Tinnitus cases are rising globally, with COVID-19 driving a surge in tinnitus worldwide. Since the start of the pandemic, the British Tinnitus Association has seen a more than threefold increase in the use of its web chat services. So, what is tinnitus, and how do you know if you have it?
Tinnitus comes from the Latin word tinnire, which means “to ring.”
Generally speaking, tinnitus is when you hear sound in one or both ears that doesn’t come from an outside source. Though it’s commonly described as a “ringing in the ears,” tinnitus can manifest as hums, whistles, clicks, tones, whooshes, and hisses. These sounds may be constant, or they could come and go.
Types of Tinnitus
Tinnitus can be broken down into two general types:
- Subjective tinnitus refers to a sound that only you can hear. It’s the most common type, and it can’t be measured, so audiologists must rely on self-reporting for diagnosis.
- Objective tinnitus can be heard or measured by an outside observer. It’s a rarer form of tinnitus caused by problems in the blood vessels or muscles near the ear.
Subtypes of Tinnitus
While most tinnitus originates in or around the ear, this type of subjective tinnitus is rooted in the brain. It usually signifies a defect in the auditory processing mechanism caused by disorders like Meniere’s disease.
This form of tinnitus is caused by spasms in the jaw or neck muscles. Muscle twitches, contractions, and clicks in the jaw can directly exert force on the mechanisms of the middle ear or the inner ear, causing objective or subjective tinnitus.
In rare cases, tinnitus can take the form of musical hallucinations, where the sounds and tones a person hears layer together, and the mind perceives them as melodies.
When you hear whooshing sounds that throb in time with your heartbeat, it’s called pulsatile tinnitus. It’s linked to blood vessel disorders and cardiovascular medical conditions that affect the blood flow around your ears.
Some tinnitus takes the form of extremely low humming or droning sounds that correspond to the bass clef of musical notation. Patients with this kind of tinnitus find it particularly uncomfortable and distressing because it’s hard to tell if the sound is coming from the outside or not.
Strictly speaking, tinnitus is a symptom of multiple underlying medical conditions, not a disorder itself. A few symptoms commonly accompany tinnitus, depending on the health conditions involved.
Some of the most frequently associated symptoms are listed below.
Hearing loss and tinnitus go hand in hand because conditions occur when the ear is damaged or blocked. Loud noise exposure is a common denominator in both.
According to the Hearing Loss Association of America, 90 percent of people with tinnitus experience some degree of hearing loss.
Studies have found a strong relationship between tinnitus and vertigo. Dizziness is a common associated complaint in cases of tinnitus caused by a neurological condition, vestibular dysfunction, or Meniere’s disease.
Chronic tinnitus can heighten feelings of anxiety because the condition is a source of irritation and distress. At the same time, anxiety and stress can also bring on tinnitus symptoms. Various relaxation techniques and anxiolytics are often an essential part of managing tinnitus.
People with severe tinnitus often report depression because the condition limits one’s ability to do things they enjoy, like listening to music or socializing. Tinnitus also causes stress, which some experts believe can weaken a person’s defenses against depression and anxiety.
Ear infections, fluid buildup, blockages and other conditions that cause tinnitus often cause pain and inflammation inside the ear. Damage to the tiny sensory hair cells of the inner ear from loud sounds is a source of pain and tinnitus.
If your tinnitus is due to a neurological condition or head and neck trauma, you’ll likely get a headache, as well. Also, people with migraines frequently experience debilitating tinnitus that is pulsatile and persists for the duration of the headache.
If your tinnitus is due to an auto-immune condition or Lyme disease, you may also experience fatigue. What’s more, severe, chronic tinnitus often leads to insomnia or poor sleep, so you won’t wake up feeling rested.
Self-Treating Your Tinnitus
Many types of tinnitus will disappear without medical intervention. Before you see a doctor, you can try a few things that might make your symptoms go away.
Maintain A Tinnitus Diary
To help you understand how your condition is progressing, you can take some basic notes. Write down things like:
- Onset of symptoms
- Duration, frequency, and characteristics of the sounds your hearing
- Factors that aggravate or relieve your tinnitus
- Other symptoms like headache, pain or congestion
Because hearing loss and damage to the inner ear play such a significant role in tinnitus, eliminating loud noises can help.
If you’re in a job where loud noise exposure is constant, noise-canceling earphones and earplugs might be an excellent way to cut down on loud noise.
