Tinnitus

What is tinnitus

Tinnitus is ringing or other noise in the ear(s) or head. It is usually a chronic (ongoing) problem, lasting for many years. Although tinnitus can be a symptom of an underlying condition, often no cause can be found.

Tinnitus affects up to one in 5 people, and about 1 in 200 people report tinnitus having a severe effect on their ability to lead a normal life.

Tinnitus symptoms

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

  • ringing;
  • buzzing;
  • roaring;
  • 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 associated with tinnitus include:

  • hearing loss;
  • difficulty concentrating;
  • sleeping problems;
  • fatigue;
  • stress;
  • 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. quinine, certain antibiotics, some cancer medicines, and aspirin taken in very high doses).
  • 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.
  • 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).

Diagnosis

The sound of your tinnitus, whether it affects one or both ears and the presence of other symptoms can help determine the cause of your tinnitus. Your doctor will also perform a physical examination of your ears, head and neck.

Your doctor may recommend tests to determine the cause of your tinnitus and exclude any of the more serious causes. Tests may include a hearing test and imaging tests such as an MRI or CT scan.

In many cases, no cause is found.

Treatments for tinnitus

Treatment of any identified underlying causes can help resolve or improve tinnitus.

If a medicine is the possible cause of your tinnitus, your doctor may recommend stopping that medicine or reducing its dose. Also, some medicines — such as non-steroidal anti-inflammatory drugs (NSAIDs) and certain antidepressants — can aggravate tinnitus regardless of its cause, and may need to be avoided.

Removing impacted earwax, if present, can help reduce tinnitus.

Other treatments are aimed at masking or reducing the tinnitus, and managing any associated problems such as anxiety or depression.

Masking techniques

Masking the sound of tinnitus with a device that creates continuous, low-level white noise can help.

A hearing aid may improve symptoms, especially if there are associated hearing problems.

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

Treatment of associated problems

Cognitive behavioural therapy (CBT) — therapy that involves identifying and challenging negative thinking patterns, and developing alternative ways of thinking and acting — has been used in the treatment of tinnitus. Evidence has shown that cognitive behavioural therapy may not reduce the loudness of tinnitus, but it can improve quality of life.

Counselling can help you develop coping techniques to deal with tinnitus.

Antidepressant medicines have been tried for the treatment of tinnitus. There is limited evidence as to their effectiveness in treating tinnitus, but they have been shown to reduce depression in people with tinnitus.

Self-help

Managing stress with relaxation therapy or exercise may help.

Avoiding anything that aggravates your tinnitus is obviously a good idea. Try to reduce your exposure to loud noises if they tend to make your symptoms worse. Cutting down on caffeine, alcohol and nicotine may improve symptoms.

Some complementary therapies have been tried for tinnitus, including acupuncture, hypnosis and ginkgo biloba, but there is a lack of evidence for their effectiveness.

Support

Tinnitus can be a distressing problem that is often difficult to treat. Support groups can provide information, reassurance and support to people with tinnitus.

Last Reviewed: 21 April 2013
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References

1. Tinnitus (revised June 2011). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2013 Mar. http://online.tg.org.au/complete/ (accessed Apr 2013).
2. MayoClinic.com. Tinnitus (updated 5 Feb 2013). http://www.mayoclinic.com/health/tinnitus/DS00365 (accessed Apr 2013).
3. Savage J, Waddell A. Tinnitus. Clinical Evidence [online] 2012 [cited Feb 3]. URL: http://clinicalevidence.bmj.com/ (accessed Apr 2013).
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