Tinnitus
This information is intended as a general introduction to this topic. As each person is affected differently by balance and dizziness problems, speak with your health care professional for individual advice.
What is tinnitus?
Tinnitus, from the Latin word tinnire (to ring), is the perception of sound generated in the head. Tinnitus (say TIN-ni-tus or tin-NI-tus) is not a disorder or disease – it is a symptom of an underlying condition. Tinnitus ranges in severity from a temporary inconvenience to a chronic, lifestyle-threatening condition.
Tinnitus is brought on by the background hum of the brain. Neurons (tiny fibres) in the brain continuously send information back and forth to the rest of the body. At rest, these neurons have some background activity. With tinnitus, the neurons are hyperactive, firing spontaneously with each other when there is no sound to be heard. That information is sent to the brain where it is mistaken as sound.
You may be aware of the sound in one ear or side of the head, in both ears, or in the centre of the head. The type of sound heard ranges in pitch (highness or lowness of tone) and loudness. The sound may or may not pulse. Commonly described sounds include clicking, humming, ringing, buzzing, hissing, and sizzling. The perception of music, indistinct voices with no meaning, and explosions are less common.
Tinnitus can start abruptly but usually comes on gradually. It may be continuous or may fluctuate (come and go).
Most people with tinnitus have some form of hearing loss, even though they may not recognize it. If the causes of hearing loss are temporary, the tinnitus often goes away.
There are two forms of tinnitus:
- subjective tinnitus is heard only by the patient (at least 95% of cases are subjective)
- objective tinnitus can be heard by a doctor with a stethoscope
People with either type of tinnitus may also have pressure in the ears (aural fullness) and dizziness.
Tinnitus is common. 43% of Canadians aged 16 to 79 experience tinnitus in their lifetime. More men than women are affected, likely because of greater exposure, in general, to loud noise at work, school, or leisure. Tinnitus becomes increasingly common with age. It is rarely a sign of a serious medical condition. About 90% of sufferers have some hearing loss in one or both ears. 40% of people with tinnitus also have decreased sound tolerance (hyperacusis).
Though not life threatening, tinnitus can have a serious impact on some people’s lives and livelihoods. For example, it is the top condition for which male RCMP qualify to receive a disability pension. In most cases, however, people with tinnitus can learn to manage the condition and get on with their lives.
What causes tinnitus?
Tinnitus may happen with no apparent cause (idiopathic) or secondary to other factors including:
- Vestibular (inner-ear) disorders such as acoustic neuroma, age-related hearing loss (presbycusis), cholesteatoma, Ménière’s disease, otosclerosis, perilymph fistula, secondary endolymphatic hydrops (SEH), and semicircular canal dehiscence (SCD).
- Other ear-related problems such as middle ear infections, hearing loss secondary to infectious disease, ruptured eardrum, trauma, and earwax blockage.
- Neurologic injuries or disease such as concussion, multiple sclerosis, and seizure disorder.
- Blood vessel problems such as atherosclerosis, head and neck tumours, high blood pressure, narrowing or kinking in a neck artery or vein, and malformation of capillaries.
Tinnitus caused by blood vessel (vascular) problems is called pulsatile tinnitus. It is rare, accounting for about 5% of all tinnitus, and warrants thorough medical investigation. People with pulsatile tinnitus hear a rushing, wave-like sound that is often synchronized to their heartbeat. There have been advances in surgical treatments for pulsatile tinnitus. - Metabolic conditions such as thyroid disorders, anemia, and diabetes.
- Musculoskeletal conditions such as temporomandibular joint (TMJ) disorders and neck problems.
- Ototoxic medications such as aminoglycoside antibiotics, some cancer therapies (in particular platinum-based drugs), some antidepressants, and non-steroidal anti-inflammatories (NSAIDs), including high daily doses of aspirin, quinine, and loop diuretics.
- Psychogenic conditions such as chronic or acute stress, depression, and anxiety.
Acute or long-term noise exposure is a common and preventable cause of tinnitus. For example, risky listening habits - such as continuous use of ear buds and exposure to loud music at rock concerts - are contributing to rising rates of tinnitus among young people.
Other suggested risk factors include:
- obesity
- smoking and exposure to second-hand smoke
- alcohol use
- history of arthritis
- high blood pressure (hypertension)
Some studies suggest a small genetic predisposition.
