Tinnitus

Tinnitus is when you hear a noise or ringing in your ears without there being an outside sound. It can be a buzzing, roaring, clicking, booming, hissing, whistling or cicada-like noise. It can be heard as a single sound or as a mix or blend of different sounds. In some cases, the sound is a whooshing noise associated with your heartbeat. Sometimes the sound may be actual noise from musculoskeletal and vascular structures near your ear.

Tinnitus can affect one or both ears and can start suddenly or gradually. The sounds can stay there all the time or come and go. The sound can vary in loudness, pitch and intensity. It’s more common for older people and for men and people who smoke.

Tinnitus often has no clear cause, but it can be caused by the following:

• Hearing loss – most people with tinnitus have hearing loss. This can be the result of living or working around loud noises or due to increasing age. 
• Ear problems such as from a build-up of earwax, ear infection, blocked ears or changes to your ear bones. 
• Head, neck or ear injuries.
• Ménière’s disease. 
• Spasms in muscles close to your inner ear.
• Temporomandibular joint disorders (TMJ) – problems with the joint in your jaw.
• Some chemotherapy medicines, antibiotics, high or frequent doses of non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin as a side-effect.
• Blood flow problems such as carotid atherosclerosis (a build-up of plaque in your arteries) and high blood pressure (hypertension).
• Tumours, particularly acoustic neuroma.

Long-term health problems (eg, diabetes, autoimmune diseases, migraines, and multiple sclerosis) plus habits (eg, smoking) may be also linked to tinnitus.

See your healthcare provider if:

• your tinnitus is new or getting worse
• you only have tinnitus in 1 ear
• your tinnitus is affecting your daily functioning
• your tinnitus beats in time with your pulse. 

Your healthcare provider will ask you some questions related to your symptoms and your work, and examine your ears. Depending on what they think is causing your problems, they may perform tests such as:

• hearing tests
• blood tests
• X-rays, or
• scans such as an MRI or CT scan.

Not everyone with tinnitus will need all these tests.

Tinnitus is a symptom not a disease. Treatment depends on what's causing it. In some cases, tinnitus is easily treated if the cause is found, such as removing earwax or changing medicines. For most people, there's no underlying cause, or it’s due to ageing processes or associated with more general hearing loss. You may be referred to an audiologist (a hearing specialist) or an ear, nose and throat (ENT) specialist for further tests and treatments. If you have tinnitus and deafness on one side, you will be referred to a specialist so an MRI can be done. 

Treatment of tinnitus may include lifestyle changes, medicines and hearing-based treatments. You may find you get used to the sound and your brain ‘switches off’ from it. This may take several months. Reassurance that this can happen may be all the treatment you need.

Lifestyle changes

For some people, lifestyle changes can help to make the symptoms easier to manage or defer the onset of them.

• Know your triggers for tinnitus and try to avoid them.
• Getting enough sleep, eating well and exercising regularly can help reduce tinnitus for some people.
• Reduce your exposure to loud noises – turn down the volume on loud music.
• Keep your blood pressure well controlled.
• Get support to quit smoking.
• In a quiet setting, use a fan, play soft music or use low-volume radio static to help cover up the noise from tinnitus.
• Play soothing music at bedtime.
• Manage stress and try to relax, as stress can make tinnitus worse. 
• Talk to your healthcare provider or pharmacist about medicines that can make your tinnitus worse. This includes over-the-counter medicines and supplements. 

Medicines

Medicines are not routinely used to treat tinnitus. However, healthcare providers may use medicines to treat conditions that cause tinnitus such as Ménière’s disease or conditions that make tinnitus worse, such as anxiety.

Hearing devices or other treatments

You may be referred to an audiologist (a hearing specialist) if your tinnitus is ongoing. Some of the treatments that may be offered include:

• hearing aids
• sound therapy using devices to mask the sound
• bedside noise generators.

Counselling such as cognitive behavioural therapy (CBT) can help with stress, whether it’s related to having tinnitus or to a different reason. It can also help you learn to respond differently to the tinnitus itself and learn to attend to it less so it’s not such a problem.

Tinnitus retraining therapy may help but the evidence isn’t clear. It combines sound therapy and psychological support to help reduce your awareness of tinnitus so that it loses its importance over time. It’s a structured programme which helps you to habituate to the sound (get used to it) so that you no longer notice. This process takes 12 to 18 months to work.

Surgery is only done if there’s an underlying cause that can be treated with surgery, such as removal of a tumour.  

There's no good evidence that complementary therapies, including acupuncture, hypnosis or homeopathy, have any benefit in managing tinnitus.

Apps reviewed by Healthify

You may find it useful to look at some tinnitus apps, quit smoking apps, and ear, nose, throat and eye health apps.

Some people with tinnitus experience other conditions as a result of their tinnitus. These can include:

• fatigue
• stress
• sleep disorders
• concentration difficulties
• depression and anxiety
• headache
• quality of life issues, at home and at work.

If you experience any of these complications, talk to your healthcare provider about self-care and other treatments to help you manage them.

Hearing NZ(external link) provides education and support for people who are deaf or hard of hearing. Visit their website(external link) or contact them via their online form(external link).

Clinical pathways and guidelines

Tinnitus(external link) B-QuiCK BPAC, NZ
Tinnitus – the sound of silence(external link) BPAC, NZ, 2023
Esmaili AA, Renton J. A review of tinnitus(external link) Aust J Gen Pract. 2018;47(4)
Tinnitus(external link) Patient Info Doctor, UK, updated 2024

Podcasts

Tinnitus(external link) Goodfellow Unit, NZ, 2018
Dr Giriraj Singh Shekhawat talks about tinnitus.

Videos and webinars

Video: Tinnitus doesn’t need to rule your life – Dr Grant Searchfield

(Goodfellow Unit, NZ, 2018)

Video: Common ENT problems – Mr Sumit Samant

(Goodfellow Unit, NZ, 2018)