Tinnitus

Tinnitus is the term for hearing sounds that come from inside your body, rather than from an outside source.

It's often described as "ringing in the ears", although several sounds can be heard, including:

• buzzing
• humming
• grinding
• hissing
• whistling

Some people may hear sounds similar to music or singing, and others hear noises that beat in time with their pulse (pulsatile tinnitus).

You may also notice that your hearing is not as good as it used to be or you're more sensitive to everyday sounds (hyperacusis).

Is it serious?

Tinnitus is rarely a sign of a serious underlying condition. For some people it may come and go and only be a minor irritation.

However, for some people, it can have a significant impact on everyday life and be very distressing, affect concentration, and cause problems such as difficulty sleeping (insomnia) and depression.

In many cases, tinnitus will get better gradually over time, either by disappearing or by the body getting used to it (habituation). But it's important to seek medical advice to see if an underlying cause can be found and treated, and to help you find ways to cope with the problem.

When to see your GP

You should see your GP if you continually or regularly hear sounds such as buzzing, ringing or humming in your ears.

They can examine your ears to see if the problem might be caused by a condition they could easily treat, such as an ear infection or earwax build-up. They can also do some simple checks to see if you have any hearing loss.

If necessary, your GP can refer you to a hospital specialist for further tests and treatment.

Read more about diagnosing tinnitus.

What causes tinnitus?

Tinnitus can develop gradually over time or occur suddenly. It's not clear exactly why it happens, but it often occurs along with some degree of hearing loss.

Tinnitus is often associated with:

• age-related hearing loss
• inner ear damage caused by repeated exposure to loud noises
• an earwax build-up
• a middle ear infection
• Ménière's disease – a condition that also causes hearing loss and vertigo (a spinning sensation)
• otosclerosis – an inherited condition where an abnormal bone growth in the middle ear causes hearing loss

However, around one in every three people with tinnitus doesn't have any obvious problem with their ears or hearing.

Read more about the causes of tinnitus.

Who is affected?

Most people have experienced short periods of tinnitus after being exposed to loud noises, such as after a music concert.

In the UK, more persistent tinnitus is estimated to affect around six million people (10% of the population) to some degree, with about 600,000 (1%) experiencing it to a severity that affects their quality of life.

Tinnitus can affect people of all ages, including children, but is more common in people aged over 65.

Treating tinnitus

There's currently no single treatment for tinnitus that works for everyone. However, research to find an effective treatment is continuing.

If an underlying cause of your tinnitus can be found, effectively treating it may help improve your tinnitus – for example, removing a build-up of earwax might help.

If a specific cause can't be found, treatment will focus on helping you manage the condition on a daily basis. This may involve:

• sound therapy – listening to neutral sounds to distract you from the sound of tinnitus
• counselling – therapy that aims to educate you about tinnitus and help you learn to cope with it more effectively
• cognitive behavioural therapy (CBT) – therapy that aims to help change the way you think about your tinnitus so it becomes less noticeable
• tinnitus retraining therapy (TRT) – therapy that aims to help retrain the way your brain responds to tinnitus so you start to tune the sound out and become less aware of it

Read more about how tinnitus is treated.

It's not clear exactly what causes tinnitus, but it's thought to be a problem with how the ear hears sounds and how the brain interprets them.

Many cases are associated with hearing loss caused by damage to the inner ear, although around one person in every three with the condition doesn't have any obvious problem with their ears or hearing.

Inner ear damage

Sounds pass from the outer ear through to the inner ear, which contains the cochlea and auditory nerve. The cochlea is a coiled, spiral tube containing a large number of sensitive hair cells. The auditory nerve transmits sound signals to the brain.

If part of the cochlea is damaged, it will stop sending information to your brain. The brain may then actively "seek out" signals from parts of the cochlea that still work. These signals might then become over-represented in the brain, which may cause the sounds of tinnitus.

In older people, damage to the cochlea often occurs naturally with age. In younger people, it can be caused by repeated exposure to excessive noise.

Other causes

As well as inner ear damage, there are several other possible causes of tinnitus. These include:

• an earwax build-up that blocks the ear
• a middle ear infection
• glue ear – a build-up of fluid in the middle ear
• a perforated eardrum
• Ménière's disease – a condition that also causes hearing loss and vertigo (a spinning sensation)
• otosclerosis – an inherited condition where an abnormal bone growth in the middle ear causes hearing loss

Rarer causes

Less commonly, tinnitus may develop as a result of:

• a head injury
• exposure to a sudden or very loud noise, such as an explosion or gunfire
• anaemia – a reduced number of red blood cells that can sometimes cause the blood to thin and circulate so rapidly that it produces a sound
• reactions to certain medications, such as some chemotherapy medicines, antibiotics, diuretics, non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin (this is more likely to occur at very high doses)
• acoustic neuroma – a rare non-cancerous growth that affects the hearing nerve in the inner ear
• high blood pressure (hypertension) and narrowing of the arteries (atherosclerosis)
• an overactive thyroid gland (hyperthyroidism) or underactive thyroid gland (hypothyroidism)
• diabetes
• Paget's disease – where the normal cycle of bone renewal and repair is disrupted

You should see your GP if you have a problem with your hearing, such as hearing ringing or buzzing sounds.

