Tinnitus
Also known as Ringing in the ears
This article is general health information for the selected condition. It is not a diagnosis and does not replace clinical judgement. If you have questions or need treatment advice, please consult a qualified healthcare professional.
What is tinnitus?
Tinnitus is the perception of sound with no external source, commonly described as ringing, buzzing or hissing. It is a symptom rather than a disease and is most often associated with hearing loss. Although there is rarely a cure, sound therapy and cognitive behavioural approaches substantially reduce its impact on daily life.
Causes
- Age related hearing loss
- Noise induced hearing damage
- Earwax impaction
- Middle ear disease
- Meniere disease
- Ototoxic medicines including high dose aspirin and some antibiotics
- Vascular causes in pulsatile tinnitus
Symptoms
- Ringing, buzzing, hissing or whooshing sound
- Sound present in one or both ears
- More noticeable in quiet environments
- Associated hearing loss
- Difficulty concentrating
- Sleep disturbance
- Distress and low mood in severe cases
Risk factors
- Loud noise exposure at work or through music
- Increasing age
- Male sex
- Smoking
- Cardiovascular disease
- Head or neck injury
Diagnosis
- History including whether the sound is pulsatile or one sided
- Ear examination for wax or middle ear disease
- Audiometry to assess hearing
- Imaging for unilateral or pulsatile tinnitus
- Review of ototoxic medicines
- Assessment of mood and sleep impact
Treatment
- Treating any identifiable underlying cause
- Hearing aids where hearing loss is present
- Sound enrichment and masking devices
- Cognitive behavioural therapy, which has the best evidence for distress
- Tinnitus retraining therapy
- Protecting hearing from further noise damage
- Managing associated anxiety, depression and insomnia
Self care
- Use background sound rather than silence, especially at night
- Protect hearing from loud noise and use ear protection
- Reduce focus on the sound rather than monitoring it
- Manage stress, which amplifies perception
- Address sleep problems directly
- Limit caffeine and alcohol if they seem to worsen it
- Try relaxation or mindfulness techniques
When to see a doctor
Book an appointment if:
- Tinnitus in one ear only
- Tinnitus with hearing loss
- Tinnitus affecting sleep, mood or concentration
- Tinnitus that pulses in time with your heartbeat
- New tinnitus after starting a medicine
- Associated dizziness or balance problems
Some symptoms need emergency care rather than an appointment. See the warning signs listed above.
Prevention
- Protect hearing at concerts, at work and when using power tools
- Follow safe listening levels with headphones
- Treat ear infections and remove wax appropriately
- Manage cardiovascular risk factors
- Review ototoxic medicines with your doctor
Outlook
Tinnitus rarely disappears completely, but the distress it causes usually reduces substantially over time, particularly with sound therapy, hearing aids where there is hearing loss, and cognitive behavioural therapy. Most people reach a point where they notice it far less. Treatable causes such as wax or middle ear disease can resolve it entirely.
Common questions
Which tinnitus needs prompt investigation?
Tinnitus in one ear only, pulsatile tinnitus that beats in time with the heartbeat, or tinnitus with sudden hearing loss, dizziness or neurological symptoms should be assessed promptly.
Do hearing aids help tinnitus?
Often yes. By restoring external sound input they reduce the contrast that makes tinnitus prominent, and many people report substantial improvement when coexisting hearing loss is treated.
Will it ever go away?
Sometimes, particularly when a treatable cause such as earwax is found. More often it persists but becomes far less intrusive over time, especially with sound therapy and cognitive behavioural approaches.
References
Important: Dard AI is not a medical device and does not diagnose, treat, or replace clinician judgement. This article is general information only. Always consult a qualified healthcare professional about diagnosis and treatment, and seek emergency care for severe or rapidly worsening symptoms.