavioral therapy or “talk therapy” may also help people with tinnitus.
Tinnitus retraining therapy and neuromonics are two other techniques that may help tinnitus. For tinnitus retraining, the patient learns how to adapt to tinnitus. With neuromonics, the patient learns how to ignore the sound. Audiologists can pursue certification in these techniques.
Other methods of managing tinnitus and its potential mental health effects include sound devices and medications.
Devices for tinnitus
These devices mask tinnitus or allow you to hear better despite your tinnitus. Devices include:
- hearing aids
- white noise generators
- tinnitus masker, a device similar to a hearing aid that directs a controlled noise into your ear to cover the tinnitus
Medications for tinnitus
Healthcare professionals have investigated many medications for treating tinnitus, but there is no single medication that can make tinnitus go away. These medicines may be effective for tinnitus or the problems it can cause:
- antianxiety drugs
- acamprosate (Campral)
There are no medications that target tinnitus specifically. If your doctor prescribes medication, ask about its purpose, side effects, and what to expect long term.
Deep brain stimulation (DBS) is a potential future therapy for tinnitus. Favorable results of a phase 1 trial of DBS for tinnitus were published in the Journal of Neurosurgery in 2019. People with tinnitus cannot receive this treatment unless they are part of a DBS clinical trial.
Complementary and alternative treatments
Certain complementary treatments may help some people to cope with the mental health effects of tinnitus. It is a good idea to notify your doctor if you are consuming nutritional supplements or nonprescription, homeopathic remedies as they may interact with the prescribed medical therapy.
Complementary treatments may include:
Your doctor will manage any treatable underlying causes of tinnitus, which may make your symptoms go away. This may include assessing your medications to determine whether any are causing the symptoms.
Complications of tinnitus include:
- difficulty performing daily tasks
- difficulty sleeping
- mood changes, such as anxiety, depression, and stress
- progressive hearing loss
Tinnitus can be due to many different treatable conditions, including ear infections, hearing loss, and hypertension, as well as medication side effects. Tinnitus itself is not curable, but the underlying cause may be. Even when there is no identifiable trigger, a person with tinnitus has several treatment options.
The outlook with tinnitus treatment is variable. Possibly the most important thing to do is contact a healthcare professional, get a hearing test, and learn more about the condition.
Tinnitus is the perception of ringing in the ears and other high-pitched sounds that only the person with tinnitus can detect. There is no audible sound to others (with the exception of objective tinnitus, which another person can hear with a stethoscope or other devices).
Tinnitus is a symptom of an underlying condition, most often hearing loss due to exposure to loud noises. Tinnitus itself is not dangerous, but it can occur due to serious conditions, including a brain tumor.
Treatment options for tinnitus include hearing aids, patient education, sound therapy, and various strategies to reduce anxiety about the condition.