The noise of an MRI scan may trigger or worsen tinnitus. Scanning sequences for the internal auditory canal (IAC) are especially noisy. Hearing protection should be available and equipment can be set up to reduce noise exposure.
Diagnosis of tinnitus
A general practitioner usually makes a diagnosis of tinnitus. There is no objective test to measure most tinnitus. It is based on symptoms and the patient’s medical history rather than lab tests, vestibular tests, or medical imaging. The doctor will ask questions about the location and type of perceived sound, particularly whether it is rhythmic or pulsing. In rare cases a stethoscope can be used to detect pulsatile tinnitus.
More thorough investigation by an otolaryngologist is called for if tinnitus is:
- unilateral (only in one ear)
- pulsatile (the sound has a steady beat that is often synchronized to the patient's heartbeat)
- accompanied by a sudden change in hearing, ear pain, or dizziness
Further testing and specialist referrals will likely be requested in cases where there are signs of a serious underlying medical condition.
Impact of living with tinnitus
When the brain gives tinnitus signal priority, the impact can be considerable. 7% of Canadians report having tinnitus that is bothersome enough to cause:
- disturbed sleep
- problems with concentration and focus
- difficulty hearing other sounds
- greater awareness of tinnitus in quiet surroundings
- a range of feeling including anxiety, despair, hopelessness, anger, frustration, persecution, and loss of control
Treatment and management
There are no effective drug treatments for tinnitus. Surgery may be an option for people with pulsatile tinnitus.
If you have a treatable medical condition connected to your symptoms, the doctor may be able to reduce the noise. For example:
- removing impacted earwax
- treating a blood vessel condition
- treating an infection in the ear
- changing, stopping, or reducing a medication
- treating a TMJ (temporomandibular joint disorder)
Fortunately, a variety of effective options are available to improve a tinnitus patient's quality of life. Which option is used depends on factors such as:
- The severity of the tinnitus and how much it impacts your life. Tinnitus is not equally distressing to everyone; about 25% of people seek help.
- How hearing loss also affects you.
- Individual preference.
A personalized approach is recommended and may include one or more of the following:
Tinnitus retraining therapy (TRT)
TRT can help people habituate (grow accustomed) to their tinnitus. TRT combines sound therapy with informational counselling to reduce the emotional and fearful associations of tinnitus. TRT can also help to partly or completely reverse hyperacusis.
Research shows improvement in over 80% of people after TRT. This is significantly above the placebo effect of 40%. It is higher than any other available treatment or therapy. Most people notice improvement in as little as 6 to 8 weeks.
Therapy is usually done over 16 to 24 months. The average patient reports that perceived tinnitus loudness decreases by 50% after TRT. More importantly, with TRT therapy tinnitus becomes a neutral signal and no longer causes emotional reactions.
Group and individual TRT sessions are offered through the audiology departments of some hospitals. A copy of the “consult” letter from your otolaryngologist (ENT doctor) and copies of any hearing tests are likely required to make an appointment. Fees are usually not covered by provincial or territorial health plans. Audiologists at a number of private hearing clinics in Canada offer TRT sessions. Fees are not covered by provincial or territorial health plans.
Wideband sound therapy using a sound generator
Benefits of sound therapy include:
- providing a distraction and relief from hearing tinnitus
- fostering a sense of self control over tinnitus
- helping retrain neural networks involved with tinnitus generation
- promoting relaxation
- improving sound tolerance
- indirectly validating tinnitus as a legitimate concern to family, friends, and colleagues
Pink (more bass than white) and brown (more bass than pink) noise may be most comfortable for people with tinnitus. Use of a tabletop sound machine or sound pillows rather than in-ear devices is recommended at night to improve sleep quality.
Sound amplification
Tinnitus can be helped with sound amplification with or without a sound generator using hearing aids. Most modern hearing aids have a sound generator option. Addressing even mild hearing loss can decrease tinnitus awareness.
Other benefits of using hearing aids include:
- improving listening ease and sound tolerance
- promoting relaxation
- disrupting neural activity
The success rate of using hearing aids as a standalone treatment for tinnitus is about 15%. It goes up to over 80% when used in combination with tinnitus retraining therapy (TRT). Financial help to purchase hearing aids may be available.
Medication
Drugs cannot cure tinnitus but, in some cases, antidepressants and anti-anxiety medications may help reduce symptoms or complications.
