What is Tinnitus?

By:Dimitri O

Key takeaways

Tinnitus is a condition that causes a ringing or buzzing in the ears
It’s an internal sound that can’t be heard by other people
There are a number of different causes for tinnitus, but the main one is hearing loss
You can also reduce your symptoms with different techniques including therapy, self care and addressing your hearing loss
The best way to prevent tinnitus is to protect your ears from damage by wearing earplugs

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Do you have a ringing in your ears? If so, you could be suffering from tinnitus. It can be annoying at best and debilitating at worst, but there are things you can do to help manage your symptoms and take control of your life. So, keep reading if you want to find out the answers to key questions about this condition, including ‘what is the cause of tinnitus?’ and ‘how can tinnitus be prevented?’.

What is tinnitus?

Tinnitus is an audiological and neurological condition. It’s the perception of sound when no actual external noise is present.

As audiologist Kathleen Wallace describes it:

“Tinnitus is an internal sound. So tinnitus is this like phantom sound that your brain is creating because it's expecting to get more stimulation from the outside environment, which is why you can have an increase in tinnitus when you have hearing loss because your ears are not sending as robust of a message up to your brain as it's expecting to get. So it essentially creates a sound to keep yourself busy because it thinks it's missing something.”

This video is an adapted version where we zoom in Tinnitus. Full video to be found on our blog.

The sound is often described as a ringing sound, that’s why people also call it ringing ears. But tinnitus can manifest itself in hissing, clicking, whistling or dial tones. For a small minority of tinnitus patients, it may even sound like humming, singing, music, or hearing voices. Some people even experience it as a rhythmic pulsing or whooshing sound, that’s in time with your heartbeat.

These sounds can be heard anywhere in the head, and could occur in just one ear or in both ears. They could be very low in pitch or extremely high, and it can even be so loud that it affects your ability to hear external sounds.

What is the cause of tinnitus?

Tinnitus isn’t a disease or a disorder in itself – rather, it is usually a symptom of an underlying health condition. Although we hear a buzzing or ringing in our ears, tinnitus is actually caused by a problem with how the ear hears sounds, and how they’re interpreted by the brain – although scientists disagree on what happens in the brain to cause the illusion of sound when there is none.

So, what is tinnitus a symptom of? Some of the most common causes of tinnitus include:

Age-related hearing loss

In the United States, one in three people between the ages of 65 and 74 have hearing loss, and nearly half of those aged 75 or older experience trouble hearing. There are delicate hair cells in your inner ear, known as cochlea, that move when you receive sound waves. This movement triggers electrical signals which your brain interprets as sounds. As we age, the cochlea starts to break naturally, which not only leads to hearing loss, but can also result in tinnitus, as your brain is exposed to random electrical signals.

Noise-related hearing loss

Hearing loss can also occur as a result of exposure to loud noises, either over a prolonged period or as the result of a one-time exposure to a single loud blast of sound. This type of hearing loss also impacts the structures in the inner ear, and it can also cause tinnitus. With both types of hearing loss, tinnitus tends to follow the pattern of how you hear. If you have hearing loss only in one ear, then you’ll usually also only get tinnitus in one ear.

Ear canal blockage

If your ear canal gets blocked, whether that’s through an infection, a buildup of earwax, dirt or other foreign materials, the pressure inside your ear can change. This can have an impact on your ability to hear, as well as causing tinnitus.

Sinus infections

If you’ve had a cold, you might notice you’re left with a ringing in your ears. This can be caused by an infection that increases the pressure in your ears or sinuses, leading to a case of tinnitus. It should usually only last for a week or so and not cause any long-lasting damage.

Less common causes of tinnitus include:

Medications

Some medications can cause damage to the ear. They’re known as ototoxic drugs, and they can cause hearing loss, ringing in the ear or trouble balancing. There are over 200 known ototoxic medicines, which include chemotherapy drugs, some antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs), quinine and antimalarials. With some of these medications, hearing loss can be reversed when the course is discontinued, while for other drugs, the hearing damage is permanent – but your healthcare provider will always weigh up the risks and benefits when prescribing ototoxic medication.

Problems with your jaw

If you have issues with your jaw or temporomandibular joint (TMJ), you may also find that you have issues with tinnitus. That’s because the TMJ shares some nerves and ligaments with your middle ear. You might find that you’re able to alter the intensity of your tinnitus by moving the position of your jaw, but your dentist should be able to treat your TMJ disorder and prevent your tinnitus from getting worse.

Ménière's disease

This is a rare condition that affects the inner ear, that can cause a feeling of pressure inside the ear and cause hearing loss, vertigo and tinnitus. People who suffer from this condition will experience some or all of these symptoms in a sudden attack that usually lasts two to three hours, although the effects can remain for a day or two after symptoms subside.

Problems with your blood pressure

Certain conditions that affect your blood pressure, like high blood pressure, can change the way blood flows through your veins and arteries, causing it to move with more force. This can cause tinnitus, or if you already have tinnitus, it can make the ringing in your ears more noticeable.

