The results were calculated using a measure called “effect size”, which is a way of quantifying the size of the difference between the two groups. For the difference in quality of life scores between groups, the effect size was calculated to be 0.24. This can be interpreted as a “small” effect. In other words, treatment including CBT gave a small improvement in quality of life compared with usual care.
Changes in the bones of the middle ear. A person’s ear is made up of several different bones: the malleus, Incus and Stapes. In some individuals, these bones may actually change shape or harden over the years. This process is known as otosclerosis and often runs in the family. This can cause ringing in the ears to begin or, if it has already started, to get worse over time.

Hearing (audiological) exam. As part of the test, you'll sit in a soundproof room wearing earphones through which will be played specific sounds into one ear at a time. You'll indicate when you can hear the sound, and your results are compared with results considered normal for your age. This can help rule out or identify possible causes of tinnitus.
Although there’s no proven cure for tinnitus, there are treatments that help make it easier to ignore. For example, you can wear devices in your ear(s) that produce soothing therapeutic noises to shift your focus away from the tinnitus. Other devices produce constant, soft noise to mask the tinnitus. Tinnitus sufferers who also have hearing loss sometimes find relief simply by wearing properly fitted hearing aids.
Antidepressants. Antidepressants, such as nortriptyline and amitriptyline, have been used as mood enhancers to help someone with tinnitus cope with the life changing implications and complications it brings. However, they are often only prescribed in the most severe of tinnitus cases as they carry some serious side effects that might not make them worth taking for everyone. These include blurred vision, heart problems, dry mouth and constipation.
The researchers point out that up to one in five adults will develop tinnitus, a distressing disorder in which people hear buzzing, ringing and other sounds from no external source. Tinnitus can occur in one or both ears, and is usually continuous but can fluctuate. A randomised controlled trial is the best way of assessing the effectiveness of an intervention.
Other causes of tinnitus include middle ear infections, disorders that block the ear canal (such as an external ear infection [external otitis], excessive ear wax, or foreign bodies), problems with the eustachian tube (which connects the middle ear and the back of the nose) due to allergies or other causes of obstruction, otosclerosis (a disorder of excess bone growth in the middle ear), and temporomandibular disorders. An uncommon but serious cause is an acoustic neuroma, a noncancerous (benign) tumor of part of the nerve leading from the inner ear.
A brain tumor can be either non-cancerous (benign) or cancerous (malignant), primary, or secondary. Common symptoms of a primary brain tumor are headaches, seizures, memory problems, personality changes, and nausea and vomiting. Causes and risk factors include age, gender, family history, and exposure to chemicals. Treatment is depends upon the tumor type, grade, and location.

Take the first step toward relief by scheduling a consultation with one of our audiologists. By carefully examining your case history and conducting audiometric testing, we can identify the likely causes of your tinnitus and recommend an effective treatment. In addition, if medically necessary, we may refer you to another physician to complete your diagnosis.
Imagine you’re settling in for a night’s rest. In your quiet bedroom, you’re tune right into those tinnitus noises—and you can’t shake your focus on them. You start to wonder about how you’ll ever fall asleep with these sounds in your ears. You think about the rest you’re missing out on because you’re not already asleep, and you wonder how you’ll have the energy to make it through your day.
The diagnosis of tinnitus is usually based on the person's description.[3] A number of questionnaires exist that may help to assess how much tinnitus is interfering with a person's life.[3] The diagnosis is commonly supported by an audiogram and a neurological examination.[1][3] If certain problems are found, medical imaging, such as with MRI, may be performed.[3] Other tests are suitable when tinnitus occurs with the same rhythm as the heartbeat.[3] Rarely, the sound may be heard by someone else using a stethoscope, in which case it is known as objective tinnitus.[3] Spontaneous otoacoustic emissions, which are sounds produced normally by the inner ear, may also occasionally result in tinnitus.[6]

Ear protection can mitigate the negative effects of loud noises and prevent the exacerbation of tinnitus. This is especially important if you work in a loud environment or regularly visit loud places, like shooting ranges, concerts, and clubs. Wearing custom earplugs or special earmuffs can go a long way toward preventing your tinnitus from worsening.


A diagnosis of tinnitus is based upon identification of characteristic symptoms, a detailed patient history, a thorough clinical evaluation and complete audiologic testing. These steps will help to differentiate rhythmic tinnitus from non-rhythmic tinnitus. It cannot be overemphasized that tinnitus is a symptom of another underlying condition and not a diagnosis in and of itself. Because of the high number of underlying causes of tinnitus, a variety of specialized tests to detect the specific cause may be necessary. Attempting to identify the underlying cause of tinnitus is the first step in evaluating a person with tinnitus.
If you're not sure of what is causing your tinnitus, a hearing care professional can help pinpoint the issue through a series of tests. It can be helpful to take notes of the sounds you are regularly or irregularly experience to help your hearing healthcare professional put together the clues to what may be causing it. Be sure to alert your practitioner of any pertinent medical history, medications or excessive noise exposure that could be playing a role in your tinnitus.

