Tinnitus 101: Making Sense of the Ringing in Your Ears

Do You Recognize These Symptoms?

Tinnitus is different for everyone. Some people experience tinnitus all the time, hearing a ringing in their ears both day and night. Others have tinnitus that comes and goes, or isn’t too bothersome. Here’s how people describe tinnitus:

• “I have a hissing sound in my ears I can only hear when everything around me is very quiet.”
• “Tinnitus keeps me awake at night.”
• “The buzzing in my ears makes me anxious, and I’m more easily irritated than before.”
• “My tinnitus is really intense. It gives me a headache several days a week.” 
• “For me, tinnitus is a whistling sound that comes and goes, I maybe only hear it once a week.”
• “I hear this pulsing sound. It feels like a heartbeat in my ear, and sometimes it leads to a migraine.”
• “A low-pitched roaring in my ears makes it hard to hear during conversations.”
• “It’s a whirring sound that I hear after I get into bed. Some nights it’s impossible to sleep.” 
• “Once when I was leaving a loud concert, I had ringing in my ears for a few hours.”

Do any of these descriptions sound familiar? Each person will experience tinnitus in their own unique way. Tinnitus can be high or low pitched. It can also be constant or intermittent, very soft or very loud. These factors can even change from day to day. For example, you may experience tinnitus as a very low-pitched rumbling or a high-pitched squealing. Tinnitus usually fades into the background when there are other sounds around you. This means you’ll most likely notice tinnitus when you’re in a quiet room, or trying to fall asleep at night.

What Does Tinnitus Sound Like?

Tinnitus is a subjective noise. Since you’re the only one who can hear this sound, it will sound different for everyone.

Tinnitus can sound like:

• Ringing
• Buzzing
• Clicking
• Whistling
• Rushing
• Roaring
• Whirring
• Whooshing
• Hissing
• Pulsing
• Screeching
• Humming
• Static

What is Tinnitus?

Tinnitus is a sound that only you can hear. It’s not an auditory sound that comes from the environment around you. Instead, this phantom sound comes from in your ears and brain. The most common tinnitus sound is a high-pitched ringing sound. No matter kind of tinnitus you have, it’s extremely annoying, and can lead to a lot of negative health outcomes.

People of any age can have tinnitus, but it’s more common for older adults. Tinnitus can be in one or both ears. Some people experience tinnitus as a constant irritation, while other people say it comes and goes throughout the day or the week. Even the volume of the sound can change. Because your experience of tinnitus isn’t always the same, you may sometimes wonder if this time the sound really is in your environment instead of in your ears. This makes tinnitus even more frustrating.

An unusual kind of tinnitus is musical tinnitus or musical ear syndrome. This can include the perception of music, a melody, or a song. Just like tinnitus, this music isn’t a real auditory sound, and only you can hear it. While musical tinnitus isn’t very common, it is another kind of tinnitus and it’s not associated with a neurological disease or a psychiatric disorder

Who Has Tinnitus?

Hearing ringing in your ears is a lot more common than you think. It’s estimated that 15-20%of Americans have tinnitus. That’s over 50 million Americans. Of these, about 20 million people have chronic tinnitus they hear every single day. Tinnitus is common in adults over 50 but many younger adults can also have tinnitus. Even children or teens sometimes report experiencing tinnitus.

This constant tinnitus can a lot of negative outcomes, affecting concentration, productivity and mood. It even deprives you of sleep and increases your stress and anxiety. It often gets worse with age. However, it’s not usually a sign of anything serious. Instead, tinnitus can be a sign of another underlying health issue you should address

Medical Causes of Tinnitus

The medical community doesn’t fully understand what causes tinnitus. They do agree that tinnitus is usually linked to cell damage in the ear. This is the same damage that leads to hearing loss. When the delicate cells in your inner ear are damaged or die, they stop sending signals to the brain. You will no longer hear the sounds associated with these exact cells.

