What is tinnitus

Tinnitus is ringing or other noise in the ear(s) or head. It is a symptom of an underlying condition, which in most cases is not serious.

Tinnitus is common, with at least two-thirds of Australians experiencing it at some point in their lives. It’s most common among people aged between 40 to 70 years.

In some people, tinnitus can become a chronic (ongoing) and bothersome problem, but there are treatments available that can help relieve or improve tinnitus.

Symptoms

People who have tinnitus report a variety of noises in the ears, including:

  • ringing;
  • buzzing;
  • roaring;
  • clicking;
  • pulsing;
  • whistling; or
  • hissing.

Tinnitus may be present all of the time, or may come and go, and may affect one or both ears.

Other problems that may be associated with tinnitus (depending on the cause) include:

  • hearing loss;
  • hyperacusis (extreme sensitivity to sounds and loud noises);
  • ear pain; and
  • vertigo.

Complications

Tinnitus can be a distressing symptom, and it can cause stress and increase your risk of mental health problems such as anxiety and depression.

People with ongoing tinnitus may have trouble concentrating or falling asleep due to the noise. Lack of sleep can lead to problems concentrating during the day and can also contribute to anxiety and depression.

Causes

There are several known causes of tinnitus, including the following.

  • Hearing loss, especially age-related hearing loss and noise-induced hearing loss.
  • Exposure to excessively loud noise over time.
  • Medicines (e.g. certain antibiotics, some cancer medicines, aspirin and some diuretics).
  • Earwax build-up — excessive amounts of earwax can block your ear canal, causing hearing loss and irritation to the ear drum, which can cause tinnitus.
  • Ear inflammation (otitis media or otitis externa) or eardrum perforation.
  • Otosclerosis, a condition that usually runs in families and affects the tiny bones in the middle ear.
  • Meniere’s disease — a condition that affects the middle ear and causes tinnitus, hearing loss, vertigo and a sensation of fullness in the ear.
  • Head injury (usually linked to tinnitus in only one ear).
  • Acoustic neuroma — a type of non-cancerous tumour of the nerve that controls hearing and balance. Acoustic neuroma usually causes one-sided tinnitus.
  • High blood pressure and abnormalities in the blood vessels in the head or neck can cause a pulsatile form of tinnitus (a rhythmical noise that is in time with your heart beat).

Other conditions that are associated with the development of tinnitus include multiple sclerosis, diabetes, high cholesterol, thyroid disorders and anaemia.

Diagnosis

If you have tinnitus, see your GP (general practitioner).

To help work out the cause of your tinnitus, your doctor will ask about the sound(s) you can hear, whether your tinnitus affects one or both ears, and whether you have any other symptoms. Your doctor will want to know how long you’ve had symptoms, whether they come and go, and how much they bother you. Your doctor will also perform a physical examination of your ears, head and neck.

Tests can help work out the cause of your tinnitus. Hearing tests (audiology assessments) are recommended for all people with tinnitus. Imaging tests, such as an MRI or CT scan, and blood tests may be recommended for some people.

Depending on the cause of your tinnitus, your doctor may refer you to a specialist (such as an Ear, nose and throat specialist or audiologist) for further tests and treatment.

Treatments

Treatment for tinnitus will depend on the cause.

If you have a treatable underlying cause, your symptoms should get better with treatment. For example, removing a build-up of earwax or stopping a medicine that could be the cause of your tinnitus.

When tinnitus is persistent and bothersome, treatment aims to mask or reduce the tinnitus, as well as manage any associated problems such as difficulty sleeping, anxiety or depression.

Treatments for ongoing, troublesome tinnitus

Several treatments are available to help reduce the impact of tinnitus – a combination of several different treatments may work best.

A hearing aid may improve symptoms, especially if there are associated hearing problems. Amplifying sounds should help make tinnitus less obvious.

Sound therapy involves creating external sounds to distract people from their tinnitus. Masking the sound of tinnitus with a device that creates either continuous, low-level white noise or a pleasant background sound can help, especially if tinnitus is worse in silent environments. This can be particularly helpful if tinnitus is making sleep difficult. Hearing aids with an inbuilt sound generator, tinnitus maskers that fit behind the ear, music players or other devices can be used.

Tinnitus retraining or desensitisation can help reduce your awareness of tinnitus and help you to notice it less. This treatment involves listening to a customised music programme (in the background) through a wearable device, in combination with counselling.

Treatment of associated problems

Counselling can help you develop coping techniques to deal with tinnitus. This is especially useful if it is causing significant stress and stopping you from doing things. Cognitive behavioural therapy (CBT) is a type of therapy that involves identifying and challenging negative thinking patterns, and developing alternative, more positive, ways of thinking and acting. It can help in how you respond to your tinnitus.

Antidepressant medicines may be helpful in people with tinnitus who also have depression.

Complementary treatments for tinnitus

Some complementary therapies have been tried for tinnitus (including acupuncture, hypnosis, Ginkgo biloba, vitamin B, melatonin and zinc) but there is a lack of evidence for their effectiveness.

Self-help

The following self-help measures can help reduce tinnitus.

  • Avoid anything that aggravates tinnitus. Try to reduce your exposure to loud noises if they tend to make your symptoms worse – wearing earplugs can help. Also, avoid medicines that are known to aggravate tinnitus, such as non-steroidal anti-inflammatory drugs (NSAIDs) and certain antidepressants.
  • Cut down on caffeine, alcohol and nicotine/tobacco, which may help improve symptoms. You may also want to try adjusting your diet – reducing or avoiding salt, simple sugars, monosodium glutamate, and artificial sweeteners can help some people.
  • Keep busy – this helps some people distract themselves from their tinnitus.
  • Finding out as much as you can about your condition can help you to better understand your symptoms.
  • Relaxation therapy or exercise can help if you are feeling stressed or frustrated. Taking steps to improve sleep can also improve mood and help you feel more in control.

Support for people living with tinnitus

Tinnitus can be a distressing problem that is often difficult to treat. Support groups can provide understanding, information and reassurance. Ask your doctor or search online for a support group that suits your needs. You may be surprised by how much talking to others with tinnitus can help.

Last Reviewed: 16/05/2019

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References

1. Esmaili AA, Renton J. A review of tinnitus. Australian Journal of General Practice (AJGP) 2018;47(4). https://www1.racgp.org.au/ajgp/2018/april/tinnitus (accessed May 2019). 2. BMJ Best Practice. Tinnitus (updated Oct 2018; reviewed Apr 2019). https://bestpractice.bmj.com (accessed May 2019). 3. Tinnitus (published November 2017). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2019 Apr. https://tgldcdp.tg.org.au/ (accessed May 2019).