Tinnitus: What’s that Noise in Your Ears?

Do you hear annoying ringing, buzzing, roaring, or hissing sounds that no one else can hear? You are not alone. You are experiencing tinnitus, one of the most common health conditions in the United States, impacting over 50 million Americans. While there isn’t a cure and it can be a frustrating condition, there are effective ways to manage the situation.

What are the symptoms of tinnitus?

What tinnitus sounds like varies from person to person. According to the National Institute on Deafness and Other Communication Disorders (NIDCD), “Tinnitus is commonly described as a ringing in the ears, but it also can sound like roaring, clicking, hissing, or buzzing. It may be soft or loud, high-pitched or low-pitched.” The sound might be constant, or it might come and go. People with tinnitus may hear the noise in one or both ears or feel like it is emanating from inside their head.

To gain a better understanding of what a person is experiencing, there are tools that allow symptoms to “be identified and quantified using specific questionnaires such as the Tinnitus Handicap Inventory or the Tinnitus Severity Index,” said Christine Pickup, AuD, at Mt. Harrison Audiology in Rupert, ID.

Stella Fulman, AuD, an audiologist at Audiology Island in Staten Island, NY, told HearingTracker that, when determining whether you might have tinnitus, ask yourself: Could the noises be exterior noises? Do I hear noises that no one else is hearing? Can I identify a triggering event, such as a concert or head trauma? Your answers can then help a healthcare professional diagnose your condition.

What are the types of tinnitus?

Tinnitus and hearing loss often occur together, but not everyone with hearing loss will experience tinnitus. Regardless of the cause, how it is described, or when it first occurs, there are two main types of tinnitus: subjective tinnitus and objective tinnitus.

As explained by Donna Pitts, AuD, assistant professor at Loyola University in Baltimore, MD, “Subjective tinnitus is the most common type of tinnitus, and sometimes it is referred to as ‘phantom” tinnitus.’” The word phantom” refers to the fact that only the person experiencing the sound can hear it.

That is not the case with objective tinnitus, often referred to as pulsatile tinnitus or sometimes vascular tinnitus. With this less common variation, there is typically a medical condition causing a change in blood flow, especially in the head and neck region. Objective tinnitus can be heard by the person affected and via a stethoscope by a medical professional.

What are the causes of tinnitus?

Tinnitus is not a disease; rather, it is a symptom generated within the auditory system and is usually caused by an underlying condition. “Tinnitus is strongly associated with hearing loss, and in most cases, we believe that tinnitus stems from damage to the outer hair cells of the cochlea,” according to Eric Sandler, ScD, director of audiological services at the Hearing Center in Manalapan, NJ.

Damage to these sensory-receptor cells leads to less auditory stimulation reaching the brain. In the absence of auditory input from the inner ear, the brain may spontaneously send signals to fill the empty space. In fact, tinnitus has sometimes been likened to "phantom limb syndrome,” where people experience sensations, whether painful or otherwise, in a limb that does not exist. In the auditory system, these signals may be interpreted as sound, creating tinnitus.

Some other known causes include excessive earwax, medications, stress and depression, sleep deprivation, smoking, high blood pressure, and noise exposure.

What are the consequences of untreated tinnitus?

Some people with tinnitus report experiencing associated emotional issues. Hadassah Kupfer, AuD, an audiologist in Brooklyn, NY, told HearingTracker, “The fear associated with an unknown, uncontrollable sound in the ear activates the limbic system, which triggers an emotional response—panic, distress, and sometimes depression.” It can affect a person’s ability to fall asleep, leaving them feeling sluggish. If tinnitus is not successfully managed, it may lead to feelings of anger, guilt, hopelessness, and irritability. Tinnitus may also put a strain on interpersonal relationships, impacting work and social life.

Some people encounter what's called the "vicious cycle of tinnitus,” where their perception of tinnitus leads to anxiety, fear, irritability, avoidance of regular activities, social withdrawal, and depression—all of which can contribute to an increased perception or awareness of their tinnitus.

How is tinnitus treated?

“The most important thing you can do to start alleviating and coping with tinnitus is to see a doctor, typically an ENT or an audiologist,” said Melissa Wikoff, AuD, audiologist at Peachtree Hearing in Marietta, GA. Your doctor can work to determine the underlying cause of your tinnitus. When describing your tinnitus sounds, try to do so in as much detail as possible. This information can help your doctor identify the root of the issue and choose the appropriate treatment methods for managing the symptoms.

“Rather than ‘treating’ tinnitus, the goal is to help a patient manage it,” said Pickup. There are several strategies that can help manage tinnitus. These may include correcting any hearing loss with hearing aids, limiting stress, and using sound generators (aka “white noise machines”) to help mask or minimize the sounds.

Two of the best-known therapies for bothersome or debilitating tinnitus involve counseling via Cognitive Behavioral Therapy (CBT) and Tinnitus Retraining Therapy (TRT). Both aim to change one's behaviors and reactions to tinnitus. CBT usually involves working with a psychologist to learn coping techniques to make tinnitus symptoms less bothersome. TRT generally involves a more individualized program that combines sound masking with CBT concepts administered by a hearing care professional who has specialized training in tinnitus management.

Many people with tinnitus employ DIY self-help approaches, such as using headphones paired with apps that feature nature sounds or music/audio playlists. Others might own a gurgling aquarium in their office or bedroom that provides soothing, pleasant background noise. However, these noise-generating approaches usually represent temporary solutions, masking the tinnitus only while in use. But, if they work and are helpful, then they represent a good outcome.

In some cases, doctors may prescribe drugs to reduce the severity of tinnitus symptoms or treat an underlying condition (e.g., anxiety or depression) that can accompany tinnitus.

Although the internet is full of sketchy supplements, devices, and "cures" for tinnitus, there are some newer FDA-cleared approaches. These include the Lenire neuromodulation device and the CBT-based Mahana Tinnitus digital therapeutic app, both of which can be offered by hearing care providers and tinnitus specialists. More evidence-based options will continue to emerge for people looking for reliable tinnitus solutions.

Can tinnitus be prevented?

Since there are a variety of causes of tinnitus, it is not always possible to prevent it. Pickup recommends taking measures to prevent both tinnitus and hearing loss, such as avoiding exposure to loud noises, eating a healthy diet, and exercising. And activities like smoking can make your tinnitus spike.

Do any celebrities have tinnitus?

Tinnitus doesn’t discriminate; it can affect anyone at any age. “In fact, because tinnitus often develops because of exposure to loud noises, actors and musicians may even be more prone to tinnitus,” said Fulman. Among celebrities who’ve spoken about having tinnitus are Eric Clapton, Whoopi Goldberg, Steve Martin, William Shatner, and Barbra Streisand.

As these celebrities show us, you can still live a full and successful life despite the challenges of living with tinnitus.

Taking the next step

If you are struggling to manage your tinnitus, don’t suffer in silence. Make an appointment to speak to your hearing healthcare provider to discuss how to manage your symptoms and prevent further damage.