When these inner ear cells are damaged, the other cells in the ear may start acting differently. One explanation for tinnitus is that the remaining cells become even more sensitive to sound. So even though there are no sounds in the environment, you will “hear” tinnitus.

Other researchers say that tinnitus is your brain’s way of adapting to these changes in the ear. The brain fills in the missing sounds that correspond to the cells in the ear that no longer send signals to the brain. When the brain fills in for these cells, you experience tinnitus.

Some of the causes of tinnitus include:

• Hearing loss
• Nosie exposure that damages the cells in the ear
• Stiffening of the bones in the middle ear
• An ear infection
• A problem with the eustachian tube that connects the middle ear to the back of the throat
• A buildup of earwax in the ear canal
• A head or neck injury
• Temporomandibular joint (TMJ) disorders
• Muscle spasms or contractions in the inner ear
• Meniere’s disease
• A benign cranial tumor

There are also several medications that can cause or worsen tinnitus. Over 200 drugs are ototoxic and can damage the ear, including:

• Antibiotics like polymyxin B, vancomycin, and neomycin
• Cancer treatments like methotrexate and cisplatin
• Diuretics like bumetanide and furosemide
• Some antidepressant medications
• Aspirin when taken in very high doses

Tinnitus can even appear without any of these conditions. Sometimes the cause of tinnitus is completely unknown.

The Two Kinds of Tinnitus

Doctors recognize two kinds of tinnitus:

• Subjective tinnitus is the most common kind of tinnitus. You’re the only one who can hear this phantom sound. Subjective tinnitus is caused by hearing loss, problems in the outer, middle, or inner ear, or any of the other causes mentioned above.
• Objective tinnitus is very rare. This type of tinnitus can be heard by a medical professional during an exam. It’s caused by problems with the blood vessels, problems with the bones in the middle ear, or muscle contractions. It’s often a sign of a serious medical condition that needs immediate attention.

Medical Treatment for Tinnitus

Sadly, tinnitus can’t be cured. Treatment focuses on managing tinnitus so that it doesn’t play such a big role in your life. Many people with tinnitus can learn to cope with this ringing in the ears, but about20% of people with chronic tinnitus say it’s debilitating, leading to problems concentrating and sleeping, and increasing anxiety and irritability. Medical treatments for tinnitus focus on treating the underlying issue, for example treating an ear infection, treating an injury, wearing hearing aids, or stopping medications that can cause tinnitus.

Related Conditions

If you have tinnitus, you most likely have another underlying health condition. Tinnitus rarely shows up without at least one other condition. There are several related health conditions where tinnitus is often a factor.

Hearing Loss

The most common correlated condition is hearing loss. In fact, 90%of people with tinnitus have some underlying hearing loss. This is because the same underlying mechanism can cause both hearing loss and tinnitus. Just like tinnitus, sensorineural hearing loss is also caused by damage to the cells in the inner ear. These cells are very susceptible to damage from loud noise, oxygen deprivation, changes in blood flow, or even the normal wear and tear we experience in aging. Once these cells are damaged, they can’t be repaired. And this damage often leads to hearing loss and tinnitus.

Meniere’s Disease

Another condition closely related to tinnitus is Meniere’s Disease. Just like hearing loss, this condition also affects the inner ear. Meniere’s Disease is a vestibular disorder that can disrupt the fluid in the inner ear. Symptoms include hearing loss and loss of balance, along with vertigo, migraine headaches, tension headaches, nausea, and tinnitus. Meniere’s Disease will usually only affect one ear.

Hyperacusis

If you have a hard time tolerating everyday sounds, you may have hyperacusis. This is also linked to tinnitus. Hyperacusis is extreme sensitivity to noise. It makes normal, everyday sounds seem very loud. For example, a normal conversation with your partner, driving your car, or even watching TV can be uncomfortable. Hyperacusis affects many areas of your life, including disrupting your social life, making your workplace unbearable, and taking away your peace of mind. This increased sensitivity to sound affects a certain range of sounds, and only when sounds are at a normal volume or louder. Some people will even experience pain when exposed to these sounds.

