When a medication is ototoxic, it has a toxic effect on the ear or its nerve supply. In damaging the ear, these drugs can cause side effects like tinnitus, hearing loss, or a balance disorder. Depending on the medication and dosage, the effects of ototoxic medications can be temporary or permanent. More than 200 prescription and over-the-counter medicines are known to be ototoxic, including the following:

Like Shore and Kilgard’s work, most of the promising research on tinnitus has to do with stimulating or altering the brain’s hyperactivity in ways that reduce tinnitus. Some studies have shown electromagnetic brain stimulation — using either invasive or noninvasive techniques, including procedures that involve surgically implanted electrodes or scalp electrodes — may help reverse a patient’s tinnitus. (6) While none of these treatment options are currently available, all have shown some success in treating the condition.
There are eight main causes of tinnitus that when avoided or removed from your life can help improve your tinnitus dramatically. Ironically, these 8 causes do not affect everyone in the same way. Some people will have no reaction to some of these tinnitus causes, while others will have a severe reaction. There’s no clear answer to why this is, but the condition is a growing one with one in five individuals who reach the age of fifty-five suffering from tinnitus.
If you’re struggling with tinnitus and experience anxiety or depression relating to your condition, cognitive behavioural therapy is a form of counselling that helps you to cope and readjust your negative feelings. Tinnitus retraining therapy (TRT) can also be used in conjunction with CBT, harnessing the body's natural ability to tune out sounds and make it part of your subconscious mind rather than at the forefront.
Overdosing on certain prescription drugs, recreational drugs or alcohol. This can sometimes cause permanent damage to nerves that affect hearing. In some cases when a pregnant women uses drugs during pregnancy, this can cause tinnitus to develop in her child. Common drugs that might contribute to tinnitus include ototoxics, psychotropic drugs, aminoglycosides, certain antibiotics and vancomycin.
Earwax (ear wax) is a natural substance secreted by special glands in the skin on the outer part of the ear canal. It repels water, and traps dust and sand particles. Usually a small amount of wax accumulates, dries up, and then falls out of the ear canal carrying with it unwanted particles. Under ideal circumstances, you should never have to clean your ear canals. The absence of ear wax may result in dry, itchy ears, and even infection. Ear wax may accumulate in the ear for a variety of reasons including; narrowing of the ear canal, production of less ear wax due to aging, or an overproduction of ear wax in response to trauma or blockage within the ear canal.
Though the exact cause of tinnitus — as in the specific mechanism that creates these phantom sounds in some people — remains unknown, contributing factors and triggers have been identified. Excessive exposure to loud noise is often a factor because of the damage done to your auditory system. Tinnitus may also result from jaw-joint dysfunction (e.g., teeth grinding, temporomandibular joint disorder) or chronic neck muscle strain.

Tinnitus can be caused by a variety of less common underlying conditions or injuries. If you have tinnitus, start your treatment path by seeking out a hearing healthcare professional who specializes in tinnitus diagnostics so they can help identify the underlying cause. If the common causes for tinnitus are ruled out, the practitioner will refer you to another specialist for further evaluation. Listed below are related medical specialties who might be able to help you determine the cause of 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).
Don’t ignore ear pain. Pain or discomfort in your ear can be a sign of conditions associated with tinnitus, including ear infections and earwax buildup. These conditions, and the discomfort they cause, can also interfere with sleep. Whether your ear pain is sharp or dull, constant or intermittent, accompanied by itching or not, take these symptoms to your doctor.
An assessment of hyperacusis, a frequent accompaniment of tinnitus,[56] may also be made.[57] The measured parameter is Loudness Discomfort Level (LDL) in dB, the subjective level of acute discomfort at specified frequencies over the frequency range of hearing. This defines a dynamic range between the hearing threshold at that frequency and the loudnes discomfort level. A compressed dynamic range over a particular frequency range is associated with subjectve hyperacusis. Normal hearing threshold is generally defined as 0–20 decibels (dB). Normal loudness discomfort levels are 85–90+ dB, with some authorities citing 100 dB. A dynamic range of 55 dB or less is indicative of hyperacusis.[58][59]
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.
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.
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.
Serenade by SoundCure is based on S-tones. The MP3 player-like device was developed through research from the University of California, Irvine, where it was proven that the temporal-patterned sounds produced by SoundCure can suppress a patient’s tinnitus. Instead of drowning out tinnitus with another sound played at a louder volume, it actively reduces the condition. The therapy is custom-designed by a patient’s audiologist following testing.
If you’re struggling with tinnitus and experience anxiety or depression relating to your condition, cognitive behavioural therapy is a form of counselling that helps you to cope and readjust your negative feelings. Tinnitus retraining therapy (TRT) can also be used in conjunction with CBT, harnessing the body's natural ability to tune out sounds and make it part of your subconscious mind rather than at the forefront.
Tinnitus (pronounced tin-NY-tus or TIN-u-tus) is not a disease. It is a symptom that something is wrong in the auditory system, which includes the ear, the auditory nerve that connects the inner ear to the brain, and 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 be the result of a number of health conditions, such as:
As with the first exercise, make sure you’re comfortable and unlikely to be disturbed. Now imagine yourself leaving this room. You walk out of the door and follow a path… at the end of the path is another door. You open that door and inside you see a beautiful garden – you can hear birds singing, children playing somewhere in the distance. You feel a cool breeze on your skin and hear the rustle of leaves through the trees. The colours of the leaves, green, gold, red, all dance across a beautiful pond in the middle… as you walk over to the pond, you feel the soft grass under your bare feet… you dip your toes into the calm, clear pond and stop for a moment – just experiencing the beauty of everything around you…

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.