Head or neck injuries

Trauma to the head or neck can affect your inner ear, hearing nerves or the brain functions that are linked to hearing. If you have an accident or a blow to the head, you’ll usually only experience tinnitus in the ear that’s been affected.

Anemia

Anemia, or iron deficiency, can lead to tinnitus. That’s because iron helps your blood cells to carry oxygen from your lungs around your body, and when you’re lacking iron, your arteries may pump harder in order to deliver more blood. This results in pulsatile tinnitus, when you can hear your heartbeat in your ears.

Acoustic neuroma

This rare, non-cancerous tumor, can affect the hearing nerve of your inner ear, causing tinnitus.

Side effects of tinnitus

As well as a ringing in your ears, if you suffer from tinnitus, you may also experience other symptoms.

Most people with tinnitus find that it affects their life in some way. In 2014, the American Tinnitus Association conducted a survey amongst its members to evaluate how tinnitus patients experience their tinnitus. Just 4% of the respondents indicated that they barely even notice the impact of their tinnitus, while 34% described it as annoying.

If you’re one of the 34% who find it annoying, then you may experience a range of additional symptoms. These could include:

Depresion
Anxiety
Fatigue
Stress
Trouble sleeping
Lack of focus and concentration
Headaches

Different types of tinnitus

There are three different kinds of tinnitus: subjective, objective and somatic tinnitus.

Subjective tinnitus is the most common kind and mostly caused by hearing loss. This kind of tinnitus can only be heard by no one other than the patient.

Objective tinnitus is less common and is audible to other people other than the patient. In most cases, it can be heard through a stethoscope.

Somatic tinnitus is a form of subjective tinnitus that can only be heard in one ear. It’s often related to head, neck or dental issues.

Aside from the different types above, there’s also a difference in the tones perceived by people:

Tonal Tinnitus: whistling, ringing or humming noises with well-defined frequencies.
Pulsatile Tinnitus: a rhythmic pulsing, often in-beat with that person’s heartbeat.
Musical Tinnitus: The perception of music and/or singing. This type is very rare; about 3% of tinnitus patients experience it.

Find out more about the different types of tinnitus and how they affect sufferers.

How is tinnitus diagnosed?

The diagnosis of tinnitus is usually based on a person’s description because in 95% of all cases it’s a subjective noise. That means, only the person who has it can hear it, making it harder to diagnose.

If you’re experiencing a ringing or buzzing in your ear, and it bothers you, you should see your healthcare provider in the first instance. Some people don’t find that their tinnitus disrupts their daily life, while others find that their ringing ears make everyday life unbearable.

You should see a doctor if your tinnitus is disruptive or you find it affecting your mood. You should also see your doctor if your ringing ears were brought on by an upper respiratory infection, or you have vertigo (dizziness) or hearing loss along with your tinnitus.

Additionally, even if you’re not especially concerned about the tinnitus itself, it could be a sign of hearing loss. As Kathleen Wallace says:

“If you develop ringing or buzzing in your ears, that’s a good sign that you should get your hearing checked out.”

When you go to see your doctor or audiologist, they’ll ask you about your tinnitus symptoms, and may want to know things like:

Whether you’re affected in one or both ears
If the sound comes and goes, or if it’s continuous
If your tinnitus is impacting your everyday life
If you have any other symptoms, including hearing loss or vertigo
If you’re taking any medication that may be causing your tinnitus, like very high doses of ototoxic drugs

They may also carry out some tests to diagnose tinnitus. The five most common tests are:

Speech recognition test to determine how well the patient hears, and their ability to repeat certain words
Pure tone audiogram, which tests the patient’s ability across different volumes and frequencies
Tympanogram, which measures how well the middle ear functions
Acoustic reflex test, which measures how the middle ear contracts in response to loud noises
Otoacoustic emission test, which measures the movement of hair cells in the middle ear

Is there a cure for tinnitus?

If your tinnitus is caused by an underlying health condition, then addressing the cause will either stop the tinnitus completely or reduce its impact.

If your tinnitus is due to your ears being blocked with ear wax, for example, then using ear drops or having the earwax removed by an audiologist is likely to stop your symptoms.

If there’s no clear cause of your tinnitus, then it may be more about managing your symptoms rather than curing your ringing ears entirely. Some treatments for tinnitus include:

Correcting your hearing loss

If your tinnitus is linked to hearing loss, it’s important to address the root cause. If you have hearing loss, your brain may replace the absence of sound with a perceived sound, which manifests as a ringing in your ears.

Addressing this, with a hearing aid for instance, will ensure that your brain isn’t working as hard, which may reduce the effects of tinnitus. It also means that you’ll be better able to hear sounds that you weren’t able to hear before, which may counteract the tinnitus noises.

Tinnitus retraining therapy

Tinnitus retraining therapy, also known as TRT, helps to retrain your brain. Through a combination of sound therapy and counseling, TRT supports you to tune out the ringing sounds and become less aware of it. This in turn, should help you to become less bothered by it over time.

