Tinnitus Treatment

Tinnitus is commonly described as a ringing sound, but some people hear other types of sounds, such as roaring or buzzing. Tinnitus is common, with surveys estimating that 10 to 25% of adults have it. Children can also have tinnitus. For children and adults, tinnitus may improve or even go away over time, but in some cases, it worsens with time. When tinnitus lasts for three months or longer, it is considered chronic.

The causes of tinnitus are unclear, but most people who have it have some degree of hearing loss. Tinnitus is only rarely associated with a serious medical problem and is usually not severe enough to interfere with daily life. However, some people find that it affects their mood and their ability to sleep or concentrate. In severe cases, tinnitus can lead to anxiety or depression.

Tinnitus Treatment

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Currently, there is no cure for tinnitus, but there are ways to reduce symptoms. Common approaches include the use of sound therapy devices (including hearing aids), behavioral therapies, and medications.

The symptoms of tinnitus can vary significantly from person to person. You may hear phantom sounds in one ear, in both ears, and in your head. The phantom sound may ring, buzz, roar, whistle, hum, click, hiss, or squeal. The sound may be soft or loud and may be low or high pitched. It may come and go or be present all the time. Sometimes, moving your head, neck, or eyes, or touching certain parts of your body may produce tinnitus symptoms or temporarily change the quality of the perceived sound. This is called somatosensory (pronounced so-ma-toe-SENSE-uh-ree) tinnitus.

Most cases of tinnitus are subjective, meaning that only you can hear the sounds. In rare cases, the sound pulsates rhythmically, often in time to your heartbeat. In these cases, a doctor may be able to hear the sounds with a stethoscope and, if so, it is considered to be objective tinnitus. Often, objective tinnitus has an identifiable cause and is treatable.

One leading theory is that tinnitus can occur when damage to the inner ear changes the signal carried by nerves to the parts of your brain that process sound. A way to think about this is that while tinnitus may seem to occur in your ear, the phantom sounds are instead generated by your brain, in an area called the auditory cortex.

Other evidence shows that abnormal interactions between the auditory cortex and other neural circuits may play a role in tinnitus. The auditory cortex communicates with other parts of the brain, such as the parts that control attention and emotions, and studies have shown that some people with tinnitus have changes in these nonauditory brain regions.

If you have tinnitus, first see your primary care doctor, who will check for earwax or fluid from an ear infection that could be blocking your ear canal. Your doctor will also ask about your medical history to find out if an underlying condition or a medication may be causing your tinnitus.

Next, you may be referred to an otolaryngologist (commonly called an ear, nose, and throat doctor, or an ENT). The ENT will ask you to describe the tinnitus sounds and when they started, and will examine your head, neck, and ears. You might also be referred to an audiologist, who can measure your hearing and evaluate your tinnitus.

The ENT may order imaging tests, especially if your tinnitus pulsates. Imaging tests such as magnetic resonance imaging (MRI), computed tomography (CT), or ultrasound can help reveal whether a structural problem or underlying medical condition is causing your tinnitus.

When tinnitus has an underlying physiological cause, such as earwax or jaw joint problems, addressing the cause can eliminate or greatly reduce symptoms. But for many people, symptoms can persist for months or even years. There are several ways to lessen the impact of tinnitus. Below are some of the treatments that your doctor may recommend.

Investigators at the National Institutes of Health (NIH) and at other research centers across the country, many supported by NIDCD, are working to better understand what causes tinnitus and to develop new treatment strategies. Evidence suggests that tinnitus is caused by changes in neural networks in the brain, so many research efforts are aimed at testing the benefit of magnetic or electrical stimulation of the brain.

Your doctor will typically diagnose you with tinnitus based on your symptoms alone. But in order to treat your symptoms, your doctor will also try to identify whether your tinnitus is caused by another, underlying condition. Sometimes a cause can't be found.

Treatment for tinnitus depends on whether your tinnitus is caused by an underlying health condition. If so, your doctor may be able to reduce your symptoms by treating the underlying cause. Examples include:

Many times, tinnitus can't be cured. But there are treatments that can help make your symptoms less noticeable. Your doctor may suggest using an electronic device to suppress the noise. Devices include:

Behavioral treatment options aim to help you live with tinnitus by helping you change the way you think and feel about your symptoms. Over time, your tinnitus may bother you less. Counseling options include:

Drugs can't cure tinnitus, but in some cases they may help reduce the severity of symptoms or complications. To help relieve your symptoms, your doctor may prescribe medication to treat an underlying condition or to help treat the anxiety and depression that often accompany tinnitus.