Complementary and alternative medicine (CAM)
There is little evidence that CAM treatments such as acupuncture, hypnosis, ginkgo biloba, melatonin, zinc supplements, and B vitamins work for tinnitus.
Surgical treatments
Minimally invasive surgery may be done on patients with pulsatile tinnitus caused by narrowing of veins in the brain (venous sinus stenosis). A metal stent is inserted in the narrowed vein to restore healthy blood flow. The procedure can reduce or eliminate the pulsating noise in about 90% of these patients.
Lifestyle changes
For some people, certain lifestyle changes reduce the annoyance of tinnitus sound. These ideas may help:
- Reduce your exposure to loud noises that may make your tinnitus worse. Wear hearing protection when you cannot avoid being in a noisy environment.
- Evaluate your diet. Some people find tinnitus improves by reducing salt consumption.
- When in a quiet room, mask the noise from tinnitus by using a fan or playing soft music.
- Manage stress – it can make tinnitus worse for many people. Practicing mindfulness-based stress reduction can help you learn to refocus your mind on something other than your tinnitus. It can be done through self-study, classes, or through an online course tailored for tinnitus relief such as Mindfulness Based Tinnitus Stress Reduction. Other approaches to managing stress include practicing relaxation techniques, therapeutic massage, and physical activity.
- Reduce alcohol, caffeine, and nicotine consumption. They may increase tinnitus symptoms by increasing greater blood flow, particularly in the inner ear area.
- Get adequate sleep – lack of sleep often makes tinnitus worse.
- Avoid medications known to increase tinnitus such as aspirin, non-steroidal anti-inflammatories (NSAIDs), and preparations containing quinine.
Coping and support
Cognitive behavioural therapy (CBT) can be an effective tool for developing strategies to move forward with your life despite your tinnitus.
Simply understanding tinnitus better makes it less annoying for some people. You may find it helpful to learn as much as you can about tinnitus, both from this site and elsewhere.
Some people find it helpful to connect with others who have the same condition. Support groups, whether online or in-person, can help you share information and tips and reassure you that you are not alone.
What to expect in the future
Treatment of underlying conditions is essential and may resolve tinnitus.
There is no cure for the vast majority of tinnitus. However, evidence-based research suggests a combination of education, sound therapy and CBT-based counselling is most effective. Although this does not stop the perception of tinnitus, it can improve quality of life by reducing awareness of – and reaction to – tinnitus.
Hopefully, research will lead to the development of new technological devices to improve treatment for patients with tinnitus. Devices and techniques under development include:
- the Lenire® under-tongue treatment device
- functional near-infrared spectroscopy (fNIRS) technology to objectively measure tinnitus.
Read more about these future treatments
Currently several other potential approaches to treating tinnitus are being studied. For example, one study connects brain inflammation to tinnitus. The research group found that inflammation in a sound-processing region of the brain triggers evidence of tinnitus in mice with sound-induced hearing loss. This suggests that reducing inflammation in the brain may be a therapeutic target for treating tinnitus. However much more work is needed to figure out if these results in mice translate to humans. While a cure for tinnitus is still long way off, every bit of knowledge and every new finding gives hope that someday it may be possible.
More resources
The following can offer more help and support for affected individuals and their families.
Support groups
Contact the Candian Hard of Hearing Association for information about support groups near you.
Websites
Hearing Education and Awareness for Rockers (HEAR)
Raises awareness of the dangers of noise exposure that can lead to permanent hearing loss and tinnitus.
Mindfulness-Based Tinnitus Stress Reduction
An eight-week online course utilizing elements of deep breathing, yoga, relaxation, and meditation to reframe your relationship with tinnitus. A study showed this program, “may be an effective intervention for treating chronic tinnitus and its comorbid symptoms, and may help reduce depression and phobic anxiety while improving social functioning and overall mental health.”
Apps
Apps are not in themselves a solution for tinnitus, however they are another option to try. Check with your audiologist before using apps for tinnitus. General relaxation apps may also be helpful.
Tinnitus Calmer
Compatible with Beltone® hearing aids. Available for iOS and Android.
Oticon ON
Compatible with Oticon® hearing aids. Available for iOS and Android.
ReSound Tinnitus Relief
Compatible with ReSound® hearing aids. Available for iOS and Android.
