Experts recommend that patients with severe tinnitus become educated about tinnitus and how they best deal with its symptoms. This can include learning about biofeedback in order to control stress and your reaction to tinnitus sounds, talking with a counselor, or joining a support group. Coping strategies are most useful for managing emotional side effects of tinnitus, such as anxiety, trouble sleeping, lack of focus and depression.
Tinnitus is the hearing of sound when no external sound is present.[1] While often described as a ringing, it may also sound like a clicking, hiss or roaring.[2] Rarely, unclear voices or music are heard.[3] The sound may be soft or loud, low pitched or high pitched and appear to be coming from one ear or both.[2] Most of the time, it comes on gradually.[3] In some people, the sound causes depression or anxiety and can interfere with concentration.[2]
Tinnitus Control contains both a spray that is administered under the tongue three times a day and a gelatin capsule that is to be taken twice a day. Each package comes with a one month’s supply of the spray (1 fluid ounce) and capsules (60 capsules). Tinnitus Control is not currently available in local stores such as CVS, Walgreens and Rite Aid, but it is available directly from the manufacturer’s website at http://www.tinnituscontrol.com
Assessment of psychological processes related to tinnitus involves measurement of tinnitus severity and distress (i.e., nature and extent of tinnitus-related problems), measured subjectively by validated self-report tinnitus questionnaires.[18] These questionnaires measure the degree of psychological distress and handicap associated with tinnitus, including effects on hearing, lifestyle, health and emotional functioning.[62][63][64] A broader assessment of general functioning, such as levels of anxiety, depression, stress, life stressors and sleep difficulties, is also important in the assessment of tinnitus due to higher risk of negative well-being across these areas, which may be affected by or exacerbate the tinnitus symptoms for the individual.[65] Overall, current assessment measures are aimed to identify individual levels of distress and interference, coping responses and perceptions of tinnitus in order to inform treatment and monitor progress. However, wide variability, inconsistencies and lack of consensus regarding assessment methodology are evidenced in the literature, limiting comparison of treatment effectiveness.[66] Developed to guide diagnosis or classify severity, most tinnitus questionnaires have been shown to be treatment-sensitive outcome measures.[67]
TRT depends upon the natural ability of the brain to "habituate" a signal, to filter it out on a subconscious level so that it does not reach conscious perception. Habituation requires no conscious effort. People frequently habituate many auditory sounds -- air conditioners, computer fans, refrigerators, and gentle rain, among them. What they have in common is that they have no importance, so they are not perceived as ''loud.'' Thus, the brain can screen them out.
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]
^ McCombe A, Baguley D, Coles R, McKenna L, McKinney C, Windle-Taylor P (2001). "Guidelines for the grading of tinnitus severity: the results of a working group commissioned by the British Association of Otolaryngologists, Head and Neck Surgeons, 1999". Clinical Otolaryngology and Allied Sciences. 26 (5): 388–93. doi:10.1046/j.1365-2273.2001.00490.x. PMID 11678946. Archived (PDF) from the original on 2017-09-24.
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.
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.

If the source of the problem remains unclear, you may be sent to an otologist or an otolaryngologist (both ear specialists) or an audiologist (a hearing specialist) for hearing and nerve tests. As part of your examination, you may be given a hearing test called an audiogram. An imaging technique, such as an MRI or a CT scan, may also be recommended to reveal any structural problem.
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.
A number of vital tasks carried out during sleep help maintain good health and enable people to function at their best. Sleep needs vary from individual to individual and change throughout your life. The National Institutes of Health recommend about 7-9 hours of sleep each night for older, school-aged children, teens, and most average adults; 10-12 for preschool-aged children; and 16-18 hours for newborns. There are two stages of sleep; 1) REM sleep (rapid-eye movement), and 2) NREM sleep (non-rapid-eye movement). The side effects of lack of sleep or insomnia include:
Tinnitus is commonly accompanied by hearing loss, and roughly 90% of persons with chronic tinnitus have some form of hearing loss (Davis and Rafaie, 2000; Lockwood et al, 2002). On the other hand, only about 30-40% of persons with hearing loss develop tinnitus. According to Park and Moon (2004), hearing impairment roughly doubles the odds of having tinnitus, and triples the odds of having annoying tinnitus.
