Another way of splitting up tinnitus is into objective and subjective. Objective tinnitus can be heard by the examiner. Subjective cannot. Practically, as there is only a tiny proportion of the population with objective tinnitus, this method of categorizing tinnitus is rarely of any help. It seems to us that it should be possible to separate out tinnitus into inner ear vs everything else using some of the large array of audiologic testing available today. For example, it would seem to us that tinnitus should intrinsically "mask" sounds of the same pitch, and that this could be quantified using procedures that are "tuned" to the tinnitus.
We are all different and you may find you prefer one type of relaxation over another. You may find a class that teaches a type you like. However, you may not be able to get to classes or you may just prefer to do something yourself. Using some simple techniques regularly may help you to improve your quality of life and make a real difference to living with tinnitus. It does take practice to develop good relaxation techniques, and what may help one day, may not do so the next – so don’t give up if at first it does not seem to help.
Being exposed to loud noise on a regular basis from heavy equipment, chain saws or firearms are common causes of hearing loss and tinnitus. Noise-induced hearing loss and tinnitus can also be caused by listening to loud music through headphones or attending loud concerts frequently. It is possible to experience short-term tinnitus after seeing a concert, but long-term exposure will cause permanent damage.
An ultrasound is another test that may be used to aid in the diagnosis of tinnitus. An ultrasound uses reflected high-frequency sound waves and their echoes to create images of structures within the body. An ultrasound can reveal how blood flows within vessels, but is only useful for accessible vessels. It is not helpful for blood vessels within the skull.
Along the path a hearing signal travels to get from the inner ear to the brain, there are many places where things can go wrong to cause tinnitus. If scientists can understand what goes on in the brain to start tinnitus and cause it to persist, they can look for those places in the system where a therapeutic intervention could stop tinnitus in its tracks.
When there does not seem to be a connection with a disorder of the inner ear or auditory nerve, the tinnitus is called nonotic (i.e. not otic). In some 30% of tinnitus cases, the tinnitus is influenced by the somatosensory system, for instance people can increase or decrease their tinnitus by moving their face, head, or neck.[27] This type is called somatic or craniocervical tinnitus, since it is only head or neck movements that have an effect.[25]
Take medication for a thyroid disorder, if necessary. Tinnitus can be related to both hyperthyroidism, or an overactive thyroid, and hypothyroidism, or an underactive thyroid. Your doctor can check for swelling or lumps in your thyroid gland, which is in your throat, and order blood screens to test its function. If they find an issue, they’ll prescribe medication to regulate your thyroid hormone levels.[17]
To answer your question about NAC (N-acetyl-L-cysteine), I’ve seen little evidence suggesting that is effective for tinnitus. Instead – though the research is very limited – multiple anecdotal reports describe success with the herb ginkgo biloba. Try taking two tablets of standardized extract of ginkgo three times a day with meals (no more than a total dose of 240 mg a day). Ginkgo may work by increasing blood circulation to the head and neck. Give it at least a two-month trial. You might also explore cranial therapy, a gentle manipulative technique performed by osteopathic physicians. This approach seems to take the pressure or irritation off the auditory nerves. If high blood pressure is responsible for your tinnitus, try to get that under control through diet, exercise, and weight loss or medication if necessary.
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.

Prevention involves avoiding loud noise.[2] If there is an underlying cause, treating it may lead to improvements.[3] Otherwise, typically, management involves talk therapy.[5] Sound generators or hearing aids may help some.[2] As of 2013, there were no effective medications.[3] It is common, affecting about 10–15% of people.[5] Most, however, tolerate it well, and it is a significant problem in only 1–2% of people.[5] The word tinnitus is from the Latin tinnīre which means "to ring".[3]
^ Langguth B, Goodey R, Azevedo A, et al. (2007). "Consensus for tinnitus patient assessment and treatment outcome measurement: Tinnitus Research Initiative meeting, Regensburg, July 2006". Tinnitus: Pathophysiology and Treatment. Progress in Brain Research. 166. pp. 525–36. doi:10.1016/S0079-6123(07)66050-6. ISBN 978-0444531674. PMC 4283806. PMID 17956816.
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]

^ Langguth B, Goodey R, Azevedo A, et al. (2007). "Consensus for tinnitus patient assessment and treatment outcome measurement: Tinnitus Research Initiative meeting, Regensburg, July 2006". Tinnitus: Pathophysiology and Treatment. Progress in Brain Research. 166. pp. 525–36. doi:10.1016/S0079-6123(07)66050-6. ISBN 978-0444531674. PMC 4283806. PMID 17956816.
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.
Since most persons with tinnitus also have hearing loss, a pure tone hearing test resulting in an audiogram may help diagnose a cause, though some persons with tinnitus do not have hearing loss. An audiogram may also facilitate fitting of a hearing aid in those cases where hearing loss is significant. The pitch of tinnitus is often in the range of the hearing loss.
The researchers paired electrical stimulation of the vagus nerve — a large nerve that runs from the head to the abdomen — with the playing of a tone. Vagus nerve stimulation (VNS) is known to release chemicals that encourage changes in the brain. This technique, the scientists reasoned, might induce brain cells (neurons) to tune to frequencies other than the tinnitus one. For 20 days, 300 times a day, they played a high-pitched tone to 8 rats during VNS.
Tinnitus is commonly thought of as a symptom of adulthood, and is often overlooked in children. Children with hearing loss have a high incidence of tinnitus, even though they do not express the condition or its effect on their lives.[100] Children do not generally report tinnitus spontaneously and their complaints may not be taken seriously.[101] Among those children who do complain of tinnitus, there is an increased likelihood of associated otological or neurological pathology such as migraine, juvenile Meniere’s disease or chronic suppurative otitis media.[102] Its reported prevalence varies from 12% to 36% in children with normal hearing thresholds and up to 66% in children with a hearing loss and approximately 3–10% of children have been reported to be troubled by tinnitus.[103]

Unfortunately that means tinnitus is a very complicated condition that involves several systems of the body. The good news, though, is that as doctors and researchers have developed a better understanding of the mechanisms behind tinnitus, they’ve also been able to develop new and promising treatments that target the brain rather than the ear — and have more of a chance of actually reversing the problem.