Insomnia

If you have trouble falling asleep and staying asleep, you probably have insomnia. You wake up feeling tired and sluggish, and you struggle with daytime fatigue and drowsiness. Insomnia also increases stress, depression, and even pain. It’s easy to see how tinnitus is linked to insomnia. Tinnitus is more noticeable when you’re in a quiet room, for example whenyou’re about to go to sleep. It can make it very difficult to fall asleep, and laying awake listening to tinnitus makes the sound seem even louder. If youwake up in the middle of the night, tinnitus can also prevent you from falling asleep again.

Headache Disorders

Tinnitus is often related to headache disorders. For example, a vestibular migraine can cause tinnitus. Or if tinnitus is already present, it will get much worse during a migraine. Tinnitus and headaches have similar symptoms, including depression, anxiety, insomnia, trouble focusing, and increased stress. Tension headaches and tinnitus are also linked. For example, the side where you have the headache will be the side where you experience tinnitus. Severity is also interconnected. A severe migraine headache will cause more severe tinnitus.

If you have tinnitus and comorbid headaches, you’re more likely to experience vertigo, pain, depression, and an overalllower quality of life. For anyone with tinnitus, at least 26% also have headaches, and up to 40% of people with severe tinnitus have frequent headaches.

The Link Between Psychological Factors and Tinnitus

Tinnitus doesn’t just affect your ears. It also affects your overall mental health and wellbeing. In fact, tinnitus is closely linked to psychological factors like anxiety, depression, and stress.

Anxiety and Depression

Tinnitus can affect your mental health in profound ways. Tinnitus is closely linked to both anxiety and depression. Between 48-78% of people with severe tinnitus also have depression or anxiety. In one study, emotional difficulties were reported by more than 70% of people with tinnitus. These emotional difficulties included poor sleep, higher rates of annoyance, and depression. Tinnitus has a huge impact on your overall psychological state. Living with tinnitus can make you anxiety worse and even lead to fatigue, irritability, and depression.

Anxiety can also lead to tinnitus. When you feel anxious or overwhelmed, your body goes into a fight or flight response. Your breathing gets faster and your heartrate increases. More blood is sent to your muscles, and less is sent to your brain and your ears. This can make your tinnitus much worse and make it very difficult to cope with the ringing in your ears.

High anxiety can also cause a migraine headache or a tension headache. Not only are these headaches painful, they can even exacerbate your tinnitus and make it more noticeable. Vestibular migraines and tension headaches often lead to an onset of tinnitus.

Anxiety can even lead to muscle contractions or muscle twitching anywhere in the body. Eye muscles are the most common muscles effected by muscle contractions. If you have high anxiety, you’re more likely to experience muscle contractions or eye twitching, and these can cause tinnitus or make your tinnitus more serious.

The physical symptoms of depression can also affect your experience of tinnitus. These symptoms, such as fatigue, decreased appetite, and poor sleep, are all linked to tinnitus. When you’re not sleeping or eating well, you have a higher risk of getting a headache, feeling more anxious, and experiencing tinnitus.

The Role of Stress

Stress is another psychological factor closely linked to tinnitus. Not all stress is bad for your health. Short term stress will help you focus on what you need to accomplish, or can even protect you from some danger in your environment. However, chronic and ongoing stress has a number of negative effects on your body and your mind. If you have chronic stress, you’ll often feel tense, experience a more rapid heartbeat, have poor concentration, and have a difficult time sleeping.

Chronic stress and tinnitus are part of a negative cycle. When you feel stressed, your tinnitus gets worse. You’ll have a harder time focusing, and a harder time falling asleep at night. If you start fixating on the tinnitus, you may feel hopeless, despairing, or resentful. All these thoughts about the tinnitus will increase your experience of tinnitus, making it much more noticeable. And this sends your stress even higher. This cycle continues, with stress and tinnitus escalating together.