Over the last 40 years of treating patients suffering from tinnitus, there’s been one over the counter medication that has shown the greatest promise. While it doesn’t provide relief for everyone, I continue to see an 87% efficacy rate in my patients. The treatment, which does not require a prescription, is known as Tinnitus Control and is available online at http://www.tinnituscontrol.com
Now make your toes as tight as you can, really scrunch them up. Hold them like this for a moment – and relax. Now do the same with your ankles, then your calf muscles, your thighs… work all the way up your body to your head, making sure you tense, hold for a moment, and then release the tension. Once you’ve done this with your whole body, focus again on your breathing – notice the rhythm, it should be even and calm.
We occasionally recommend neuropsychological testing using a simple screening questionnaire -- depression, anxiety, and OCD (obsessive compulsive disorder) are common in persons with tinnitus. This is not surprising considering how disturbing tinnitus may be to ones life (Holmes and Padgham, 2009). Persons with OCD tend to "obsess" about tinnitus. Treatment of these psychological conditions may be extremely helpful.
Some people experience a sound that beats in time with their pulse, known as pulsatile tinnitus or vascular tinnitus.[40] Pulsatile tinnitus is usually objective in nature, resulting from altered blood flow, increased blood turbulence near the ear, such as from atherosclerosis or venous hum,[41] but it can also arise as a subjective phenomenon from an increased awareness of blood flow in the ear.[40] Rarely, pulsatile tinnitus may be a symptom of potentially life-threatening conditions such as carotid artery aneurysm[42] or carotid artery dissection.[43] Pulsatile tinnitus may also indicate vasculitis, or more specifically, giant cell arteritis. Pulsatile tinnitus may also be an indication of idiopathic intracranial hypertension.[44] Pulsatile tinnitus can be a symptom of intracranial vascular abnormalities and should be evaluated for irregular noises of blood flow (bruits).[45]
Hair cells can be damaged by exposure to loud noise, which could lead to tinnitus. This can occur gradually as a result of exposure to noises over prolonged periods or may be caused by exposure to louder noises over a shorter period of time. If you are exposed to loud noises, you should always wear ear protection. Find out more about the subject on our How Loud Is Loud article and see if your job or lifestyle could be putting your ears at risk,
Dr. Julie Prutsman’s team of audiologists offer a higher standard of expertise. She has been deeply involved with tinnitus for more than 15 years, long before effective treatments had been developed beyond hearing aids and maskers. Dr. Julie also studied under one of the industry’s most respected and leading medical experts, Dr. Pawel Jastreboff, and she has personally trained each and every one of her doctors.

Tinnitus – a sound in the head with no external source – is not a disease; it is a symptom that can be triggered by a variety of different health conditions. So what causes tinnitus? Common sources include hearing loss, ear wax buildup, ototoxic medications, and ear bone changes. No matter what the cause, the condition interrupts the transmission of sound from the ear to the brain. Some part of the hearing system is involved as well, whether the outer, middle, or inner ear.
Tinnitus Control contains both a spray that is administered under the tongue three times a day and a gelatin capsule that is to be taken twice a day. Each package comes with a one month’s supply of the spray (1 fluid ounce) and capsules (60 capsules). Tinnitus Control is not currently available in local stores such as CVS, Walgreens and Rite Aid, but it is available directly from the manufacturer’s website at http://www.tinnituscontrol.com
Tinnitus is a non-curable, invisible and debilitating hearing disorder that can take on many different forms – ringing, hissing, buzzing, and even the sound of crickets. Almost everyone has experienced brief periods of mild tinnitus, but for many, this sound can be permanent. Over 360,000 Canadians report suffering from chronic tinnitus, and almost half of those are severely affected.1 In the US, over 16 million tinnitus sufferers seek treatment every year.2 Tinnitus is the number one disability claim for US veterans3 and has also become the top disability claim for current and former male RCMP members.4 This persistent sound can have a serious impact on quality of life; leading to sleep deprivation, depression, anxiety, and even suicide. What adds to the challenges faced by tinnitus sufferers is a lack of knowledge, support and options available to them. Unfortunately, there are currently too few health care professionals providing services to tinnitus sufferers who are seeking ways to manage their tinnitus. Unfortunately, the phrase “learn to live with it” is still heard far too often by those that seek help for tinnitus.
