By Cathi Gandel, AARP
Do you have ringing in your ears? There's a chance it could be Tinnitus. Here are 10 ways to treat the ringing in your ears called Tinnitus. Plus causes, symptoms and diagnoses, and new treatments on the horizon that may help you get relief.
Tinnitus is an unwanted sound heard only by the person experiencing it. The first signs can be a ringing, whooshing, clicking or buzzing noise. It can be whisper soft or piercing. It can be intermittent or constant. The condition can be maddening, as often there is no main cause.
Although there are treatments, there are currently no cures. About 26 million adults in the United States suffer from tinnitus, says Joy Onozuka, tinnitus research and communications officer at the American Tinnitus Association. For some people, it’s a minor nuisance, easily ignored. But for about 20 percent of those people, it is a constant distraction that can affect sleep, concentration and daily life and lead to anxiety or depression. A review of data on the global prevalence of tinnitus found that the condition tends to increase with age, affecting 24 percent of older adults.
What is tinnitus?
There are a couple of important things to know about tinnitus. In the first place, we don’t hear with our ears; we hear with our brain. For that reason, much of the current research is focusing on ways to reprogram the brain. Researchers say people experience tinnitus when their brains pick up on a phantom sound and try to identify it but can’t. So the brain continues to focus on that sound and tries to solve the puzzle.
“Because the brain can’t make sense of it, the sound becomes the forefront of attention,” says Grant Searchfield, head of the audiology department at the University of Auckland in New Zealand. Because we focus on the phantom sound, it becomes more important. Because it becomes more important, it becomes louder. “It’s an unfortunate side effect of how the brain works,” Searchfield says.
Causes and types of tinnitus
Subjective tinnitus is the more common. These are the sounds that only the person can hear.
Objective tinnitus is extremely rare. It is often caused by a medical disorder and can be treated by correcting the underlying problem. Objective tinnitus can be heard by others as well as the patient.
“Remember, tinnitus is a symptom, not a disease,” says Douglas D. Backous, M.D., president-elect of the American Academy of Otolaryngology. Plus, it’s incredibly heterogeneous, meaning the causes are diverse. “There’s like 26 million people in the country who have tinnitus and probably 27 million reasons why they have it,” Backous says.
Well-known causes of subjective tinnitus include exposure to loud noise — for example at rock concerts, in the factory or on the battlefield. Some medications, like aspirin or some antibiotics, can contribute to tinnitus. Tinnitus can be caused by ear wax, which usually is easily removed, or in rare cases a tumor requiring surgery. Sometimes the underlying medical condition can be fixed, or changes can be made to medications that help solve the problem.
10 treatments for tinnitus
1. FIRST, SEE YOUR DOCTOR
When you first hear that pesky noise in your ear, see your doctor. Start with your primary care physician, who can determine if there is an underlying medical cause. If the tinnitus persists, the next step would be to see a hearing health professional, who would perform additional hearing and nerve tests, and perhaps an MRI or CT scan.
2. CHECK FOR MEDICATIONS
Some of the more common medications that can affect tinnitus include analgesics like aspirin, diuretics, cancer drugs and certain antibiotics. A multiyear health study involving almost 70,000 women self-reporting on their use of common pain medications found that those who used medications like ibuprofen (Advil) were at a higher risk of developing tinnitus and “the magnitude of the risks tended to be greater with increasing frequency of use.”
But, the study warns, there is no firm evidence that those medications cause tinnitus. The Center for Hearing Loss Help has developed a list of medications that may be connected to tinnitus, available free for download. If you think one of your medications may be causing your tinnitus, speak to your doctor. There may be an alternative.
3. GET EARWAX REMOVED
Be careful trying to remove earwax by yourself. You may push it deeper into the canal or even perforate the eardrum. The good news is that if earwax is the cause of your tinnitus, removing it may solve the problem. For safe (and unsafe) ways to remove earwax, see this article on earwax removal.
4. TRY A HEARING AID
Tinnitus and hearing loss are often associated, particularly in older people. “I don’t prescribe hearing aids for tinnitus, but I prescribe hearing aids for hearing loss,” Backous says, “and oftentimes that reduces their tinnitus because they are hearing what they want to hear.”
5. CONSIDER SOUND THERAPY
Sometimes called acoustic therapy, this is something you can do on your own and may make the tinnitus easier to live with, especially at night. “The ringing is always worse when it’s quiet,” Backous says. Adding a background sound may help. It doesn’t have to be loud. It can be music, water, sounds of nature or white noise. “Any sound you find pleasant and calming,” says Onozuka.