Starkey Relax
Offers 12 relief sounds that can be customized to your unique tinnitus and saved. There are multiple options for use. Play through your Apple or Android device or any connected speaker/headphone. Or stream from any Apple device to any Made for iPhone hearing aids or 900sync hearing aids (via the SurfLink Mobile® device) from Starkey®, Audibel®, NuEar®, MicroTech® or AGX Hearing®.
Widex ZEN Therapy
Compatible with Widex® hearing aids. Available for iOS and Android.
myNoise
Offers sound generators that are also relaxing. The properties of the noise can be customized to emphasize certain frequencies over others, according to user preference. Other custom sound can be purchased. Listen from the website and/or iOS and Android apps.
TMSOFT
Offers several versions of both white noise and sound generator apps. Available for iOS and Android.
Whist
Allows users to identify the individual sound characteristics that provide the most tinnitus relief and to try different sound therapy approaches. Also provides basic education related to the different sound therapy methods. Available for iOS and Androi
Books
Most of the following books are available for loan through public libraries – if your local library does not own a copy of a title that interests you, ask for it to be sent from another library through interlibrary loan.
How to Manage Your Tinnitus: A Step-by-Step Workbook by James A. Henry, Tara L. Zaugg, Paula J. Myers and Caroline J. Kendall (2010)A self-help workbook intended for use by anyone who is bothered by tinnitus. This third edition of the workbook has been extensively revised and expanded to include new sections describing key components of Cognitive-Behavioural Therapy (CBT).
Not available from public libraries in BC – download a PDF version free-of-charge from the National Center for Rehabilitative Auditory Research.
Living with Tinnitus and Hyperacusis by Drs. Lawrence McKenna, David Baguley and Don McFerran (2010)Presents recent medical thinking and treatments, including sound therapy, and suggests effective self-help techniques based on cognitive behavioural therapy (CBT). Topics include: relaxation therapy, getting a good night’s sleep, avoiding relapse, and helping adults and children with these disorders.
Rewiring Tinnitus: How I Finally Found Relief from the Ringing in My Ears by Glenn Schweitzer (2016)Actionable techniques and specific exercises to help those with tinnitus change their emotional, physical and psychological response to tinnitus so they can finally start to tune it out. The author was 24 years old when developed severe tinnitus after being diagnosed with Ménière’s disease.
Tinnitus Toolbox Hyperacusis Handbook by Jan L. Mayes (2019)Tinnitus Toolbox Hyperacusis Handbook covers currently available international science-based approaches including self-help, guided self-help, professional treatments, clinical trials, and experimental research. Written by a Vancouver audiologist who herself suffers from tinnitus.
Sources
Baguley D, McFerran D, Hall D. Tinnitus. The Lancet. 382:9904, p1600-1607. November 9, 2013. Available from: https://bit.ly/2JwgzR4
Boddu S, Dinkin M, Suurna M, Hannsgen K, Bui X, Patsalides A. Resolution of pulsatile tinnitus after venous sinus stenting in patients with idiopathic intracranial hypertension. PloS One. 2016 Oct 21;11(10). Available from: https://bit.ly/38QRzip
Evaluation of the grant to compensate members of the RCMP for injuries received in the performance of their duties. RCMP report. January 2014.Government of Canada. Available from: https://bit.ly/2Jl4U8x
Hain TC. Tinnitus. Balance-and-dizziness.com. Available fromhttps://bit.ly/2NEzrR8 Accessed August 27, 2019.
Hain TC. Tinnitus treatment. Balance-and-dizziness.com. Available from: https://bit.ly/2Xa0uql Accessed August 27, 2019.
Ramage-Morin PL, Banks R, Pineault D, Atrach M. Tinnitus in Canada. Health Reports. Statistics Canada. March 2019. 30:3; 3-11. Available from: https://bit.ly/2q37tWa
Robb MJA. A silver jubilee tribute to Pawel J. Jasterboff, PhD. Tinnitus Today. 40:3. p.14. Winter 2015. Available from: https://bit.ly/2LHDzPv
Shulman A, Wang W, Luo H, Bao S, Searchfield G, Zhang J. Neuroinflammation and Tinnitus. Curr Top Behav Neurosci. 2021;51:161-174. Abstract available from: https://bit.ly/323Fqc1
Tidball G. Tinnitus and hyperacusis. 2014. Presentation to Balance & Dizziness Canada.
Tidball G. Tinnitus – The essentials of patient care in BC (2014). Available from: https://bit.ly/2XB8YdF
Page updated December, 2021.