Sound therapy

A 2020 study found that sound therapy can be effective in suppressing tinnitus. This involves exposure to background noises like white noise to mask the symptoms of tinnitus, or to distract you from it. There are several approaches to sound therapy, ranging from simple measures like opening a window to let noises from outside filter in, to using a white noise generator to produce a soothing sound that covers up the ringing in your ears.

Counseling

As tinnitus can be debilitating, it can be difficult to deal with it on your own. Talking therapy can help you to better understand your symptoms, and devise strategies to deal with it.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) is a type of therapy that aims to change a person’s thought patterns. In the case of tinnitus, it challenges one’s ways of thinking about their tinnitus, aiming to retrain their behavior.

Changing the way you think and feel about your tinnitus may not reduce the ringing you hear in your ears, but it can improve your outlook and reduce the impact your tinnitus has on your everyday life.

Self care

You may also wish to develop your own toolkit of coping strategies for your tinnitus, which you can pull out whenever you need help. That’s because tinnitus can become worse when you let your health and wellbeing slide. As Kathleen Wallace explains it:

“With tinnitus, it actually becomes more pronounced or more bothersome when people are stressed or when they are tired, or when they haven't eaten well. All of them can cause tinnitus spikes. So just like how noise can become more bothersome and can really result in stress and anxiety and all these things, it's the same thing with tinnitus.”

Some self care ideas for improving your health and staying on top of your tinnitus include:

Relaxation techniques like meditation, yoga and deep breathing.
Improving your sleep – and your sleep routine. Things like sticking to a regular sleep schedule, avoiding using your phone before bed, and avoiding caffeine and alcohol can help you to get a better night’s sleep, and reduce your tinnitus symptoms.
Finding a hobby you enjoy: this can help to distract you from the irritating ringing you hear in your ears.
Talking and sharing your experience of tinnitus with others in the same position, through a support group.

How can tinnitus be prevented?

One of the most common causes of tinnitus is hearing loss – and while some hearing loss can’t be prevented, much of it can.

Let’s take musicians as an example. Musicians are 400% more likely to have hearing loss than the general public, and 57% more likely to have tinnitus.

But it’s not just musicians who suffer from tinnitus – people who listen to music, both at concerts and through earbuds (most of us, then!) are also at a high risk of losing their hearing and developing tinnitus. Research has shown that nearly 50% of people aged 12-35 could be exposed to unsafe noise from personal listening devices, and 40% of people in the same age group could be exposed to damaging levels of noise at concerts.

1. Wearing earplugs

It’s important, then, to be mindful of the levels of noise you’re exposed to and take action to protect your ears, both at concerts and on a daily basis. Dr Kathleen suggests that earplugs for tinnitus are a simple way of doing this. She explains:

“Earplugs are really good for protecting your hearing when you don’t have control over what you’re being exposed to, it’s environmental or you’re at a concert, whatever it is, you can’t turn that volume down yourself.”

Earplugs like Loop Experience can help you to live in the moment, by filtering sounds equally across all frequencies so you can hear sounds perfectly – but at a reduced volume, with up to 18 decibels of noise reduction.

Wearing earplugs will not only help to reduce your chances of hearing loss, but also your risk of developing tinnitus. As Dr Kathleen says:

“If you have damage in the ears from noise, you’re more likely to develop tinnitus, so you’re reducing your risk of that with earplugs.”

2. Reducing the volume

As well as wearing earplugs, it’s important to be mindful of the volume at which you’re listening to music. Although listening to music on a daily basis might not seem like a problem, it’s something that most of us should be taking more seriously. Most people listen to music through their headphones or earbuds at 75 to 105 decibels. It takes just 8 hours of exposures to sound at 80 decibels without ear protection to cause damage.

Kathleen Wallace explains:

“There is a lot of other noise that we are exposing ourselves to. It’s all self-inflicted. So if you are listening to music or podcasts or you’re watching TV, you have to think about what volume you’re listening at.”

She further explains:

“If you’re at a restaurant or some sort of situation where you don’t have your earplugs with you, I’d recommend downloading a sound level meter app where you can actually see how loud is this environment and you can make an educated decision about ‘do I want to stay in this environment?’, ‘how long can I stay in there and be safe?’ or ‘is there a quiet part I can move to, away from the kitchen or the bar?’.”

3. Improving your cardiovascular health

As mentioned already, certain conditions that affect your cardiovascular health can cause tinnitus, or make the ringing in your ears worse.

Maintaining good levels of cardio fitness, reducing your blood pressure and keeping your cholesterol at a healthy level may all help to prevent tinnitus.

Manage your tinnitus

Tinnitus can be difficult to live with, but there are ways to deal with it. Not all causes of tinnitus are preventable, but you can reduce your risk of developing it by protecting yourself from loud noises and hearing loss through the use of earplugs. You can also manage your symptoms through a variety of techniques including sound therapy, self care and addressing your hearing loss, all of which can help you to stay on top of the ringing in your ears and fully live your life, distraction-free.

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