(Last updated Apr 30, 2020)

Tinnitus Causes and Treatments

Ringing in the ears, buzzing, humming, chirping, crickets. These are just a few of the words people use to describe their tinnitus. Tinnitus is the sensation of sounds or noises within the ear (not originating outside the body).

Tinnitus is not imaginary! It is very much real, even if it is “in your head”. Just because other people don’t hear your tinnitus does not mean it isn’t there. In fact, there are two types of tinnitus. One type is subjective tinnitus, which no one else can hear. The other type is objective tinnitus which other people can also hear.

Make no mistake. Tinnitus is a significant problem that affects some 50 million Americans. About one in ten adults live with it, and as many as one in five over the age of 60. Tinnitus is not a disease or a medical condition of its own, but a symptom of a medical condition.

Damage to the auditory system

Tinnitus usually signifies some form of damage to the auditory system. The damage is often in the inner ear, which is typical of age-related hearing loss. Or it may be associated with other parts of the system including the outer ear, middle ear, and auditory nerve. Just about any source of damage to the auditory system has the potential to result in tinnitus.

A quick internet search will reveal some alarming possibilities about the causes of tinnitus. If you are worried about whether your tinnitus is caused by something dangerous, don’t panic! Tinnitus is rarely a sign of serious illness, and does not usually come from something “dangerous”.

Experiencing tinnitus? You may have hearing loss
If you experience high-pitched tinnitus in both ears, there is a good chance that hearing loss is to blame. Do you have a history of noise exposure? Difficulty hearing or understanding speech? These are some more reasons to think your tinnitus may be related to hearing loss.

You cannot tell from these symptoms alone what caused your tinnitus. However, sensorineural hearing loss is the most common cause of tinnitus, which makes this the most likely possibility in the absence of other clues. Sensorineural hearing loss includes age-related and noise-induced hearing loss.

A possible explanation: The auditory gain theory
How is tinnitus related to hearing loss? One theory goes something like this:

  1. The auditory nerve transmits information from the cochlea (inner ear) to the brain, in the form of electrical signals.
  2. Hearing loss reduces the amount of information provided by the cochlea to the auditory nerve.
  3. The brain tries to compensate by increasing gain in the auditory nerve—in effect, causing the nerve to “listen harder”.
  4. Increasing gain of the auditory nerve has an unwanted side effect in the form of spontaneous signals from the nerve that don’t come from the inner ear.
  5. The brain perceives these spontaneous signals as noise.

Notice that, according to this theory, the tinnitus perception results from a real electrical signal sent by the auditory nerve to the brain. The problem is that the signal does not represent a real acoustic event. In other words, the brain perceives the tinnitus noise as if it were a sound originating outside the head.

Phantom hearing
This concept of tinnitus is a lot like the bizarre phenomenon of phantom pain—the sensation of pain from a dismembered body part. It should not be possible for a limb that is not there to hurt, and yet it does. Tinnitus is phantom hearing.

The sounds you hear with tinnitus are just as real as the phantom pain someone might experience after amputation of an injured leg. It’s also worth mentioning that some types of tinnitus are not phantom hearing at all. In some cases, the tinnitus comes from physical noises within the body.

Tinnitus happens even without hearing loss
No one fully understands tinnitus but hearing loss can’t be the only explanation. How do we know? The auditory gain theory described above doesn’t explain how people without hearing loss suffer from tinnitus. That group accounts for about 10-15% of tinnitus cases.

Causes of tinnitus

Tinnitus has a wide range of possible causes of including:

  • Sensorineural hearing loss—This is the most common cause of tinnitus. It is often associated with high-pitched tinnitus, typically in both ears. However, people’s descriptions of tinnitus vary as much as much as hearing loss does
  • Conductive hearing loss—Problems that interfere with sound transmission in the outer ear or movement of the middle ear bones. Because many causes of conductive hearing loss are treatable, it may also be possible to alleviate this type of tinnitus, by resolving the underlying problem.
  • Drugs that can damage the inner ear—Aspirin, diuretics, certain antibiotics, chemotherapy with cis-platinum, Vicodin, and other drugs can damage the sensitive structures of the inner ear.
  • Ménière’s disease—Low-frequency hearing loss, dizziness or vertigo, and a feeling of fullness in the ear typically characterize this medical condition. Tinnitus often manifests as a low-pitched roar or rushing noise.
  • Benign tumors—Tumors are a possible cause of tinnitus in only one ear. Those affecting the auditory nerve typically result in high-pitched tinnitus, worse hearing over time, and degraded speech understanding. Tumors affecting the jugular vein can result in pulsatile tinnitus. A portion of the jugular vein passes by the eardrum, where it is possible for your pulse to cause tinnitus synchronized with your heartbeat.

Effects of tinnitus

Many people who experience tinnitus consider it only a minor irritation. For a small percentage it can be severe or even debilitating. Tinnitus sometimes interferes with sleep, concentration, and communication, leading to such problems as decreased productivity at work and strained relationships. Anxiety and depression are common among people who suffer from tinnitus.

The percentage of people who feel that tinnitus severely disrupts their life is small, but the total number of people with tinnitus is large. If only one percent of those with tinnitus fit this description, then about half a million people in the US alone experience severe distress from their tinnitus.

There isn’t a direct correlation between the loudness or type of tinnitus and its severity. Whether or not the tinnitus is debilitating, everyone who hopes for relief from tinnitus deserves compassion and access to treatment options.

What to do if you have tinnitus

Two things you should do if you experience tinnitus of any kind are 1) consult your doctor and 2) get a hearing test. You should take these steps even if your tinnitus does not bother you, in case the underlying problem requires medical attention. If the tinnitus has started suddenly, without explanation, or is accompanied by hearing loss or vertigo, you should see your doctor soon.

Tinnitus Treatment

If a medical examination fails to identify the cause of your tinnitus, you can still get help and find relief. You don’t need to know the exact cause of your tinnitus to undergo treatment.
In most cases, there is no cure for tinnitus, but it is treatable. Getting relief may take some time and effort, but there are several treatment options.

Treatment of tinnitus may include:

  • Medical treatment of the underlying cause, if known.
  • Medical and/or psychological treatment of associated symptoms such as depression or anxiety.
  • Hearing aids can help with tinnitus, when hearing loss is present. Amplification not only helps people hear better. It often makes tinnitus less noticeable.
  • Sound therapy—Pleasant sounds and therapeutic noises designed to help you ignore or alleviate your tinnitus.
  • Cognitive behavioral therapy—a form of counselling scientifically proven to provide relief from tinnitus.
  • Mindfulness or meditation to promote health and well-being.
Jeff Hall Jeff Hall Jeff is a California licensed hearing aid dispenser and the President of ZipHearing- one of the largest discount hearing aid suppliers in the United States. Jeff lives in San Diego, CA with his wife and 2 young daughters. You can learn more about hearing aids and watch Jeff on ZipHearing's Youtube channel.

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