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Tinnitus is a symptom, not a disease. Most cases are due to damage to the microscopic endings of the sensory nerve in the inner ear, commonly from exposure to loud noise (as from amplified music or gunfire). Other causes include allergy, high or low blood pressure, a tumor, diabetes, thyroid dysfunction, and head or neck injury. In addition, some drugs, including aspirin and other anti-inflammatories, antibiotics, sedatives, and antidepressants can also cause tinnitus. If so, changing drugs or lowering the dosage usually helps.
Think about your breathing. Notice that it has a natural rhythm. Try to breathe in a steady, even rhythm. It helps to breathe in through your nose, hold your breath for a moment and then breathe out through your mouth. Wait a moment before breathing in again. Every time you breathe out, try to release a little bit of your tension. Do this for a few minutes, until you feel ready to move on to the next step.
Acoustic qualification of tinnitus will include measurement of several acoustic parameters like frequency in cases of monotone tinnitus or frequency range and bandwidth in cases of narrow band noise tinnitus, loudness in dB above hearing threshold at the indicated frequency, mixing-point, and minimum masking level.[51] In most cases, tinnitus pitch or frequency range is between 5 kHz and 10 kHz,[52] and loudness between 5 and 15 dB above the hearing threshold.[53]
For many, tinnitus symptoms come on gradually and eventually go away as the brain and ears adjust. However, for others tinnitus can last for years and cause various complications. A high percentage of people with tinnitus that’s persistent and untreatable go on to also develop anxiety or depression as a result. What types of things can you do to deal with and lower tinnitus symptoms? Tinnitus treatment includes avoiding excessively loud sources of noise pollution, using certain hearing aids, preventing ear infections and avoiding drug use.
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.

Shore says her therapy isn’t for everyone — at least not yet. So far, she’s only treated patients who have a specific form of tinnitus that changes in intensity or pitch when a person moves certain parts of her body. For example, some tinnitus sufferers find the sound in their ears lessens when they clench their teeth or open their mouths wide. This suggests that some touch inputs can influence the tinnitus, Shore says. (Roughly two-thirds of tinnitus patients have this form of the condition, she adds.)
Shore says her therapy isn’t for everyone — at least not yet. So far, she’s only treated patients who have a specific form of tinnitus that changes in intensity or pitch when a person moves certain parts of her body. For example, some tinnitus sufferers find the sound in their ears lessens when they clench their teeth or open their mouths wide. This suggests that some touch inputs can influence the tinnitus, Shore says. (Roughly two-thirds of tinnitus patients have this form of the condition, she adds.)
Repetitive transcranial magnetic stimulation (rTMS). This technique, which uses a small device placed on the scalp to generate short magnetic pulses, is already being used to normalize electrical activity in the brains of people with epilepsy. Preliminary trials of rTMS in humans, funded by the NIDCD, are helping researchers pinpoint the best places in the brain to stimulate in order to suppress tinnitus. Researchers are also looking for ways to identify which people are most likely to respond well to stimulation devices.
White noise machines. These devices, which produce simulated environmental sounds such as falling rain or ocean waves, are often an effective treatment for tinnitus. You may want to try a white noise machine with pillow speakers to help you sleep. Fans, humidifiers, dehumidifiers and air conditioners in the bedroom also may help cover the internal noise at night.
Tinnitus is a common condition characterized by the perception or sensation of sound even though there is no identifiable external source for the sound. Tinnitus is often referred to as a “ringing in the ears.” However, the sounds associated with tinnitus have also been described as hissing, chirping, crickets, whooshing, or roaring sounds, amongst others, that can affect one or both ears. Tinnitus is generally broken down into two types: subjective and objective. Subjective tinnitus is very common and is defined as a sound that is audible only to the person with tinnitus. Subjective tinnitus is a purely electrochemical phenomenon and cannot be heard by an outside observer no matter how hard they try. Objective tinnitus, which is far less common, is defined as a sound that arises from an “objective” source, such as mechanical defect or a specific sound source, and can be heard by an outside observer under favorable conditions. The sounds from objective tinnitus occur somewhere within the body and reach the ears by conduction through various body tissues. Objective tinnitus is usually caused by disorders affecting the blood vessels (vascular system) or muscles (muscular system).
The important thing to remember about tinnitus is that the brain’s response to these random electrical signals determines whether or not a person is annoyed by their tinnitus or not. Magnetoencephalography (MEG, for short) studies have been used to study tinnitus and the brain. MEG takes advantage of the fact that every time neurons send each other signals, their electric current creates a tiny magnetic field. MEG allows scientists to detect such changing patterns of activity in the brain 100 times per second. These studies indicated tinnitus affects the entire brain and helps with understanding why certain therapies are more effective than others.

In addition to treating associated problems (such as depression or insomnia), there are several strategies that can help make tinnitus less bothersome. No single approach works for everyone, and you may need to try various combinations of techniques before you find what works for you. If you have age-related hearing loss, a hearing aid can often make tinnitus less noticeable by amplifying outside sounds.
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