Steven Doerr, MD, is a U.S. board-certified Emergency Medicine Physician. Dr. Doerr received his undergraduate degree in Spanish from the University of Colorado at Boulder. He graduated with his Medical Degree from the University Of Colorado Health Sciences Center in Denver, Colorado in 1998 and completed his residency training in Emergency Medicine from Denver Health Medical Center in Denver, Colorado in 2002, where he also served as Chief Resident.
Many of us experience tinnitus every once in a while. If you’re exposed to extremely loud noise, or leave a noisy environment for a quiet one, you may notice a temporary buzzing or ringing in your ear. Maybe you’ve been near loud construction—like a jackhammer, or stepped out of a loud action movie or music concert to a quiet lobby or street. (Be aware: even a single exposure to very loud noise can do damage to your hearing, and increase your risk for tinnitus.)
Use other relaxation techniques. Tinnitus is understandably anxiety provoking, often a source of frustration and stress throughout the day and night. Reducing anxiety, and finding ways to relax, have benefits for both tinnitus and sleep. Relaxation exercises can reduce the aggravation of tinnitus, and make you more able to fall asleep. A few of the relaxation techniques my patients find most effective and easy to use are:

There is no cure for tinnitus. However, it can be temporary or persistant, mild or severe, gradual or instant. The goal of treatment is to help you manage your perception of the sound in your head. There are many treatments available that can help reduce the perceived intensity of tinnitus, as well as its omnipresence. Tinnitus remedies may not be able to stop the perceived sound, but they can improve your quality of life.

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]
About 25-30 million Americans have tinnitus as a condition, and they experience these noises on a regular, most often daily, basis. About 40 percent of people with tinnitus hear tinnitus noise through 80 percent of their day. And for a smaller group of people—about 1 in 5, tinnitus is disruptive enough to significantly interfere with daily functioning, becoming disabling or nearly disabling.
Tinnitus is usually described as a ringing in the ears, but it can also sound like clicking, hissing, roaring, or buzzing. Tinnitus involves perceiving sound when no external noise is present. The sound can be very soft or very loud, and high-pitched or low-pitched. Some people hear it in one ear and others hear it in both. People with severe tinnitus may have problems hearing, working, or sleeping.
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.
Shelly-Anne Li is the VP of clinical research and operations at Sound Options Tinnitus Treatments Inc. As a research methodology consultant for various projects, she brings expertise in health research methods, as well as experience from conducting multi-site randomized controlled trials, mixed methods studies and qualitative research. Shelly-Anne Li is currently a PhD candidate at University of Toronto, and obtained her MSc (health sciences) from McMaster University.
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.
In persons with pulsatile tinnitus, additional tests maybe proposed to study the blood vessels and to check the pressure inside the head. Gentle pressure on the neck can be performed to block the jugular vein but not the carotid artery. The Valsalva maneuver reduces venous return by increasing intrathoracic pressure. If there is a venous hum, this usually abates or improves markedly. If the pulsation is arterial, these tests have no effect.
It is very well accepted that tinnitus often is "centralized" -- while it is usually initiated with an inner ear event, persistent tinnitus is associated with changes in central auditory processing (Adjamian et al, 2009). Sometimes this idea is used to put forth a "therapeutic nihilism" -- suggesting that fixing the "cause" -- i.e. inner ear disorder -- will not make the tinnitus go away.   This to us seems overly simplistic -- while it is clear that the central nervous system participates in perception of sounds, and thus must be a participant in the "tinnitus" process, we think that it is implausible that in most cases that there is not an underlying "driver" for persistent tinnitus.
As their name suggests, maskers conceal tinnitus through other sounds. They look similar to hearing aids, but they won’t enhance your hearing. In this way, they’re like band-aids, covering up the problem instead of actually solving it. In addition, some people find maskers frustrating, because they can soften important sounds, like speech. We do not recommend maskers for long-term use as they do not work in re-wiring the brain.
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.