Home Treatments

There is no medical cure for tinnitus. Doctors can’t prescribe a medication or recommend a surgery to cure tinnitus. Instead, tinnitus treatment is all about managing the symptoms of tinnitus, lowering stress, and learning how to treat tinnitus at home.

Sound Therapy

One of the most effective short-term home treatments for tinnitus is sound therapy. Certain sounds can mask tinnitus, so it fades into the background. The sound will cover the tinnitus, and you won’t notice it anymore. You’ll need to find the sound that masks your unique experience of tinnitus. For example, you’ll use a different masking sound depending on what kind of sound your tinnitus is, and if it’s low or high pitched. Sounds that can mask tinnitus include a noisy fan, a humidifier, a white noise machine, background music, or static. You can even download an app to play masking sounds while you fall asleep, so that you can fall asleep easily. The downside of sound therapy is that it’s a short-term treatment. As soon as you turn off the masking sound, your perception of tinnitus returns just as strongly as before.

Tinnitus Retraining Therapy

A long-term tinnitus treatment option is tinnitus retraining therapy (TRT). This is a way to train the auditory system to ignore the tinnitus sounds. For this therapy, you’ll need a few sessions with a trained professional, and a device that produces white noise. Through ongoing practice at home, you can retrain your brain to ignore the sounds of tinnitus, giving you long-lasting relief.

Meditation

Other effective home treatments for tinnitus are meditation, breathing exercises, or relaxation techniques. This long-term treatment helps you accept the tinnitus sounds and will break the stress cycle. By meditating every day, you can develop neutral feelings towards your tinnitus. When you hear tinnitus at other times in the day, it won’t lead to increased stress and anxiety. Instead, you’ll be able to calmly continue your day without worrying about tinnitus. This decreases tinnitus and provides long-term treatment.

Healthy Lifestyle

Improving your overall health and wellness will help you manage tinnitus. A healthy lifestyle can’t stop your tinnitus, but it can reduce the intensity, and make tinnitus easier to manage.

• Daily exercise will improve heart health and support better blood flow. This is good for your ears and it can reduce your experience of tinnitus.
• Healthy eating helps manage tinnitus. Eating a healthy balance of whole grains, lean meats, vegetables, and fruits will lower cholesterol, lower blood pressure, improve your overall health, and reduce tinnitus.
• Drinking enough water is essential, since dehydration can also affect your perception of tinnitus.
• Smoking, alcohol, and caffeine can all make tinnitus worse. These can cause high blood pressure or restrict blood flow throughout the body and to the ears, making tinnitus louder. Quitting smoking and limiting alcohol and caffeine will help you treat tinnitus at home.  

Talk About Stress and Tinnitus

Tinnitus contributes to higher stress, causes irritability, and increases fatigue. This impacts all areas of your life, from your relationships to your work and everything in between. One way to manage tinnitus is to talk about it. Talk to a trusted friend or family member, or to a professional counsellor. Talk about how tinnitus is impacting your relationships, your work, and your mental health. Becoming more aware of these issues will help you manage tinnitus at home.

Final Thoughts

Tinnitus is a mystery. Doctors don’t know exactly what causes this irritating ringing or hissing sound in your ears. However, we do know that hearing loss, insomnia, and headaches can make tinnitus worse. Not only that, but several psychological factors like anxiety, depression, and stress make our tinnitus stronger and more noticeable.

Don’t let the negative cycle of stress and tinnitus takeover your life. Learn how to treat your tinnitus at home. Try sound therapy for short-term relief, then look at long-term treatment options like meditation, relaxation techniques, and developing a healthy lifestyle. You can manage your tinnitus, get relief from that constant buzzing, and enjoy your day in peace.