According to the American Tinnitus Association, tinnitus is not a disease as much as the brain’s sensorineural response to auditory system damage caused by some other underlying condition. “It is a symptom that something is wrong in the auditory system, which includes the ear, the auditory nerve that connects the inner ear to the brain, and the parts of the brain that process sound,” according to the National Institute on Deafness and Other Communication Disorders (NIDCD).

What Are the Common Types of Tinnitus?

According to audiologists, there are four different types of tinnitus.

Subjective

This is the most common form of tinnitus. The symptoms can only be heard by the patient (hence, “subjective”) and are often the result of exposure to loud or excessive noise. Subjective tinnitus can come and go suddenly and may last months or years. In some severe cases, it continues indefinitely.

Most people who suffer hearing loss also experience tinnitus, as the brain’s auditory system compensates for the loss of external auditory stimuli.

Neurological

This form of tinnitus is usually caused by a neurological disease, such as Ménière’s disease, that impacts the brain’s auditory system.

Somatic

Somatic tinnitus relates to head, neck, or dental issues. For example, temporomandibular joint (TMJ) disorder can result in this form of tinnitus.

Objective

This rare form of tinnitus (less than 1 percent) can result from vascular deformities or involuntary contractions. The tinnitus usually stops if the cause can be treated. This is the only form of tinnitus objectively detectable by a physician. One example is a subtype called pulsatile tinnitus, in which the sound in the ear is a pulsating, “whooshing” sound that occurs in time with heartbeats. Often, the causes of this tinnitus are treatable, and the condition can be improved or resolved.

What Are the Symptoms and Early Signs of Tinnitus?

While no early signs indicate impending tinnitus, the symptoms are the characteristics of the condition itself: the sounds you hear when there appears to be no discernible source. The sounds associated with tinnitus are variously described as ringing, buzzing, whooshing, hissing, clicking, chirping, or even roaring.

What Causes Tinnitus?

Tinnitus can have a variety of causes, including:

• Damage to the inner ears’ nerves.
• Arthritis of the bones in the middle ear.
• Aging.
• Abnormal blood pressure (high or low).
• Exposure to loud noises.
• Allergies.
• Vascular tumor(s).
• Diabetes.
• Thyroid dysfunction.
• Injury to the head or neck.
• Reaction to certain medications, including over-the-counter NSAIDs.
• Clogged ears from wax buildup.
• Sinus pressure and barometric trauma, e.g., from scuba diving or concussive explosions.
• Misaligned jawbones.
• Ménière’s disease
• COVID-19
• COVID-19 vaccination, though there haven’t been enough studies to determine a link conclusively.

Auditory Pathways and Tinnitus

The connective pathway between the ear and the brain is complex and vulnerable to damage. Sound waves pass through the ear canal to the middle and inner ear, where hair cells located in the cochlea help convert sound waves into electrical signals that transmit via the auditory nerve to the auditory cortex inside the brain.

According to audiologist Kathleen Wallace, “The leading tinnitus theory is that your brain is expecting to get a certain amount of stimulation from your ears, and if it doesn’t, it creates a phantom sound, which you perceive as tinnitus, to keep itself busy. This is why tinnitus often occurs along with hearing loss or after significant noise exposure, such as a concert.”

Who Is More Likely to Develop Tinnitus?

While tinnitus can affect anyone, it is most likely to occur in aging adults experiencing some degree of hearing loss. It also can occur in people exposed to loud music or loud working environments (such as construction sites) or those with trauma or conditions affecting the head and neck. More rarely, it can develop in response to a tumor in the middle ear or the inner ear disorder Ménière’s disease.

Tinnitus can affect people at any age, including children, and can be caused by several medical conditions. Individuals with mast cell activation syndrome (MCAS) also are more likely to develop tinnitus.

What Are the Tests to Detect Tinnitus?