6. MASK THE SOUND
Maskers are a step up from sound therapy. They look like hearing aids but with open ear buds. Some hearing aids also offer masking options. Masking requires attention from a hearing health professional who can replicate the sound of the tinnitus.
7. REDUCE STRESS
Studies have shown that stress can contribute to the beginning or worsening of tinnitus. While it may never be possible to eradicate stress in your life, you may be able to manage it with a healthy diet, exercise and recreation.
8. TRY COGNITIVE BEHAVIORAL THERAPY
One of the most common treatments for tinnitus relief is to moderate the person’s reaction to the sound. The aim of cognitive behavioral therapy (CBT) is to help the patient, working with a therapist, reduce their emotional response to the tinnitus. It aims to change the thoughts of “I can’t take this anymore” to “This is no big deal.” A review of studies of this treatment published in the Journal of the American Academy of Audiology in 2014 found that “CBT treatment for tinnitus management is the most evidence-based treatment option so far.”
9. TRY A MEDITERRANEAN DIET
You are what you eat — and what you eat can affect your tinnitus. Choose a diet heavy in green and orange fruits and vegetables and low in carbohydrates, fats and sugars. A study published in 2020 in Ear and Hearing reported that eating higher amounts of protein could help reduce the risk of tinnitus. And because tinnitus is so specific to the sufferer, there may be individual no-nos. For example, salt can elevate the sound of tinnitus for some people, Onozuka says.
10. LIMIT ALCOHOL AND NICOTINE; COFFEE IS PROBABLY FINE
There is no evidence that alcohol causes tinnitus. But it may contribute to it by increasing risk of dehydration and high blood pressure, both of which can affect tinnitus.
In 2018, a group of researchers in Germany reviewed data on smoking and tinnitus. Their findings: Rates of tinnitus were higher in smokers than in nonsmokers. But a cause-and-effect relationship has not yet been proven. And caffeine? There is no conclusive research that shows it affects tinnitus. However, one study in about 65,000 women found a link between drinking coffee and a fewer cases of tinnitus.
Research in new tinnitus treatments
Exciting new treatments for tinnitus are being studied at several universities. They are currently being tested as part of trials, but they could help those with tinnitus find relief in the near future. This research has focused on ways to reprogram the brain to diminish the sound and so lessen its impact. Here are four examples of recent research.
DISRUPT THE TINNITUS NETWORK
Dirk De Ridder is a professor of neurosurgery at the University of Otago in Dunedin, New Zealand. His most recent research includes what he calls a “network” approach. “We are trying to block the networks in the brain that we think are involved in tinnitus,” he says. One way to do this is to try to disrupt the connections in the tinnitus network using electrical stimulations to the brain, or psychedelics like LSD. “If these products are capable of disrupting the tinnitus networks, then we can use the stimulator to try to rebuild the normal network, that is the non-tinnitus network,” he says.
De Ridder is also working with the Delft University of Technology in the Netherlands on a different approach. When the brain attaches prominence to the tinnitus sound, it activates the sympathetic system, creating a fight-or-flight response. The lab in the Netherlands is building a device that can make the tinnitus sound less important while at the same time reconditioning the brain. It does this by stimulating the parasympathetic or rest-and-digest-and-restore system. If the tinnitus sound is always paired to this signal, the brain will connect the two and expect the rest-and-restore signal to kick in whenever the tinnitus sound appears. “It’s a Pavlovian approach,” De Ridder says.
DOUBLE STIMULI
Bimodal auditory-somatosensory stimulation is a noninvasive technique that acts on the brain in two ways: Sounds are paired with electrical zaps. At the University of Michigan, Susan Shore, a professor of otolaryngology, physiology and biomedical engineering, recently concluded a second clinical trial of a device. It includes headphones that play a sound matching the tinnitus and small electrodes attached to the neck or cheek. These electrodes deliver weak impulses specifically timed with the sounds.
The results of the first clinical trial, published in 2018, were promising. Participants were trained to complete daily sessions of 30 minutes for four weeks. At the end, some participants reported a 12-decibel reduction in the tinnitus sound and two said their tinnitus had gone completely. The device, called Auricle, is waiting approval from the Food and Drug Administration (FDA).
Hubert Lim, a professor of biomedical engineering and otolaryngology at the University of Minnesota in Minneapolis, has developed a slightly different device. Headphones deliver sound to the ears, but the electrical impulses are applied to the tongue. In 2022, 191 adults with tinnitus tested the device. After 12 weeks of one-hour daily treatments, more than 70 percent of the participants reported that the effect of their tinnitus had been reduced. These effects lasted for up to a year after completion of the treatment.
