Tinnitus

Tinnitus is common. Almost everyone notices a mild form of tinnitus once in a while. It usually lasts a few minutes. However, constant or recurring tinnitus may be stressful and may make it harder to focus or sleep.

Tinnitus can be:

• Subjective, which means that the sound is only heard by the person
• Objective, which means that the sound is heard by both the affected person and the examiner (using a stethoscope near the person's ear, head, or neck)

It is not known exactly what causes a person to "hear" sounds with no outside source of the noise. However, tinnitus can be a symptom of almost any ear problem, including:

• Ear infections
• Foreign objects or wax in the ear
• Hearing loss
• Meniere disease -- an inner ear disorder that involves hearing loss and dizziness
• Problem with the eustachian tube (tube that runs between the middle ear and the throat)

Antibiotics, aspirin, or other drugs may also cause ear noises. Alcohol, caffeine, or smoking may worsen tinnitus if the person already has it.

Sometimes, tinnitus is a sign of high blood pressure, an allergy, or anemia. In rare cases, tinnitus is a sign of a serious problem such as a tumor or aneurysm. Other risk factors for tinnitus include temporomandibular joint disorder (TMJ), diabetes, thyroid problems, obesity, and head injury.

Tinnitus is common in war veterans and in adults age 65 years or older. Children can also be affected, especially those with severe hearing loss.

Tinnitus is often more noticeable when you go to bed at night because your surroundings are quieter. To mask tinnitus and make it less irritating, background noise using the following may help:

• White noise machine
• Running a humidifier or dishwasher

Home care of tinnitus mainly includes:

• Learning ways to relax. It is not known if stress causes tinnitus, but feeling stressed or anxious can worsen it.
• Avoiding things that may make tinnitus worse, such as caffeine, alcohol, and smoking.
• Getting enough rest. Try sleeping with your head propped up in an elevated position. This lessens head congestion and may make noises less noticeable.
• Protecting your ears and hearing from further damage. Avoid loud places and sounds. Wear ear protection, such as earplugs, if you need them.

Contact your health care provider if:

• Ear noises start after a head injury.
• The noises occur with other unexplained symptoms, like dizziness, feeling off balance, nausea, or vomiting.
• You have unexplained ear noises that bother you even after you try self-help measures.
• The noise is only in one ear and it continues for several weeks or longer.
• If the noises are pulsatile (rhythmic noise that follows a steady beat).

The following tests may be done:

• Audiometry to test hearing loss
• Head CT scan
• Head MRI scan
• Blood vessel studies (duplex Doppler ultrasound and angiography)

TREATMENT

Fixing the problem, if it can be found, may make your symptoms go away. (For example, your provider may remove ear wax.) If TMJ is the cause, your dentist may suggest dental appliances or home exercises to treat teeth clenching and grinding.

Talk to your provider about all your current medicines to see if a medicine may be causing the problem. This may include over-the-counter medicines, vitamins, and supplements. Do not stop taking any medicine without talking to your provider.

Many medicines are used to relieve symptoms of tinnitus, but no medicine works for everyone. Your provider may have you try different medicines or combinations of medicines to see what works for you.

A tinnitus masker worn like a hearing aid helps some people. It delivers low-level sound directly into the ear to cover the ear noise.

A hearing aid may help reduce ear noise and make outside sounds louder.

Counseling may help you learn to live with tinnitus. Your provider may suggest biofeedback training to help with stress.

Some people have tried alternative therapies to treat tinnitus. These methods have not been proven, so talk to your provider before trying them.

Tinnitus can be managed. Talk with your provider about a management plan that works for you.

The American Tinnitus Association offers a good resource center and support group.

Ringing in the ears; Noises or buzzing in the ears; Ear buzzing; Otitis media - tinnitus; Aneurysm - tinnitus; Ear infection - tinnitus; Meniere disease - tinnitus

Tunkel DE, Bauer CA, Sun GH, et al. Clinical practice guideline: tinnitus. Otolaryngol Head Neck Surg. 2014;151(2 Suppl):S1-S40. PMID: 25273878 pubmed.ncbi.nlm.nih.gov/25273878/.

Worral DM, Cosetti MK. Tinnitus and hyperacusis. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 153.

Yew KS. Tinnitus. In: Kellerman RD, Rakel DP, Heidelbaugh JJ, Lee EM, eds. Conn's Current Therapy 2024. Philadelphia, PA: Elsevier; 2024:66-70.

Updated by: Josef Shargorodsky, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.