Tinnitus

Tinnitus is hearing noise or ringing in your ears without a sound from outside. It is common, affecting about 15% of the population, especially older adults.

Key points about tinnitus

  1. Tinnitus can be described as a buzzing, roaring, clicking, booming, hissing, whistling or cicada-like noise. For some people, these symptoms are severe.
  2. It is common in older adults, especially men and smokers.
  3. In most cases the cause of tinnitus is unclear. However, causes can include ageing, diabetes, Meniere’s disease, medicines, stress or anxiety, high blood pressure or head injury.
  4. Treatment depends on the cause of your tinnitus. However, for most people there is no underlying cause.
  5. There are things you can do to help manage tinnitus, such as quitting smoking, keeping your blood pressure well controlled, managing stress and avoiding triggers.

What is tinnitus?

Tinnitus is noise or ringing in your ears without an outside sound. It can also be described as a buzzing, roaring, clicking, booming, hissing, whistling or cicada-like noise. It can be heard as a single sound or as a mix or blend of different sounds. In some cases, the sound is a whooshing noise associated with your heartbeat. In some cases, the sound may be actual noise from musculoskeletal and vascular structures near your ear.

Tinnitus can affect one or both ears, and can start suddenly or gradually. The sounds can stay there all the time or come and go. The sound can vary in loudness, pitch and intensity.

What causes tinnitus?

In many people with tinnitus, the exact cause is not known, but it can be caused by factors such as:

  • ageing
  • living or working around loud noises
  • a buildup of earwax
  • ear infections
  • eardrum rupture
  • hearing loss – 80% of people with tinnitus have hearing loss
  • scuba diving
  • stress or anxiety – caused by the tinnitus or causing the condition
  • some medicines such as aspirin
  • drinking an excessive amount of alcohol or caffeinated drinks
  • dental or other problems affecting your mouth such as problems with your temporomandibular joint (TMJ), the joint that connects your jaw with your skull
  • head, neck or ear injuries
  • spasms in muscles close to your inner ear
  • injury to your inner ear following surgery or radiation therapy to your head or neck
  • severe weight loss from malnutrition or excessive dieting
  • repeated exercise with your neck in a hyperextended position, such as when cycling 
  • diabetes
  • Meniere’s disease
  • autoimmune conditions, such as rheumatoid arthritis 
  • blood flow problems such as carotid atherosclerosis (a buildup of plaques in your arteries) and high blood pressure (hypertension)
  • nerve problems such as multiple sclerosis or migraine headache
  • tumours, particularly acoustic neuroma.

How is tinnitus diagnosed? 

See your GP if:

  • your tinnitus is new or getting worse
  • you only have tinnitus in one ear
  • your tinnitus is affecting your daily functioning
  • your tinnitus beats in time with your pulse. 

Your doctor will ask you some questions related to your symptoms and your work, and examine your ears. Depending on what they think is causing your problems, they may perform tests such as hearing tests, blood tests, x-rays or scans such as an MRI or CT scan. Not everyone with tinnitus will need all these tests.

Contact your GP, call 111 or go to the nearest emergency department immediately if you or someone you care for experiences any of the following:

  • tinnitus after a head injury
  • tinnitus with sudden hearing loss, muscle weakness or vertigo.

How is tinnitus treated?

Tinnitus is a diagnosis not a disease. Treatment depends on what is causing it. In some cases, tinnitus is easily treated if the cause is found, such as removing ear wax or changing medicines. For most people, there is no underlying cause. You may be referred to an audiologist (a hearing specialist) or an ear, nose and throat (ENT) specialist for further tests and treatments. If you have tinnitus and deafness on one side, you will be referred to a specialist so an MRI can be done. 

Treatment of tinnitus may include lifestyle changes, medicines, hearing-based treatments and other treatments. In some cases you may get used to the sound and your brain ‘switches off’ the sounds. This may take several months. Reassurance that this can happen may be all the treatment you need.

Lifestyle changes

For some people, lifestyle changes can help to make the symptoms easier to manage or defer the onset of them.

  • Know your triggers for tinnitus and try to avoid them.
  • Reduce your exposure to loud noises – turn down the volume on loud music.
  • Reduce alcohol or caffeine intake.
  • Keep your blood pressure well controlled.
  • Get support to quit smoking.
  • In a quiet setting, use a fan, play soft music or use low-volume radio static to help cover up the noise from tinnitus.
  • Play soothing music at bedtime.
  • Manage stress and try to relax, as stress can make tinnitus worse. 
  • Talk to your doctor or pharmacist about medicines that can make your tinnitus worse. This includes over-the-counter medicines and supplements. 

Medicines

In some people, medicines may be helpful in reducing the severity of tinnitus, but there is no medicine to cure tinnitus. Medicines that have been trialled in individual patients include antidepressants, anticonvulsants (such as gabapentin and carbamazepine), and benzodiazepines. Sometimes, vitamin B12 injections are helpful, especially in older women. 

Hearing devices or other treatments

You may be referred to an audiologist (a hearing specialist) if your tinnitus is ongoing. Some of the treatments that may be offered include:

  • hearing aids
  • sound devices to mask the sound
  • counselling for stress
  • sound therapy
  • bedside noise generators
  • in rare cases, surgery.

There is no good evidence that complementary therapies, including acupuncture, hypnosis or homeopathy, have any benefit in managing tinnitus.

Are there any complications associated with tinnitus?

Some people with tinnitus experience other conditions as a result of their tinnitus. These can include:

If you experience any of these complications, talk to your healthcare provider about self-care and other treatments to help you manage them.

What support is available for someone with tinnitus?

Hearing New Zealand provides education and support for people who are deaf or hard of hearing. Visit their website or contact them via the online form here.

Learn more

The following links provide further information on tinnitus. Be aware that websites from other countries may contain information that differs from New Zealand recommendations

Tinnitus HealthInfo Canterbury, NZ
Understanding tinnitus Auckland University Tinnitus Clinic, NZ
Treatments for tinnitus
 The University of Auckland Clinics, NZ 
Tinnitus Health Direct, Australia
Tinnitus Better Health Channel, Australia
What is tinnitus Tinnitus Australia
Tinnitus Patient Info, UK
Tinnitus NHS, UK
Self-help tips for tinnitus ENT Group Clinic, Auckland

References

  1. Tinnitus Auckland Regional HealthPathways, NZ, 2020
  2. A review of tinnitus Australian Journal of General Practice, Australia, 2018
  3. Tinnitus Patient Info, UK
Credits: Health Navigator Editorial Team. Reviewed By: Dr Bryan Frost, FRNZCGP, Morrinsville Last reviewed: 29 May 2021