Tinnitus

Tinnitus is noise or ringing in your ears without an outside sound. It can also be described as 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. In some cases, 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.

In many people with tinnitus, the exact cause is not known, but it can be caused by factors such as:

• ageing
• living or working around loud noises
• a buildup of earwax
• ear infections
• eardrum rupture
• hearing loss – 80% of people with tinnitus have hearing loss
• scuba diving
• stress or anxiety – caused by the tinnitus or causing the condition
• some medicines such as aspirin
• drinking an excessive amount of alcohol or caffeinated drinks
• dental or other problems affecting your mouth such as problems with your temporomandibular joint (TMJ), the joint that connects your jaw with your skull
• head, neck or ear injuries
• spasms in muscles close to your inner ear
• injury to your inner ear following surgery or radiation therapy to your head or neck
• severe weight loss from malnutrition or excessive dieting
• repeated exercise with your neck in a hyperextended position, such as when cycling 
• diabetes
• Meniere’s disease
• autoimmune conditions, such as rheumatoid arthritis 
• blood flow problems such as carotid atherosclerosis (a buildup of plaques in your arteries) and high blood pressure (hypertension)
• nerve problems such as multiple sclerosis or migraine headache
• tumours, particularly acoustic neuroma.

See your GP if:

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

Your doctor 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 diagnosis not a disease. Treatment depends on what is causing it. In some cases, tinnitus is easily treated if the cause is found, such as removing ear wax or changing medicines. For most people, there is no underlying cause. 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, hearing-based treatments and other treatments. In some cases you may get used to the sound and your brain ‘switches off’ the sounds. 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.
• Reduce your exposure to loud noises – turn down the volume on loud music.
• Reduce alcohol or caffeine intake.
• 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 doctor or pharmacist about medicines that can make your tinnitus worse. This includes over-the-counter medicines and supplements. 

Medicines

In some people, medicines may be helpful in reducing the severity of tinnitus, but there is no medicine to cure tinnitus. Medicines that have been trialled in individual patients include antidepressants, anticonvulsants (such as gabapentin and carbamazepine), and benzodiazepines. Sometimes, vitamin B12 injections are helpful, especially in older women. 

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 devices to mask the sound
• counselling for stress
• sound therapy
• bedside noise generators
• in rare cases, surgery.

There is 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 the online form here(external link).

Clinical pathways and guidelines

Tinnitus(external link) Auckland Regional HealthPathways, NZ, 2020
Tinnitus – the sound of silence(external link) BPAC, NZ, 2023
A review of tinnitus(external link) Australian Journal of General Practice, Australia, 2018
Tinnitus(external link) Patient Info, UK

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

This video may take a few moments to load.

(Goodfellow Unit, NZ, 2018)

Video: Common ENT problems – Mr Sumit Samant

This video may take a few moments to load.

(Goodfellow Unit, NZ, 2018)

Apps

Tinnitus apps
Quit smoking apps
Ear, nose, throat and eye health apps