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.”
Individuals with tinnitus describe perceiving a wide variety of sounds including ringing, clicking, hissing, humming, chirping, buzzing, whistling, whooshing, roaring, and/or whirling. These sounds may be present at all times, or they may come and go. The volume, pitch or quality of tinnitus sounds can fluctuate as well. Some people report that their tinnitus is most obvious when outside sounds are low (i.e. during the night). Other individuals describe their tinnitus as loud even in the presence of external sounds or noise, and some describe it as exacerbated by sounds. Tinnitus can affect one ear or both ears. It can also sound like it is inside the head and not in the ears at all.
Tinnitus is not a disease — it’s a symptom. It’s a sign that something is wrong with your auditory system, which includes your ear, the auditory nerve that connects the inner ear to the brain, and the parts of the brain that process sound. There are a variety of different conditions that can cause tinnitus. One of the most common is noise-induced hearing loss.

Vertigo is the sensation of spinning or rocking, even when someone is at rest. Vertigo may be caused by a problem in the brain or spinal cord or a problem within in the inner ear. Head injuries, certain medications, and female gender are associated with a higher risk of vertigo. Medical history, a physical exam, and sometimes an MRI or CT scan are required to diagnose vertigo. The treatment of vertigo may include:

When tinnitus is unexpected and unwelcomed, it can lead to a negative reaction to the tinnitus. This can create a vicious cycle. When tinnitus is perceived, it can prompt emotions, including frustration, fear, unhappiness, etc.  These can, in turn, cause physical reactions such as anxiety and stress.  This reinforces the tinnitus and perpetuates the cycle. 

It can often be very helpful to talk to someone who understands how you are feeling, who can reassure you about any anxieties you may have, and answer your questions. We can provide details of self-help groups and contacts in the UK, and we also run a helpline on 0800 018 0527. Most of the people who run groups or are contacts have tinnitus themselves and have been helping people with the condition for a long time. Even if you don't want to take part in group activities, it can be a comfort to know there is someone you can contact.
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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.
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.
The treatment group (245 patients) received some elements of standard care (such as a masking device and hearing aid if needed), but also received CBT. The CBT included an extensive educational session, sessions with a clinical psychologist and group treatments involving “psychological education” explaining their condition, cognitive restructuring, exposure techniques, stress relief, applied relaxation and movement therapy.
One group of 247 patients received standard (usual) care for tinnitus. This included audiological checks, counselling, prescription of a hearing aid if indicated, prescription of a “masker” if requested by the patient (a device that generates neutral sounds to distract from the noise of the tinnitus), and counselling from social workers when required.
This well-designed study found that using CBT alongside elements of standard therapy can help patients with tinnitus of varying severity. However, the differences in outcomes between the two groups were quite small, and this technique can only help manage tinnitus rather than curing it, as some papers implied. Also, the patients in the study were followed for only 12 months, so it is unclear whether this approach can help in the longer term.
If your mind is occupied with something absorbing, it is easier to forget about the tinnitus. Work, leisure pursuits and other interests can all help to provide a worthwhile focus. If you don't have a hobby, now might be the time to start something, many people say that painting or writing helps. Bear in mind however, that excessive activity may produce stress, so take time for relaxing activities and social interaction where possible.

Tinnitus sufferers have tried many alternative therapies but often to no avail. Some have heard of success stories involving the use of certain vitamins, minerals, herbal preparations, or even a change in diet, but often did not experience personal success in treating tinnitus using such options. Unfortunately, no studies to date have been able to associate such treatments to any real benefits. While much of the existing research have been dedicated to helping us understand tinnitus and its etiological underpinnings, there are currently very few treatments that are clinically validated. Of the few that conducted clinical studies to evaluate the effectiveness, most did not use rigorous clinical methods such as controlling for placebo effects or double-blinding to ensure the integrity of the data and to eliminate any sources of bias. Tinnitus sufferers who access such treatments often do not experience relief from their tinnitus. As a result, tinnitus sufferers often experience confusion, frustration, a loss of hope, and skepticism after having invested time and money on available treatment options.


Tinnitus can be perceived in one or both ears or in the head. It is the description of a noise inside a person’s head in the absence of auditory stimulation. The noise can be described in many different ways. It is usually described as a ringing noise but, in some patients, it takes the form of a high-pitched whining, electric buzzing, hissing, humming, tinging or whistling sound or as ticking, clicking, roaring, "crickets" or "tree frogs" or "locusts (cicadas)", tunes, songs, beeping, sizzling, sounds that slightly resemble human voices or even a pure steady tone like that heard during a hearing test.[4] It has also been described as a "whooshing" sound because of acute muscle spasms, as of wind or waves.[7][not in citation given] Tinnitus can be intermittent or continuous: in the latter case, it can be the cause of great distress. In some individuals, the intensity can be changed by shoulder, head, tongue, jaw or eye movements.[8] Most people with tinnitus have some degree of hearing loss.[9]

Almost everyone has had tinnitus for a short time after being exposed to extremely loud noise. For example, attending a loud concert can trigger short-lived tinnitus. Some medications (especially aspirin and other nonsteroidal anti-inflammatory drugs taken in high doses) can cause tinnitus that goes away when the drug is discontinued. When it lasts more than six months, it's known as chronic tinnitus. As many as 50 to 60 million people in the United States suffer from this condition; it's especially common in people over age 55 and strongly associated with hearing loss. Many people worry that tinnitus is a sign that they are going deaf or have another serious medical problem, but it rarely is.
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