John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

Persistent tinnitus may cause anxiety and depression.[14][15] Tinnitus annoyance is more strongly associated with psychological condition than loudness or frequency range.[16][17] Psychological problems such as depression, anxiety, sleep disturbances and concentration difficulties are common in those with strongly annoying tinnitus.[18][19] 45% of people with tinnitus have an anxiety disorder at some time in their life.[20]


Diseases, illnesses and injuries. There are several medical conditions that can cause tinnitus. These include Meniere’s disease, temporomandibular joint disorders (TMJ), head or neck injuries, brain tumors, etc. Most people don’t know if they have Meniere’s disease until properly diagnosed. This RARE disease brings on dizziness, tinnitus and ear pressure that can last for a short period of time and then disappears. TMJ causes pain in your jaw muscles. With TMJ, you’ll often hear a clicking noise when chewing. TMJ has shown to influence your chances of developing tinnitus, so be sure to treat the condition in order to reduce your chances of getting tinnitus. Head and neck injuries have also been shown to cause tinnitus, so always wear your helmet when you’re out biking and drive safely when you’re in your car.Believe it or not, but tinnitus can be caused by something as simple as an ear infection. Don’t take ear infections lightly they can be devastating at any age. Brain tumors, while equally as rare as Meniere’s disease, can also generate tinnitus symptoms. While you can alleviate your tinnitus immediately with an over the counter tinnitus treatment, you should also seek the help of a tinnitus specialist in your area to determine what the underlying cause of your tinnitus is.
Somatic tinnitus is caused, worsened, or otherwise related to your body’s own sensory system. Sensory signals coming from various parts of the body are disrupted, causing a spasm that produces tinnitus. Those who have somatic tinnitus usually have it in only one ear. Depending on the root cause your doctor may come up with treatment options to alleviate the symptoms.
The yearlong Dutch trial gave adults with tinnitus a standard package of care or a programme which added cognitive behavioural therapy (CBT) to elements of standard therapy for tinnitus. CBT is a type of therapy that challenges people’s negative assumptions and feelings to help them overcome their worries. Compared with those given usual care, the group receiving specialised treatment reported improved quality of life, and reduced severity and impairment caused by tinnitus.
Until recently, most tinnitus patients had little reason to believe doctors would ever be able to completely cure or reverse the affliction. Drug therapies had consistently failed, and so had more invasive procedures — including some surgeries to remove the auditory nerve that transmits sound from the ear to the brain, according to past research. (1,2)
Tinnitus might also get worse with age and is most common among older adults who suffer from general hearing loss. Some 27 percent of older and elderly adults report having tinnitus, many of them seemingly due to factors like loud workplaces. (9) The elderly commonly experience tinnitus and hearing loss due to symptoms associated with circulatory problems, inflammation and nerve damage.

This personalized solution offers a selection of tinnitus relief sounds to support common management approaches. The flexible programming provides sound stimulation through select auditory options that can ease the effects of tinnitus. The sounds offer a variety of customized options and are used in conjunction with tinnitus retraining therapy to provide instructional counseling.
Information on this website is provided for informational purposes only and is not intended as a substitute for the advice provided by your physician or other healthcare professional. You should not use the information on this website for diagnosing or treating a health problem or disease, or prescribing any medication or other treatment. Any third party offering or advertising on this website does not constitute an endorsement by Andrew Weil, M.D. or Healthy Lifestyle Brands.
There are many different conditions and disorders that affect nerve channels leading to the ears, which can cause someone to hear abnormal ringing or other sounds in their ears. These conditions usually cause other symptoms at the same time (such as dizziness, hearing loss, headaches, facial paralysis, nausea and loss of balance), which doctors use as clues to uncover the underlying cause of tinnitus.
Luckily, many can live with their tinnitus as it may only occur occasionally and/or is relatively quiet, but for some the tinnitus is so bothersome, severe and intense that it negatively influences their daily life to a very large extend. For those people, it is very natural to look for a cure that can make the tinnitus go away - or at least reduce it.
White Noise Machines. These devices do a great job of simulating the sound of everything from ocean waves, to rain, to a thunder storm, to a crackling fire to an oscillating fan to just plain old static. The result is that your brain focuses on the sounds around you instead of the ringing in your head. You can even download apps on your iPhone that do the same thing so that you can always have a noise machine with you wherever you go. The constant background noise can not only bring back nostalgic feelings of joy, if you used to site around a crackling fire on holidays with your family, but also allow you to forget about your tinnitus.
When TRT was developed in the 1980s by neuroscientist Dr. Pawel Jastreboff (now at Emory University in Atlanta), it was designed to be administered according to a strict protocol. Today, the term TRT is being used to describe modified versions of this therapy, and the variations make accurate assessment of its effectiveness difficult. Individual studies have reported improvements in as many as 80% of patients with high-pitched tinnitus. In a Cochrane review of the one randomized trial that followed Jastreboff's protocol and met the organization's standards, TRT was much more effective in reducing tinnitus severity and disability than a technique called masking (see below).
The latest news about tinnitus treatment comes from a UK study showing that Mindfulness Based Cognitive Therapy (MBCT) significantly helps reduce the severity of the disorder. The researchers reported that, among the 75 patients being studied, both relaxation therapy and MBCT worked to alleviate symptoms as well as reducing psychological distress, anxiety and depression related to the disorder. MBCT led to greater reductions in tinnitus severity and the improvements lasted longer.
Tinnitus (pronounced tih-NITE-us or TIN-ih-tus) is sound in the head with no external source. For many, it's a ringing sound, while for others, it's whistling, buzzing, chirping, hissing, humming, roaring, or even shrieking. The sound may seem to come from one ear or both, from inside the head, or from a distance. It may be constant or intermittent, steady or pulsating.
The sound perceived may range from a quiet background noise to one that can be heard even over loud external sounds. The specific type of tinnitus called pulsatile tinnitus is characterized by hearing the sounds of one's own pulse or muscle contractions, which is typically a result of sounds that have been created by the movement of muscles near to one's ear, or the sounds are related to blood flow of the neck or face.[10]
The outlook for tinnitus depends on its cause. In people with tinnitus related to earwax buildup or medications, the condition usually will go away when the earwax is removed or the medication is stopped. In people with tinnitus related to sudden, loud noise, tinnitus may improve gradually, although there may be some permanent noise-related hearing loss.
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]
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.