They will ask you some questions about your symptoms, such as:

• Does the sound come and go, or is it continuous?
• Does the problem affect one or both ears?
• Is it a constant tone or is it like a pulse?
• Is the problem having an impact on your everyday life?
• Have you noticed any other symptoms, such as hearing loss or vertigo (a spinning sensation)?

They may also want to know whether you're taking any medication that could cause the condition, such as high doses of antibiotics or aspirin.

They will examine the outside and inside of your ear to check for obvious problems they may be able to treat, such as an earwax build-up or an ear infection. If you have a pulsatile tinnitus they will also listen to your neck and side of the head with a stethoscope.

They might also carry out a simple test of your hearing (free field speech testing and tuning fork tests) and arrange blood tests to look for conditions sometimes associated with tinnitus, such as anaemia (a reduction in red blood cells), diabetes or a problem with your thyroid gland.

Seeing a specialist

In some cases, your GP may refer you to a hearing specialist called an audiologist, who can carry out a range of hearing tests and talk to you about the treatments available.

Alternatively, you may be referred to the ear, nose and throat (ENT) department of your hospital. An ENT specialist may see you directly or organise a CT scan or MRI scan before arranging an appointment with ENT or Audiology depending on the results.

There's not usually a quick fix for tinnitus, but it will often improve gradually over time. A number of treatments are available to help you cope.

If your tinnitus is caused by an underlying health condition, treating the condition will help stop or reduce the sounds you hear.

For example, if your tinnitus is caused by an earwax build-up, eardrops or ear irrigation may be used. Ear irrigation involves using a pressurised flow of water to remove the earwax.

Read more about how an earwax build-up is treated.

However, in many cases a cause for tinnitus can't be found, so treatments will be used to help you manage the problem on a daily basis. These are described below.

Correcting hearing loss

Any degree of hearing loss you have should be addressed because straining to listen can make tinnitus worse.

Correcting even fairly minor hearing loss means the parts of the brain involved in hearing don't have to work as hard and therefore don't pay as much attention to the tinnitus.

A specialist will test your hearing and recommend appropriate treatment. This could involve having a hearing aid fitted, and occasionally surgery.

Improving your hearing will also mean sounds you wouldn't otherwise hear will now be audible, which may help override the sounds of your tinnitus.

Read more about treating hearing loss.

Sound therapy

Tinnitus is often most noticeable in quiet environments. The aim of "sound therapy" or "sound enrichment" is to fill any silence with neutral sounds to distract you from the sound of tinnitus.

This may involve simple measures such as opening a window to hear noises coming from outside, leaving a radio or television on, or listening to sounds on a portable music player.

You can get specially-designed sound generators that look similar to a radio. These produce quiet natural sounds, such as leaves rustling in the wind and waves lapping on the shore. White noise generators are similar devices that produce a continuous "shushing" sound at a level that's comfortable and soothing.

Also available are pillows containing built-in speakers to help distract you from tinnitus when you go to sleep, and small sound-generator devices that fit in your ear like a hearing aid. Some hearing aids have built-in sound generators for people with tinnitus.

Counselling

Understanding tinnitus plays an important part in learning how to cope with the condition and manage it more effectively.

Tinnitus counseling is a type of therapy where you work with a healthcare professional to help you learn more about your tinnitus and find ways of coping with it. It's usually carried out by hearing therapists, audiologists (hearing disorder specialists) or doctors.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is often used to treat mental health problems, such as anxiety and depression. It's based on the idea that your thoughts affect the way you behave. Treatment aims to retrain the way you think to change your behaviour.

This technique can be effectively applied to tinnitus. For example, if your knowledge about tinnitus is limited, you may have certain ideas about it that make you feel anxious and depressed. This can make your tinnitus worse.

Changing the way you think about your tinnitus and what you do about it can help reduce your anxiety and enable you to accept the noises, which after a while may become less noticeable.

Tinnitus retraining therapy (TRT)

Tinnitus retraining therapy (TRT) is a special type of therapy that aims to help retrain the way your brain responds to tinnitus so you start to tune the sound out and become less aware of it. The therapy involves a combination of more intensive sound therapy and long-term counselling.

TRT is widely available privately and may be available on the NHS for people with very severe or persistent tinnitus. It should only be carried out by someone specially trained in the technique.

Self-help

Some people find self-help techniques useful for managing their tinnitus. These techniques include:

• relaxation – stress can make your tinnitus worse, so relaxation techniques such as deep breathing and yoga may help
• listening to music – calming music and sounds may help you relax and fall asleep at bedtime
• sleep hygiene – if tinnitus is affecting your sleep, sleep hygiene measures such as sticking to a regular sleep pattern and avoiding caffeine or alcohol shortly before going to bed may help
• hobbies and activities – having a hobby or regularly participating in any activity you find enjoyable may help distract you from tinnitus
• support groups – sharing your experiences with others who have tinnitus may help you cope better

Action on Hearing Loss provide further details about support and activities in your local area. Their free information line telephone number is 0808 808 0123.

You may also find the British Tinnitus Association a useful source of information. You can call their confidential helpline free of charge on 0800 018 0527.