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.
Tinnitus habituation therapies, such as tinnitus retraining therapy (TRT), involve using low level sounds in a graduated fashion to decrease the perception of tinnitus. This differs from use of masking devices such as described earlier. TRT involves a wearable device that an affected individual can adjust so that the level of sound emitting from the device is about equal to or matches the tinnitus sound. This may be called the “mixing point” because the sound from the device and the tinnitus sound begin to mix together. An affected individual must repeatedly adjust the device so that the sound is at or just below the mixing point. TRT is supported by counseling with a trained professional who can teach the individual the proper techniques to maximize the effectiveness of TRT. Eventually, by following this method, affected individuals no longer need the external sound generating device. Affected individuals will become accustomed to the tinnitus sound (habituation), except when they choose to focus on it. Even then the sound will not be bothersome or troubling. The theory is akin to a person’s ability to ignore sounds such as the hum of air conditioner, the refrigerator motor turning on, or raindrops falling on the roof when driving a car in the rain.
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]
^ Jump up to: a b Schecklmann, Martin; Vielsmeier, Veronika; Steffens, Thomas; Landgrebe, Michael; Langguth, Berthold; Kleinjung, Tobias; Andersson, Gerhard (18 April 2012). "Relationship between Audiometric Slope and Tinnitus Pitch in Tinnitus Patients: Insights into the Mechanisms of Tinnitus Generation". PLOS One. 7 (4): e34878. Bibcode:2012PLoSO...734878S. doi:10.1371/journal.pone.0034878. PMC 3329543. PMID 22529949.
Tinnitus affects males and females in equal numbers. It can affect individuals of any age, even children. Tinnitus, collectively, is a very common condition and estimated to affect approximately 10% of the general population. Rhythmic tinnitus occurs far less frequently than non-rhythmic tinnitus, accounting for approximately 1% of all cases of tinnitus and is considered relatively rare in the general population. The exact prevalence or incidence of rhythmic tinnitus is unknown. Rhythmic tinnitus due to pseudotumor and sinus wall anomalies is found most commonly in overweight women in their 3rd to 6th decade of life. The onset of tinnitus can be abrupt or develop slowly over time.
A large, 2014 study of almost 14,000 people found obstructive sleep apnea was linked to significantly higher rates of hearing impairment and hearing loss. Scientists think one reason for this is changes to blood flow to the ear that result in inflammation. (We know that sleep apnea causes changes to circulation and weakens blood flow to some areas of the body, including the brain.) A related factor? People with sleep apnea are at greater risk for high blood pressure, and high blood pressure can exacerbate hearing loss, according to research.
 Sound therapy can be effective in treating tinnitus because it may make the tinnitus less noticeable or mask the tinnitus or fade tinnitus. Hearing aids are included as a critical component of a sound therapy program. Modern hearing aids come with a special tinnitus managing sounds along with digital amplification. They are much evolved over the older technology. Different products work in different ways, although most hearing aids can alleviate tinnitus, certain hearing aids have built-in technology specifically for tinnitus relief. At amplifon, we have a clearly defined way to measure and quantify chronic tinnitus. As per the severity of the problem, an appropriate combination of treatment methods is selected to deal with your tinnitus. Amplifon audiologists are specially trained in counselling procedures as well which is another critical element of sound therapy. Consult your Amplifon audiologist to find more details about what suits you to deal with your tinnitus problem.
You don’t need to enroll in an eight-week program to get started with mindfulness training. Participants in the MBTSR program all received a copy of the groundbreaking book “Full Catastrophe Living” by Jon Kabat-Zinn. Kabat-Zinn’s book is the premier manual for practicing mindfulness in daily life. You will learn about, and be encouraged to practice, meditation and breathing techniques that can help draw your focus away from tinnitus.
Hyperacusis is a different, but related condition to tinnitus. People with hyperacusis have a high sensitivity to common, everyday environmental noise. In particular, sharp and high-pitched sounds are very difficult for people with hyperacusis to tolerate—sounds like the screeching of brakes, a baby crying or a dog barking, a sink full of dishes and silverware clanging.  Many people with tinnitus also experience hyperacusis—but the two conditions don’t always go together.
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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