If you have tinnitus, consult your primary care doctor first. He or she will check for obstructions to the ear canal, such as earwax or fluid from an infection. Your doctor will also discuss your medical history, looking for underlying conditions or a prescribed or over-the-counter drug (ibuprofen, naproxen, aspirin) that may be causing tinnitus.

The ENT may order imaging tests, such as ultrasound, MRI, or CT, especially if your tinnitus pulsates. These tests help determine whether a structural issue or underlying medical condition is at the root of your tinnitus.

What the Sounds May Mean

According to Mayo Clinic, different types of sounds can indicate different causes of your tinnitus.

• Clicking may mean muscle contractions in and near the ear might be causing your tinnitus.
• Pulsing, rushing, or humming sounds usually result from vascular causes, such as high blood pressure. Exercising or changing positions, such as lying down or getting up, may make these more apparent.
• Low-pitched ringing sounds may indicate ear canal blockages, Meniere’s disease, or otosclerosis (stiff inner ear bones).
• High-pitched ringing, the most commonly heard tinnitus sound, is probably caused by loud noise exposure, hearing loss, or medications. Additionally, acoustic neuroma, a noncancerous tumor growing from the middle to the inner ear, can generate a continuous, high-pitched ringing in one ear.

Once the doctor has diagnosed or ruled out underlying health conditions that must be addressed independently, treatment options for tinnitus can be discussed.

What Are the Complications of Tinnitus?

Tinnitus can lead to anxiety, depression, agitation, and insomnia. In the 2007 Integrated Health Interview Series, of adults suffering from tinnitus, about 26 percent reported anxiety, and nearly the same percentage reported depression. The condition can also affect cognitive functioning, including concentration and short-term memory. There is some disputed evidence of a correlation between the condition and suicide, particularly among single older males.

Individuals with tinnitus can also develop hyperacusis, an extreme sensitivity to sounds that would not aggravate the average person. Studies have found that over 15 percent of tinnitus sufferers also reported experiencing hyperacusis.

What Are the Treatments for Tinnitus?

There is no cure per se for tinnitus. Still, according to Mayo Clinic, treatment options vary depending on the underlying cause, ranging from ear wax removal to treating an underlying blood vessel condition to prescribing a hearing aid.

Tinnitus Retraining Therapy

Some individuals, including actor William Shatner, have found relief with tinnitus retraining therapy (TRT).

Shatner told Weekend Edition host Scott Simon in 2012 that he was diagnosed with tinnitus about 15 years earlier. He described his tinnitus tone as sounding like an empty television channel that broadcasts a constant “hiss static.”

The treatment combines sound masking and therapy designed to train your brain to interpret tinnitus sounds as neutral and ignore them. Typically, the patient wears a device in the ear that helps mask tinnitus symptoms while also receiving directive counseling. Over time, TRT may help patients notice tinnitus less and feel less distressed by symptoms.

Cognitive Behavioral Therapy

According to the American Academy of Audiology, cognitive behavioral therapy (CBT) can effectively manage tinnitus.

CBT does not typically resolve the symptoms so much as intervene in the psychologically vicious cycle of anxiety and fear that can accompany these symptoms and make them worse.

Hearing Aids and Other Devices

If hearing loss is an issue, a hearing aid can help turn up the sounds of the environment, effectively turning down the perception of tinnitus.

Sound generators like white noise machines can create sounds that mask the perception of tinnitus, delivering soothing sounds such as rain, a shower, or other white noise effects.

Experimental Treatments

Researchers at the National Institutes of Health (NIH) and elsewhere are working to understand what causes tinnitus more fully and develop new treatment approaches. Since evidence suggests that tinnitus is caused by changes in neural networks in the brain, many of these efforts are exploring the benefit of brain stimulation by magnetic or electrical means.