Lim’s device is available as Lenire in Europe. It, too, is waiting for FDA approval before being released in the United States.
MOBILE PHONE APP
At the University of Auckland in New Zealand, Searchfield and his team are developing a therapy that includes a smartphone-based digital app with headphones, a neck speaker and a dashboard so the clinician and patient can communicate. Searchfield calls the prototype a “polytherapeutic approach” because there is no one-size-fits-all treatment for tinnitus. “We’re taking different approaches because certain aspects will be more beneficial for certain people.”
These approaches include providing relief through background sounds and relaxation via guided exercises. Retraining is accomplished through auditory games that reward patients for not listening to their tinnitus. “We want to get people involved in their therapy and remove the focus from the tinnitus onto other sounds,” he says.
In a recent clinical trial, participants were divided into two groups. Thirty individuals were part of the control group and used a white noise app that is readily available and has been shown to have some benefit in reducing tinnitus distress. Thirty-one people used the new digital polytherapeutic system developed by Searchfield and his team. After 12 weeks, 65 percent of the group using the polytherapeutic reported a significant improvement in how they experienced their tinnitus.
Searchfield is working on a new version of the app, which he hopes to make commercially available in six months.
PROGRESSIVE TINNITUS MANAGEMENT
Tinnitus is the number one disability reported by veterans returning from combat, says James Henry, a career scientist recently retired from the National Center for Rehabilitative Auditory Research. Henry and his colleagues developed the five-step progressive tinnitus management (PTM) plan. The stepped approach means that every patient can find the right level of support to help mitigate the effects of their individual tinnitus. “We’re teaching patients different skills so they can help themselves to live a more normal life despite having tinnitus,” he says. There is a PTM self-help handbook, "How to Manage Your Tinnitus: A Step-by-Step Workbook," available online.
Although this program was developed within the Department of Veterans Affairs, “it is universal to anyone who has tinnitus,” Henry says. A 2019 study conducted by telephone with 205 tinnitus sufferers from across the United States who were using PTM found that almost 84 percent of the participants felt more able to cope with their tinnitus and nearly 73 percent felt their overall quality of life had improved.
New methods of diagnosing tinnitus
Traditionally, tinnitus is diagnosed by patients describing symptoms to their doctors. A primary care physician will conduct a thorough physical exam as well as asking you about how your tinnitus started and what the noise sounds like. To date there has been no way of objectively diagnosing tinnitus in the way that cancer and heart disease can be diagnosed, but advances are being made in this area.
DIAGNOSING BY ELECTRICAL RESPONSES IN THE BRAIN
An auditory brain stem response (ABR) may provide a solution. Small electrodes attached to the head are connected to a computer. Clicks delivered via earphones are measured by the computer and reveal how the inner ear (the cochlea) and the brain’s auditory pathways are working together.
In 2022, Christopher C. Cederroth, a researcher at the department of physiology and pharmacology at the Karolinska Institutet in Stockholm, and his colleagues conducted ABR tests on 405 individuals. Of those, 228 had tinnitus. The results showed a clear difference in brain stem responses between those with constant tinnitus and those without. The scientists hope that being able to identify alterations in the brain connected with tinnitus will help with diagnosis.
DIAGNOSING BY GENETICS
Another possibility for diagnosing tinnitus also comes from Cederroth and scientists at the Karolinska Institutet. In some cases, there may be a genetic component.
A Swedish study of more than 10,000 twins with tinnitus revealed that male twins showed bilateral tinnitus (tinnitus in both ears), suggesting a genetic link. Another study with adoptees revealed that their odds of having tinnitus were increased if their biological parents were diagnosed with it, but not the adoptive parents.
“Patients have often been told to go home and learn to live with [their tinnitus], nothing can be done — and it’s not really true,” said Henry, of the National Center for Rehabilitative Auditory Research, when he received an award for his work with tinnitus. For those looking for help, the American Tinnitus Association is a good place to start. It provides access to the Tinnitus Advisor Program and a Volunteer Peer Support Network.
The new research builds on all that has gone before and benefits from new technologies. The hope is that eventually treatment will be more personalized — like drugs for cancer. “What we prescribe as a therapy over time will be more and more targeted,” says the University of Auckland’s Searchfield. “So, the therapy itself becomes quicker, more effective, more efficient.”
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