This tinnitus treatment we developed makes use of software that customizes a music-based therapy for each individual tinnitus sufferer. The software achieves this by incorporating a computational model of the “tinnitus brain.” This model captures changes in the auditory brain which may be causing the tinnitus.5,7 We do this by taking into account the individual’s audiogram and a pitch match of their tinnitus, which generates a tinnitus profile unique to him or her. The software then uses the model to predict how each music track can be altered spectrally to reduce tinnitus for that specific tinnitus profile. Delivering the treatment using headphones that could produce high frequencies (above 10–12 kHz) was an integral part of treatment effectiveness. With such headphones, the treatment could work by taking advantage of the same kind of brain plasticity that may contribute to the person's tinnitus in the first place without being limited by a lack of high-frequency sounds.8 By incorporating the latest tinnitus research into our software, we developed a treatment approach that provides greater promise in treating tinnitus than existing treatments with a one-size-fits-all approach.
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]
Addressing Any TMJ Disorders. A small percentage of people will experience tinnitus if they are having problems with their temporomandibular joint. This joint is located in front of the ears, on each side of the head, where the lower jawbone meets the skull. In these rare cases, a dental treatment or bite realignment may relieve you of the ringing you hear in your ears.

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.


^ 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.

Tinnitus usually comes in the form of a high-pitched tone in one or both ears, but can also sound like a clicking, roaring or whooshing sound. While tinnitus isn't fully understood, it is known to be a sign that something is wrong in the auditory system: the ear, the auditory nerve that connects the inner ear to the brain, or the parts of the brain that process sound. Something as simple as a piece of earwax blocking the ear canal can cause tinnitus, but it can also arise from a number of health conditions. For example, when sensory cells in the inner ear are damaged from loud noise, the resulting hearing loss changes some of the signals in the brain to cause tinnitus.
Some persons with severe TMJ (temporomandibular joint) arthritis have severe tinnitus. Generally these persons say that there is a "screeching" sound. This is another somatic tinnitus. TMJ is extremely common -- about 25% of the population. The exact prevalence of TMJ associated tinnitus is not established, but presumably it is rather high too. Having TMJ increases the odds that you have tinnitus too, by about a factor of 1.6-3.22 (Park and Moon, 2014; Lee et al, 2016). This is the a large risk factor for tinnitus, similar to the risk from hearing loss (see table above).
If you have tinnitus you also may suffer from anxiety, depression, or insomnia. Discuss treatments with your doctor. While tinnitus cannot always be cured, there are many treatments available for you to make it easier to live with tinnitus. See your doctor if tinnitus is accompanied by dizziness, fever, or headache; as this may signal a more serious condition.

Age-Related Hearing Loss: Also known as presbycusis, age-related hearing loss results from the cumulative effect of aging on hearing. This permanent, progressive, and sensorineural condition is most pronounced at higher frequencies. It commonly impacts people over the age of 50, as all people begin to lose approximately 0.5% of the inner ear’s hair cells annually starting at age 40.


Tinnitus matching is helpful to identify the frequency and intensity of the tinnitus. This is a simple procedure in which the audiologist adjusts a sound until a patient indicates that it is the same as their tinnitus.  Most patients match their tinnitus to the region of their hearing loss (Konig et al, 2006; Mahboubi et al, 2012). Unfortunately, the "gap detection test", does not work to confirm tinnitus in humabs (Boyen et al, 2015).
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.
Muscular tinnitus can be caused by several degenerative diseases that affect the head and neck including amyotrophic lateral sclerosis or multiple sclerosis. Myoclonus can also cause muscular tinnitus, especially palatal myoclonus, which is characterized by abnormal contractions of the muscles of the roof of the mouth. Spasms of the stapedial muscle (which attaches to the stapes bone or stirrup), which is the smallest muscle in the body, and tensor tympani muscle, both of which are located in the middle ear, have also been associated with objective tinnitus. Myoclonus or muscle spasms may be caused by an underlying disorder such as a tumor, tissue death caused by lack of oxygen (infarction), or degenerative disease, but it is most commonly a benign and self-limiting problem.
Most people with tinnitus also have hearing loss. Hence, hearing aids can be an effective part of any sound therapy.  Hearing aids alone can provide partial or total relief from tinnitus. If you’re experiencing challenges with your hearing as well as tinnitus, a combination of a hearing solution with built-in sound generators can often be prescribed. You can expect improved levels of hearing which also helps to minimise the effects of the condition in the same way that sound therapy might.
When TRT was developed in the 1980s by neuroscientist Dr. Pawel Jastreboff (now at Emory University in Atlanta), it was designed to be administered according to a strict protocol. Today, the term TRT is being used to describe modified versions of this therapy, and the variations make accurate assessment of its effectiveness difficult. Individual studies have reported improvements in as many as 80% of patients with high-pitched tinnitus. In a Cochrane review of the one randomized trial that followed Jastreboff's protocol and met the organization's standards, TRT was much more effective in reducing tinnitus severity and disability than a technique called masking (see below).
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