Here are some current experimental approaches that have shown the most promise:

• Electric stimulation: Some research suggests cochlear implants can suppress tinnitus and restore functional hearing in patients with severe-to-extreme hearing loss. However, they aren’t helpful for most tinnitus patients with significant hearing ability.
• Bimodal stimulation: A large, randomized trial published in Nature in 2022 showed that acoustic stimulation coupled with electric stimulation of the tongue, vagus nerve, or head and neck areas can substantially relieve tinnitus.
• Deep brain stimulation (DBS): Normally used to treat people with certain kinds of movement disorders or neuropsychiatric conditions, this treatment reduces tinnitus for some patients. However, DBS is invasive, as surgery is needed to implant electrodes deep inside the brain. Though initial results of using DBS for tinnitus have been promising, more research needs to be done to determine if the approach is medically justified for treating tinnitus alone.

How Does Mindset Affect Tinnitus?

There is evidence of a connection between anxiety and tinnitus, though the precise causal relationship is unknown, and not all tinnitus sufferers have anxiety issues. That said, one study found that those with anxiety disorder were thrice more likely to suffer from tinnitus than the control group. Another study found that 28 to 45 percent of chronic tinnitus sufferers also suffered from anxiety. Anxiety can also affect the sufferer’s subjective perception of how intrusive or disabling the tinnitus is.

What Are the Natural Approaches to Tinnitus?

While natural treatments are also not a cure-all for tinnitus, research has found that certain practices can reduce the distress caused by tinnitus, even if they don’t resolve the condition.

Mindfulness and CBT

A systematic review published in Frontiers in Neurology in 2019 found a “statistically significant decrease in tinnitus distress scores” after mindfulness therapy. Another 2019 research review in the same journal noted that cognitive behavioral therapy could have a similar effect.

Acupuncture

Acupuncture can also help reduce or eliminate tinnitus, according to peer-reviewed studies. Traditional Chinese medicine (TCM) practitioner Dr. Wu Kuo-pin told the Epoch Times that tinnitus and loss of hearing are common after the age of 50, but acupuncture can effectively treat a variety of causes of tinnitus. This acupuncture approach uses points in and around the ear for tinnitus causes connected to the inner and middle ear and other body points for causes related to allergies, liver and spleen deficiencies, and structural issues with the spine, neck, and head.

NAC

While more research is needed, there has been some evidence that the antioxidant N-acetylcysteine (NAC) may protect against hearing loss, and it may even potentially treat tinnitus symptoms. A case report also showed NAC’s promising effects, with the antioxidant significantly reducing one woman’s tinnitus. NAC seems to be most effective if taken before or shortly after hearing damage has occurred.

Always consult a health care professional before starting a new treatment approach.

Oxytocin

According to a 2017 pilot study published in Frontiers in Neurology, oxytocin nasal spray is another possible treatment for tinnitus, though it is unsuitable for pregnant women.

How Can I Prevent Tinnitus?

You can reduce your risks of experiencing severe or chronic tinnitus by doing the following:

• Supplement with vitamins and minerals: Take supplements that support brain and ear health, such as magnesium, and a high-quality daily multivitamin containing vitamins A, E, and C. These supplements may help prevent damage to the hair cells of your inner ear.
• Get sufficient and good-quality sleep: Sleep problems are common among tinnitus patients. If you have insomnia, consider consulting a sleep specialist.
• Avoid loud sounds: If you work in a noisy environment, use safety-approved noise-canceling headphones or effective earplugs.
• Turn down the volume on your auditory devices: Earbuds, particularly, are associated with damage to the inner ear, so keep the volume moderate with these especially. Many newer audio electronics come with decibel ratings; choose one with a lower rating to preserve your hearing and reduce tinnitus.
• If you have anxiety, consider treatment: Consult a doctor regarding possible treatments, including medication, therapy, relaxation techniques, and meditation.
• Stay up to date with comprehensive physicals: Ear and sinus infections, tumors, thyroid issues, positional vertigo, and Ménière’s disease can also cause tinnitus, so stay current with physicals to ensure you haven’t developed a condition that may lead to tinnitus.

Medically reviewed by Beverly Timerding, MD.