What Is Tinnitus? Symptoms, Causes, Diagnosis, Treatment, and Prevention
Tinnitus is commonly known as “ringing in the ears.” But that’s a bit of a misnomer. It’s really any noise you hear in your ear that isn’t coming from an external source. The “ringing” could also be a hissing, a roaring, or a clicking sound. (1) “Or, it can be a high-pitched tone, buzzing, a whooshing, a pulsing,” says Kit Frank, an audiologist in Las Vegas and owner of The Hearing Hub. “It could be crickets, ocean noises, or white noise.”
Just as the noise itself varies, so does the way a person experiences it. Some people have it in one ear, and others hear it in both. Some people hear the noise as if it’s far away, while for others it’s close up. (2) And some people are extremely bothered by it, while others easily tolerate it.
You’ve likely experienced tinnitus before. Nearly everyone has, even if it was just for a short time, such as that “ringing” or hum you hear after attending a loud workout class or concert. Tinnitus that lasts longer than six months is called chronic tinnitus.
Tinnitus is common and affects about one in every six people. (3) It’s more common for people 55 and older, but young people can experience it, too.
There are two types of tinnitus:
It’s important to note that tinnitus, by definition, isn’t a disease or a condition. Instead, it’s a symptom of something else that’s happening in the body (such as inner ear damage or hearing loss). In rarer cases, tinnitus can be a side effect of a medication.
Researchers don’t yet know what’s going on in the brain when someone experiences tinnitus. “Part of the reason why tinnitus is so difficult to treat is that we don’t 100 percent know [why it happens],” says Lori Zitelli, an audiologist with the University of Pittsburgh’s Pittsburgh Hearing Research Center.
Learn More About What Tinnitus Is and Its Symptoms
Tinnitus can happen for a lot of reasons. It can stem from something as simple and treatable as an earwax blockage. Stress, anxiety, and some types of infections are associated with the emergence of tinnitus. These conditions also tend to make the experience of tinnitus more noticeable and distressing. Certain tumors can also cause tinnitus. (2)
In most cases, tinnitus is the result of hearing loss. But Dr. Zitelli says that tinnitus on its own doesn’t necessarily mean you’ve experienced hearing loss or are going to.
Though doctors don’t know for sure what’s happening in the brain when someone experiences tinnitus, evidence suggests it could be caused by abnormalities in hearing-related neural circuits of the brain.
Tinnitus could also occur as a result of damage to the ear’s hair cells. (3) These tiny cells within the ear move in response to sound, and the brain is able to interpret these movements as noise. (4) When these hair cells become damaged — which can happen as a result of aging, disease, or a head injury — hearing loss can occur, and the hair cells may end up sending false signals to the brain, leading to tinnitus.
Other common causes of tinnitus include: (1,3)
Zitelli notes that some of the medications linked to tinnitus can damage the structure of your inner ear. You may want to ask your prescribing doctor if the medication you’re on is linked to hearing loss or tinnitus, especially if you’ve noticed a change in your hearing.
Certain foods and drinks may also be to blame. Dr. Frank says to watch out for stimulants, such as caffeine or alcohol, because they can sometimes make tinnitus worse.
There seems to be a link between headphones (or earbuds) and a person’s risk of tinnitus. Studies have found that people who wear headphones all the time are at increased risk for tinnitus. (5)
It’s not that wearing headphones always leads to tinnitus, Zitelli says. Rather, wearing headphones and listening at high volumes can damage hearing in ways that result in tinnitus.
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There’s been an alarming trend in recent years of young people experiencing hearing loss prematurely. Rates of teenagers experiencing hearing loss today are 30 percent higher than they were two decades ago. (6) Headphones aren’t the only thing to blame for the uptick, but the prevalence of people wearing headphones on a daily basis is likely a factor.
Other activities, such as the use of firearms or attendance at loud sporting events or concerts, can lead to hearing loss. (7)
In general, over-the-ear headphones (ideally ones with noise-cancellation technology) are a safer option than earbuds that go directly into your ear, Frank says. That’s because regular headphones have to compete with a lot of background sound, which may cause you to crank up the volume to unsafe levels.
The bottom line is that exposing your ears to loud sounds is a major risk factor for tinnitus — and if wearing headphones frequently is causing you to do that often, they may be doing damage.
Your doctor will likely begin by asking several questions about what you’re experiencing. What do you hear? When did it start? How often do you notice it? Is it associated with balance problems or hearing loss?
Your doctor will probably ask you to clench your jaw and move your head or neck in certain ways. This can help your doctor pinpoint the underlying cause of your tinnitus. (8) In some cases, you may need an MRI or a CT imaging scan so that your doctor can see what’s going on inside your head and around your ear. Your doctor may also refer you to an audiologist for a hearing exam.
In some cases, the cause of tinnitus is clear and also treatable. But even if there’s no clear-cut origin of the problem, there are usually several possible options that can help minimize the noise and keep it from interfering with your daily life. “Tinnitus is not a problem that has one solution,” Zitelli says.
Tinnitus can last anywhere from a few seconds to a lifetime. It can come on gradually, or it can show up suddenly.
Doctors usually define “acute” or short-term tinnitus as a sound that persists for several weeks but then goes away. This type of tinnitus often occurs if you’ve been to a loud concert or exposed your ears to some other very loud sound, like a gunshot.
Chronic tinnitus is anything that lasts longer than a few weeks. If the tinnitus persists for two years or more, doctors consider it a permanent condition. The good news: More than 75 percent of people who develop tinnitus tend to become “habituated” to the condition. That means their brain gets used to it, and it ceases to bother them.