Researchers are investigating whether magnetic or electrical stimulation of the brain can help relieve symptoms of tinnitus. Examples include transcranial magnetic stimulation (TMS) and deep brain stimulation.

Often, tinnitus can't be treated. Some people, however, get used to it and notice it less than they did at first. For many people, certain adjustments make the symptoms less bothersome. These tips may help:

The diagnosis of tinnitus includes a complete history and physical exam. Your health care provider may request an audiological evaluation. Depending on the suspected cause of the tinnitus, other tests may be needed.

Tinnitus can affect your quality of life. Your healthcare provider may be able to determine the underlying cause, which can then be treated. Work with your healthcare provider to determine strategies for reducing tinnitus.

Almost everyone has had tinnitus for a short time after being exposed to extremely loud noise. For example, attending a loud concert can trigger short-lived tinnitus. Some medications (especially aspirin and other nonsteroidal anti-inflammatory drugs taken in high doses) can cause tinnitus that goes away when the drug is discontinued. When it lasts more than six months, it's known as chronic tinnitus. As many as 50 to 60 million people in the United States suffer from this condition; it's especially common in people over age 55 and strongly associated with hearing loss. Many people worry that tinnitus is a sign that they are going deaf or have another serious medical problem, but it rarely is.

The course of chronic tinnitus is unpredictable. Sometimes the symptoms remain the same, and sometimes they get worse. In about 10% of cases, the condition interferes with everyday life so much that professional help is needed.

Most people who seek medical help for tinnitus experience it as subjective, constant sound like constant ringing in the ears or a buzzing sound in the ear, and most have some degree of hearing loss. Things that cause hearing loss (and tinnitus) include loud noise, medications that damage the nerves in the ear (ototoxic drugs), impacted earwax, middle ear problems (such as infections and vascular tumors), and aging. Tinnitus can also be a symptom of Meniere's disease, a disorder of the balance mechanism in the inner ear.

Most tinnitus is "sensorineural," meaning that it's due to hearing loss at the cochlea or cochlear nerve level. But tinnitus may originate in other places. Our bodies normally produce sounds (called somatic sounds) that we usually don't notice because we are listening to external sounds. Anything that blocks normal hearing can bring somatic sounds to our attention. For example, you may get head noise when earwax blocks the outer ear.

If you develop tinnitus, it's important to see your clinician. She or he will take a medical history, give you a physical examination, and do a series of tests to try to find the source of the problem. She or he will also ask you to describe the noise you're hearing (including its pitch and sound quality, and whether it's constant or periodic, steady or pulsatile) and the times and places in which you hear it. Your clinician will review your medical history, your current and past exposure to noise, and any medications or supplements you're taking. Tinnitus can be a side effect of many medications, especially when taken at higher doses (see "Some drugs that can cause or worsen tinnitus").

Tinnitus that's continuous, steady, and high-pitched (the most common type) generally indicates a problem in the auditory system and requires hearing tests conducted by an audiologist. Pulsatile tinnitus calls for a medical evaluation, especially if the noise is frequent or constant. MRI or CT imaging may be needed to check for a tumor or blood vessel abnormality.

In addition to treating associated problems (such as depression or insomnia), there are several strategies that can help make tinnitus less bothersome. No single approach works for everyone, and you may need to try various combinations of techniques before you find what works for you. If you have age-related hearing loss, a hearing aid can often make tinnitus less noticeable by amplifying outside sounds.

There is no FDA-approved drug treatment for tinnitus, and controlled trials have not found any drug, supplement, or herb to be any more effective than a placebo. That includes ginkgo biloba, which is sometimes promoted for this purpose. Some patients believe that acupuncture helps, but it too has been found to be no better than a placebo.

Tinnitus retraining therapy (TRT). This technique is based on the assumption that tinnitus results from abnormal neuronal activity (see "What's going on?"). The aim is to habituate the auditory system to the tinnitus signals, making them less noticeable or less bothersome. The main components of TRT are individual counseling (to explain the auditory system, how tinnitus develops, and how TRT can help) and sound therapy. A device is inserted in the ear to generate low-level noise and environmental sounds that match the pitch, volume, and quality of the patient's tinnitus. Depending on the severity of the symptoms, treatment may last one to two years. 2351a5e196