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. 
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.
Although mitochondrial DNA variants are thought to predispose to hearing loss, a study of polish individuals by Lechowicz et al, reported that "there are no statistically significant differences in the prevalence of tinnitus and its characteristic features between HL patients with known HL mtDNA variants and the general Polish population." This would argue against mitochondrial DNA variants as a cause of tinnitus, but the situation might be different in other ethnic groups.
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]

Limit use of earplugs. Earplugs are important to use to protect your hearing when you’re likely to be exposed to loud noises. (Remember, exposure to loud sounds, and noise-induced hearing loss, are common causes of tinnitus, and may make tinnitus worse if you already have the condition.) But otherwise, people with tinnitus are advised not to wear earplugs, including for sleep. Earplugs reduce your ability to hear external noise and can make tinnitus more noticeable.


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.
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.
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.

Technology and portable music devices also contribute to noise pollution, especially in younger people. Keep the volume of your phone, MP3 players or iPod on the lower end when listening to headphones, and don’t play very loud noises for long durations of time. To aid in tinnitus treatment, look out for changes in your ability to hear if you’re frequently exposed to loud noises, limit use of headphones or consider wearing earplugs.
While it’s definitely not a cure by any stretch of the imagination, if your tinnitus does not respond to Tinnitus Control, nor is there any identifiable underlying medical condition, then an effective way to drown out the sounds in your head is via noise suppression devices. These sound generators, in essence, mask the sounds of tinnitus so that you notice them less and can go about your daily life without going crazy over the annoying buzzing, whistling or ringing in your ears.
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.
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.
Microvascular compression may sometimes cause tinnitus. According to Levine (2006) the quality is similar to a "typewriter", and it is fully suppressed by carbamazepine. It seems to us that response to carbamazepine is not a reliable indicator of microvascular compression as this drug stabilizes nerves and lowers serum sodium. Nevertheless, this quality of tinnitus probably justifies a trial of oxcarbamazine (a less toxic version of carbamazepine).

Most tinnitus is "sensorineural," meaning that it's due to hearing loss at the cochlea or cochlear nerve level. But tinnitus may originate in other places. Our bodies normally produce sounds (called somatic sounds) that we usually don't notice because we are listening to external sounds. Anything that blocks normal hearing can bring somatic sounds to our attention. For example, you may get head noise when earwax blocks the outer ear.

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.
The similarities between chronic pain and tinnitus have led researchers to develop a mindfulness-based tinnitus stress reduction (MBTSR) program. The results of a pilot study, which were published in The Hearing Journal, found that participants of an eight-week MBTSR program experienced significantly altered perceptions of their tinnitus. This included a reduction in depression and anxiety.
Avoid a too-quiet bedroom. People with tinnitus may find it easier to sleep in a less quiet bedroom, and may benefit from white noise or other sleep-friendly sounds that help mask and minimize their tinnitus. To my patients who are looking to introduce soothing sounds to their sleep environment, I recommend the iHome Zenergy Sleep System, which combines relaxing sounds with aromatherapy and sleep-promoting light therapy.
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.

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]
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.
Some patients question the value of treatments that fall short of an absolute cure. ATA believes patients should do everything possible to lessen the burden of tinnitus until a definitive cure is found. An appropriate analogy may be the use of ibuprofen for a headache. Ibuprofen itself does not cure the underlying cause of most headaches, but it does reduce the pain that makes headaches feel so awful. Likewise, the most effective tinnitus treatment tools address the aspects of tinnitus that so often make the condition feel burdensome: anxiety, stress, social isolation, sound sensitivity, hearing difficulties, and perceived volume.
Can an iPhone app truly relieve tinnitus? Believe it or not, the answer is yes. The ReSound LiNX2 app utilizes a combination of sound therapy and relaxation exercises to reduce the severity of tinnitus. The convenient app can be used in combination with hearing instruments, which are small but strong. This groundbreaking program transforms your iPhone into a remote control for your hearing aid.
Most tinnitus is subjective, meaning that only you can hear the noise. But sometimes it's objective, meaning that someone else can hear it, too. For example, if you have a heart murmur, you may hear a whooshing sound with every heartbeat; your clinician can also hear that sound through a stethoscope. Some people hear their heartbeat inside the ear — a phenomenon called pulsatile tinnitus. It's more likely to happen in older people, because blood flow tends to be more turbulent in arteries whose walls have stiffened with age. Pulsatile tinnitus may be more noticeable at night, when you're lying in bed and there are fewer external sounds to mask the tinnitus. If you notice any new pulsatile tinnitus, you should consult a clinician, because in rare cases it is a sign of a tumor or blood vessel damage.
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