The degree of loudness or annoyance caused by tinnitus varies greatly from one individual to another. Loudness and annoyance do not always covary. An individual with loud tinnitus may not be troubled, while an individual with soft tinnitus may be debilitated. Most individuals with subjective tinnitus have hearing loss that shows up in a standard clinical audiogram. Tinnitus can sometimes worsen or sometimes improve over time.
Smoking. Contrary to popular belief, there are some external irritants that can cause tinnitus. For example, Nicotine has been proven to be an irritant that can cause someone to develop a ringing in their ears. Smokers may find that their chances of developing the condition may be higher than someone who is a non-smoker. If you’re suffering from tinnitus right now, and you’re a smoker, please quit as soon as possible. If that’s just not an option for you right now, be sure to at least pick up an over the counter tinnitus treatment that will dramatically reduce the ringing in your ears.
While tinnitus is as varied as its causes, it can be grouped into two categories: tonal and non-tonal. Tonal tinnitus is more common and describes the perception of a near-continuous sound or overlapping sounds with a well-defined frequency (e.g., whistling, ringing, buzzing). Non-tonal forms of tinnitus include humming, clicking, crackling, and rumbling.
Glenn Schweitzer is an entrepreneur, blogger, and the author of Rewiring Tinnitus and Mind over Meniere’s. He is passionate about helping others who suffer from tinnitus and vestibular disorders and volunteers as an Ambassador Board Member for the Vestibular Disorders Association (VEDA). Through his blogs, he continues raise awareness for tinnitus, Meniere’s disease, and other vestibular disorders, spreading his message of hope to those in need.
Even with all of these associated conditions and causes, some people develop tinnitus for no obvious reason. Most of the time, tinnitus isn’t a sign of a serious health problem, although if it’s loud or doesn’t go away, it can cause fatigue, depression, anxiety, and problems with memory and concentration. For some, tinnitus can be a source of real mental and emotional anguish.

People with warning signs should see a doctor right away. People without warning signs in whom tinnitus recently developed should call their doctor, as should people with pulsatile tinnitus. Most people with tinnitus and no warning signs have had tinnitus for a long time. They can discuss the matter with their doctor and be seen at a mutually convenient time.

Research regarding using cognitive behavioral therapy for tinnitus shows that tolerance to tinnitus can be facilitated by “reducing levels of autonomic nervous system arousal, changing the emotional meaning of the tinnitus, and reducing other stresses.” (6) It’s been found that there’s some overlap in anxiety and tinnitus due to an association between subcortical brain networks involved in hearing sounds, attention, distress and memory functions.
As of 2014 there were no medications effective for idiopathic tinnitus.[3][73] There is not enough evidence to determine if antidepressants[81] or acamprosate are useful.[82] While there is tentative evidence for benzodiazepines, it is insufficient to support usage.[3] Usefulness of melatonin, as of 2015, is unclear.[83] It is unclear if anticonvulsants are useful for treating tinnitus.[3][84] Steroid injections into the middle ear also do not seem to be effective.[85][86]
Masking. Masking devices, worn like hearing aids, generate low-level white noise (a high-pitched hiss, for example) that can reduce the perception of tinnitus and sometimes also produce residual inhibition — less noticeable tinnitus for a short time after the masker is turned off. A specialized device isn't always necessary for masking; often, playing music or having a radio, fan, or white-noise machine on in the background is enough. Although there's not enough evidence from randomized trials to draw any conclusions about the effectiveness of masking, hearing experts often recommend a trial of simple masking strategies (such as setting a radio at low volume between stations) before they turn to more expensive options.

It’s the same mechanism that’s happening in people who feel a phantom limb sensation after losing a limb, explains Susan Shore, PhD, a professor of otolaryngology, molecular physiology, and biomedical engineering at the University of Michigan in Ann Arbor. With tinnitus the loss of hearing causes specific brain neurons to increase their activity as a way of compensating, she explains. “These neurons also synchronize their activity as they would if there were a sound there, but there is no external sound,” she adds.
Most tinnitus is subjective, meaning that only you can hear the noise. But sometimes it's objective, meaning that someone else can hear it, too. For example, if you have a heart murmur, you may hear a whooshing sound with every heartbeat; your clinician can also hear that sound through a stethoscope. Some people hear their heartbeat inside the ear — a phenomenon called pulsatile tinnitus. It's more likely to happen in older people, because blood flow tends to be more turbulent in arteries whose walls have stiffened with age. Pulsatile tinnitus may be more noticeable at night, when you're lying in bed and there are fewer external sounds to mask the tinnitus. If you notice any new pulsatile tinnitus, you should consult a clinician, because in rare cases it is a sign of a tumor or blood vessel damage.
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