Ringing in Ears: Tinnitus Symptoms and Treatment Options

Tinnitus, often described as a ringing sound in the ears, affects more than 50 million adults in the U.S. For 5 million of those people, the condition is a chronic, daily annoyance. For another 2 million, the impact is even more significant. In some cases, tinnitus can make it hard to concentrate and sleep. It may even interfere with an individual’s ability to work or maintain relationships.

Symptoms of Tinnitus

According to Jeanne Coburn, AuD., CCC-A/SLP, an audiologist with Baystate Rehabilitation Care, tinnitus is the perception of sound when no external noise is present. While commonly described as a ringing in the ears, tinnitus may also be experienced as a buzzing, roaring, clicking, whistling, whooshing, hissing, or even as music or indistinct voices. The sounds can be constant or intermittent, vary in volume, and affect one or both ears. For many people, the perceived sound may randomly change or, for a lucky few, it may even go away over time.

Causes of Tinnitus

As Coburn explains, “Tinnitus is not a disease itself but the result of abnormal neural activity that the brain interprets as sound.”

“Normally, the brain and the sensitive hair cells in the cochlea, which is your inner ear, have an ongoing dialog in which the hair cells send signals to the brain that are perceived as sound and signals also travel the auditory pathways from the brain back to the cochlea. When that process is disrupted by hearing loss or a medical condition, the tinnitus may be present.”

While the exact cause of tinnitus is not fully understood, many factors are known to contribute to damage to the auditory pathways. These include:

Age-related hearing loss: The hair cells in the inner ear deteriorate with age

• Noise-induced hearing loss: Also causes damage to the hair cells in the cochlea and can account for up to 90% of tinnitus cases.
• Disease: Tinnitus is associated with over 200 health conditions including high blood pressure, diabetes, heart disease, and Meniere’s disease.
• Head injuries: Trauma to head can cause damage to the cochlea.
• Medications: Many common medications, including some antibiotics, chemotherapy, aspirin, blood pressure medications, and antihistamines can trigger or worsen tinnitus.

Diagnosing Tinnitus

Because there is no specific test for tinnitus, a diagnosis requires a comprehensive health history and physical exam. Your provider will ask about any current medications you take—including supplements, history of head injury or noise exposure, and they’ll examine your ears. Depending on the suspected cause of the tinnitus, other tests, including imaging or an audiological evaluation, may be recommended.

Tinnitus Treatments

While there's no cure for most cases of tinnitus, several treatments can help manage symptoms and improve quality of life.

“The goal of treatment,” says Coburn, “is to lessen the burden of tinnitus and improve quality of life.

• Hearing aids: Using hearing aids to amplify external sounds can decrease or eliminate tinnitus for 80% of people who use them. For many people, the relief can last for a period of time even after the aid is removed.
• Masking devices: Similar in appearance to hearing aids, masking devices produce a pleasant, low-volume white noise that masks tinnitus
• Noise machines: Like masking devices, noise machines provide a steady stream of white noise that covers up tinnitus.
• Cognitive Behavioral Therapy (CBT): Not intended as a cure or a means to make tinnitus quieter, CBT, is a form of counseling that helps you identify your response and behavior related to tinnitus. With that understanding, CBT aims to restructure your thought process so that your response shifts from negative to neutral.
• Mindfulness-Based Stress Reduction (MBTSR): By combining principles of mindfulness meditation with specific techniques for addressing tinnitus, MBTSR changes an individual’s relationship with their condition and improves emotional well-being. MBTSR programs generally run eight weeks, with many available online.
• Tinnitus Activities Treatment (TAT): TAT is a holistic approach to tinnitus management that focuses on thoughts and emotions, hearing and communication, sleep, and concentration while often incorporating sound therapy (using devices to mask tinnitus with background noise) to reduce the perceived loudness of the tinnitus.
• Tinnitus Retraining Therapy (TRT): A combination of sound therapy (using devices to mask tinnitus with background noise) and counseling to help the brain gradually become less bothered by the perceived tinnitus sounds. Studies show that up to 80% of TRT participants report improvement over 12 to 18 months.
• Medications: Currently there are no FDA-approved drugs specifically for tinnitus. However, in some cases, medications for stress, anxiety, and PTSD have been found to reduce tinnitus symptoms.

Resources for Living with Tinnitus

While tinnitus can be frustrating, Coburn notes there are many resources available designed to help you live peacefully with it.

“The Veteran’s Administration offers a free Progressive Tinnitus Management (PTM) program that teaches you how to use sound to cope with tinnitus as well as how to change your thoughts and feelings around tinnitus,” says Coburn. “An essential part of the program is the How to Manage Your Tinnitus: A Step-by-Step Workbook that helps you assess your response to tinnitus and masking sound options so that you can craft personalized sound plan that works for you.”

In addition, she notes you can access a wide range of white noise options using a smartphone or laptop. “Both YouTube and Spotify, for example, have uninterrupted white noise ranging from crashing waves and rain to a continuous soft hum and running water.”

She also recommends exploring apps and videos related to sleep hygiene, stress management, and meditation.

“It’s easy to feel helpless or even powerless over tinnitus,” says Coburn, “but there’s actually a lot you can do to find relief and improve your perspective and quality of life.”

When to See a Doctor for Ringing in Your Ears

If persistent tinnitus impacts your life, contact your doctor to determine the best course of action for your situation.

If you’re experiencing the following types of tinnitus or accompanying symptoms, contact your doctor for a referral to an ENT or for an audiological assessment:

• Unilateral tinnitus: persistent ringing or another noise in just one ear
• Pulsatile tinnitus: tinnitus perceived as a rhythmic sound, often in sync with your heartbeat
• Tinnitus accompanied by dizziness, vertigo, or nausea
• Tinnitus accompanied by pain or drainage from the ear