For a small subset of patients, tinnitus can grow worse or more distressing over time. But for most people, tinnitus becomes more bearable as time passes. (9)
Your doctor will likely start by trying to identify and treat any underlying condition, whether it’s a wax blockage in the ear, a response to medication, or the result of hearing loss. “The first thing we do is if the patient has hearing loss, we treat the hearing loss,” Frank says. “It’s kind of a 50/50 chance when we do hearing aids that the person will get relief from the tinnitus as well.”
Hearing aids can help with tinnitus because they can make external noises louder and internal ones less noticeable. “With hearing aids, it makes you more aware of the sounds around you so it’s not so quiet in your head — and you don’t hear the tinnitus as much as a result,” Frank says. This approach doesn’t directly treat the tinnitus, but it can make it less bothersome.
Frank says she sometimes recommends masking devices, which (as the name implies) put a sound into the ear that gives you something else to listen to. In other cases, a well-rounded approach to treating tinnitus offers the best outcome. That might include hearing aids plus cognitive therapy or visits with a psychologist, who can help you learn to cope with the tinnitus or address any depression or anxiety it may cause or worsen.
“The available evidence suggests that the best way of helping people to cope with their tinnitus is using a combination of education and counseling and sound therapy,” Zitelli says. Giving the patients tools to help them cope should improve their quality of life, she adds.
Other potential therapies that can help you manage tinnitus include: (1,3)
More and more, people are turning to nondrug treatment approaches to help them manage their health conditions, and tinnitus is no exception.
Relaxation therapy — by allowing people to better manage the stress and anxiety associated with tinnitus — can help many people with the condition. While relaxation-based therapies do not likely cure the tinnitus, they can help people ignore it and feel less distressed by its presence. Research has also found that mindfulness practices, especially when coupled with CBT, can also help reduce the distress and distraction associated with tinnitus. (10)
Hypnosis and acupuncture are two complementary therapies that come up frequently in the tinnitus literature. The research is mixed, and overall study quality is low, yet a recent review showed some effects of acupuncture on tinnitus, and a randomized control trial looking at the effects of acupuncture on subjects with chronic tinnitus showed a significant reduction in symptoms compared to controls in the short term. (11,12)
Most experts believe that hearing loss or damage is the most common cause of tinnitus. For that reason, taking steps to protect your hearing may be the surest way to prevent the condition.
To do that, start by keeping your headphones or speaker volume at a safe level. (Most health authorities peg this at 85 decibels.) If you’re listening on your phone, most are equipped with “volume limiters” that allow you to set the maximum headphone volume at a safe level. If you’re going to expose your ears to very loud sounds — especially concerts or firearm blasts — wear protective earphones or plugs. (13)
Ear infections are also a cause of tinnitus. To avoid one, make sure you clean or regularly change your earplugs, hearing aids, or anything else you put in your ears.
Finally, stress and anxiety can make the experience of tinnitus worse. It’s not clear why this is the case. But doctors know that stress and anxiety can heighten a person’s awareness of tinnitus, making it more distressing. (14) Consider this point just one more good reason to make your mental health a priority. Regular exercise, a good diet, and proper sleep are among the basic ingredients for a sound mind (and body).
How distressing tinnitus is depends on the person and how he or she experiences it. For many, the experience of tinnitus isn’t a big deal. Or if it is, it tends to get better over time.
“Most people with tinnitus — an estimated 70 percent — are not bothered by it,” Zitelli says. “It may be something that they notice from time to time, but isn’t bothersome or doesn’t impact them on a day-to-day basis.”
The other 30 percent, however, truly suffer from tinnitus.
Some complications for people with tinnitus include:
Frank says that, for some people, it can take over their lives and even lead to suicidal thoughts.
“People suffering from tinnitus often report that it significantly impacts their concentration, sleep, ability to be productive, relationships, hearing, emotional state, cognition, sense of control, and overall quality of life,” Zitelli says.
But it’s also worth noting that, for many, these struggles are temporary or likely to decrease in severity.
Learn More About Tinnitus Complications and How Living With It Can Affect Your Life
While estimates vary, the American Tinnitus Association estimates that approximately 10 percent of the U.S. adult population — over 25 million Americans — experience some form of tinnitus. Roughly 5 million people struggle with burdensome chronic tinnitus, while 2 million find it debilitating. (16)
Tinnitus is slightly more common among men than among women, and a person’s risk of tinnitus is greatest between ages 60 and 69. (17)
While there’s no cure for tinnitus, researchers are actively exploring ways to lessen the ringing and get rid of it entirely. Zitelli says the research being done centers on nailing down what’s going on in the ear and the brain to generate the tinnitus.
“Some of the newer technologies are getting closer to it,” Frank says. One of these is a treatment technology called Desyncra, which focuses on retraining the way the brain interprets the information it receives from the ear. At home, a person wears special headphones and listens to therapeutic tones for a certain amount of time each day.
“The theory is that by listening to this therapy, you’re retraining the nerves to make a different pattern with their impulses so you’re not hearing the tinnitus anymore,” Frank says. Usually, it’s a 36-week treatment period that involves wearing the retraining device for 4 to 6 hours per day, Frank says.
Another approach called targeted bimodal auditory-somatosensory stimulation has been explored. This uses a device that couples earphone sounds with small electrical impulses, delivered to a person’s neck or cheek. Some evidence has shown it can reduce or stop the signals in the brain that cause tinnitus symptoms. (19,20)
Some newer experimental approaches that may have promise are magnetic or electrical stimulation of the brain — examples of which include transcranial magnetic stimulation (TMS) and deep brain stimulation — and vagus nerve stimulation using an implanted device.
Tinnitus can interfere with a person’s sleep and mental health, and so the list of tinnitus-associated conditions is quite long. There are also some closely related conditions that stem from damage to or diseases of the ear.
These related conditions include: (16,21)
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