Check the levels of your electronic devices, and try to curb the amount of time spent listening to loud music or television. Avoid noisy places like bars and clubs, and wear ear protection if noise is unavoidable.
Limit Caffeine, Nicotine and Alcohol
While these substances may not cause tinnitus directly, they affect blood flow to the ear. Some theories suggest that turbulence in the bloodstream can cause some forms of tinnitus. All of them potentially cause insomnia, which can worsen tinnitus.
Mindfulness and De-stress
Practice mindfulness-based techniques to help you relax and stress. Deep breathing, meditation, massage therapy have all been found to help people with tinnitus.
Get Enough Sleep
Many people with tinnitus report that it disappears with a good night’s rest. Pay attention to how your tinnitus is affecting your sleep patterns. If it’s keeping you up at night, you might want to try going to sleep with soft music or white noise playing to mask the sound.
When To Seek Help
If your tinnitus only lasts for a few minutes, you can probably ignore it. However, you should seek medical attention if your tinnitus:
- Persists longer than two weeks
- Gets progressively worse
- Is constant and debilitating
Talk to Your Primary Care Provider
You should first consult with your primary care provider, who will examine the middle ear for signs of blockage and infection as well as the inner ear to see if there are ruptures.
The doctor may administer a hearing test and a preliminary screening for hearing loss or other underlying medical conditions. They’ll review your medical history to see if any medications you’re taking could be to blame and prescribe alternatives if necessary. They might also request bloodwork.
If it’s something simple like an impaction of wax or an ear infection, your primary care provider can give your ear drops, antibiotics or other medications. However, If they cannot determine the correct diagnosis and course of treatment, the doctor may refer you to an ENT specialist or audiologist for further testing.
Seeing a Specialist
If you seem to be showing signs of hearing loss, you’ll need to see an audiologist to zero in on the precise cause so that you can treat it correctly. An audiologist will examine you for damage or degeneration to the inner and middle ear. The most common types of tests are:
- Pure-Tone Testing
- Speech Testing
- Auditory Brainstem Response (ABR)
- Otoacoustic Emissions (OAEs)
If the audiologist finds that you have hearing loss, they’ll recommend hearing aids to help you hear better.
A hearing aid can help deal with tinnitus.
Since tinnitus has multiple causes, it can take some time to eliminate all of them before your doctors find the root. In many cases, tinnitus is idiopathic, meaning no single cause can be identified.
After your doctors rule out the most likely culprits, they will look for rarer conditions. A doctor may have to get X-rays for head or neck trauma, or they could order a brain MRI to check for tumors in the auditory nerve.
Treatments and Therapies
In most cases, tinnitus goes away by treating the underlying condition.
However, some types of tinnitus—like those associated with age-related hearing loss—are chronic and irreversible. Luckily, there are many highly effective treatments that can make living with tinnitus much more bearable.
Common treatments include:
- Tinnitus Masking Therapy (TMT)
- Tinnitus Retraining Therapy (TRT)
- Hearing aids
- Cognitive Behavioral Therapy
TRT, which uses sound generators to train the brain to ignore symptoms, is particularly promising. Clinical tests show that it provides tinnitus relief in 80 percent of tinnitus patients. What works for one person may not work for someone else.
As with diagnosis, tinnitus treatment is often by trial and error, so be patient.
Tinnitus is a common symptom of various medical conditions. Most of these are mundane and easily treatable, but intense, long-lasting tinnitus might signify something serious. The intensity, frequency, duration and characteristics of tinnitus symptoms offer clues about the underlying cause.
If chronic tinnitus affects your ability to do ordinary tasks, keep a record of your symptoms and see a doctor. You may need to undergo a long series of tinnitus tests and treatments, but you should be able to find relief in all but the rarest cases.
1. Miura M, Goto F, Inagaki Y, Nomura Y, Oshima T, Sugaya N. The Effect of Comorbidity between Tinnitus and Dizziness on Perceived Handicap, Psychological Distress, and Quality of Life. Front Neurol. 2017;8:722. Published 2017 Dec 22. doi:10.3389/fneur.2017.00722
3. Lugo, A., Edvall, N.K., Lazar, A. et al. Relationship between headaches and tinnitus in a Swedish study. Sci Rep 10, 8494 (2020). https://doi.org/10.1038/s41598-020-65395-1