None of these treatment options are supported by science. Many people are convinced that the herb gingko biloba is helpful, however large-scale studies have been unable to prove this. There are many nutritional supplements claiming to be tinnitus remedies. These are usually a combination of herbs and vitamins, often including zinc, ginkgo, and vitamin B-12.
Seek out cognitive-behavioral therapy. Cognitive behavioral therapy, or CBT, involves working with a clinician (or independently, with a clinically-developed self-treatment program) to re-frame negative thoughts, emotions, and behaviors. CBT is effective with a wide range of physical and mental health conditions, including stress, anxiety, and depression. CBT is also highly effective in treating insomnia and other sleep problems. And research shows CBT can help improve the management of tinnitus.
The noise heard by people with tinnitus may be a buzzing, ringing, roaring, whistling, or hissing sound and is often associated with hearing loss. Some people hear more complex sounds that may be different at different times. These sounds are more noticeable in a quiet environment and when people are not concentrating on something else. Thus, tinnitus tends to be most disturbing to people when they are trying to sleep. However, the experience of tinnitus is highly individual. Some people are very disturbed by their symptoms, whereas others find them quite bearable.
The results were calculated using a measure called “effect size”, which is a way of quantifying the size of the difference between the two groups. For the difference in quality of life scores between groups, the effect size was calculated to be 0.24. This can be interpreted as a “small” effect. In other words, treatment including CBT gave a small improvement in quality of life compared with usual care.
Muscle spasms: Tinnitus that is described as clicking may be due to abnormalities that cause the muscle in the roof of the mouth (palate) to go into spasm. This causes the Eustachian tube, which helps equalize pressure in the ears, to repeatedly open and close. Multiple sclerosis and other neurologic diseases that are associated with muscle spasms may also be a cause of tinnitus, as they may lead to spasms of certain muscles in the middle ear that can cause the repetitive clicking.
The accepted definition of chronic tinnitus, as compared to normal ear noise experience, is five minutes of ear noise occurring at least twice a week.[50] However, people with chronic tinnitus often experience the noise more frequently than this and can experience it continuously or regularly, such as during the night when there is less environmental noise to mask the sound.
^ Tyler RS, Pienkowski M, Roncancio ER, Jun HJ, Brozoski T, Dauman N, Dauman N, Andersson G, Keiner AJ, Cacace AT, Martin N, Moore BC (2014). "A review of hyperacusis and future directions: part I. Definitions and manifestations" (PDF). American Journal of Audiology. 23 (4): 402–19. doi:10.1044/2014_AJA-14-0010. PMID 25104073. Archived (PDF) from the original on May 9, 2018. Retrieved September 23, 2017.
FACT: Many people with tinnitus will also have a hearing loss. In fact, a recent French study showed that of 123 people with tinnitus surveyed only one did not have hearing loss.  The British Tinnitus Association estimates that 90 percent of people with tinnitus also have a hearing loss. Moreover, research says that those who don’t may have a “hidden hearing loss.”
While there are many different FDA-approved treatments for tinnitus available, the most important component is finding the right partner (i.e. a Doctor of Audiology), who will work closely with you to help explain your tinnitus and treatment progress over time. In order for the options below to be as successful as possible, the proper support and guidance from an experienced tinnitus specialist is mandatory.
Cartoon of the middle ear showing muscles that attach to ossicles (ear bones), and ear drum. The stapedius is attached to the stapes (of course -- horseshoe object above), while the tensor tympani is attached to the ear drum. While useful, be aware that there are multiple errors in this illustration from Loyola Medical School. With permission, from: http://www.meddean.luc.edu/lumen/meded/grossanatomy/dissector/mml/images/stap.jpg
The sound you hear is actually being generated by the part of your ear known as the cochlea. It’s a very complicated organ with sensory hairs, internal fluid and nerve receptors, that when damaged (or as it naturally degrades as you get older), can cause it to send incorrect input into your brain. In layman’s terms, because it’s no longer working as well as it used to, it thinks there’s a ringing sound in the area and tells your brain to generate that sound in your head. There are other symptoms of tinnitus, but this is the main one.
If your tinnitus is a symptom of an underlying medical condition, the first step is to treat that condition. But if the tinnitus remains after treatment, or if it results from exposure to loud noise, health professionals recommend various non-medical options that may help reduce or mask the unwanted noise (See Masking Devices below). Sometimes, tinnitus goes away spontaneously, without any intervention at all. It should be understood, however, that not all tinnitus can be eliminated or reduced, no matter the cause.
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