By Sarabeth Lowe, MPH

Ms. Lowe is a Communication Specialist at the University of Delaware Disaster Research Center.

Most of us crave peace and quiet after a long day, and, fortunately, most are able to find it. However, some people hear a dull ringing or buzzing even when there is no external noise source. This population likely has tinnitus (pronounced tih-NITE-us or TIN-uh-tus), an auditory condition in which a person perceives sound in one or both ears that does not have an external source.^1–3 

This condition has a long history dating back 4,000 years to Ancient Babylon, plaguing everyone from Leonardo da Vinci to Charles Darwin.² In fact, the word tinnitus comes from the Latin verb tinnire, which means “to ring.” Today, roughly one in seven people have tinnitus worldwide, but that number is expected to grow.^1–3 Here’s what you need to know.

Signs and Symptoms

Tinnitus is a common problem for millions of people. Many epidemiologic studies estimate that between 8 to 25 percent of the population of the United States (US) has this condition.^2–5 Such a wide range in estimates may be due to inconsistencies in reporting and defining tinnitus.⁵ This makes sense because symptoms can vary significantly from person to person.^2,3,5–7 

Noise. Tinnitus is most often described as a ringing in the ears, but this “phantom noise” can also sound like a dull roaring, hissing, buzzing, clicking, or humming.^2,3,7–10 The sound can feel low- or high-pitched and softer or louder at times. For those with somatosensory tinnitus, certain movements or touching certain parts of the body may produce tinnitus symptoms or temporarily change the quality of the perceived sound.¹

Time.Most people experience tinnitus after being exposed to loud noise, but this phenomenon is temporary, lasting only a few minutes or hours. When symptoms last longer than six months, it’s considered chronic tinnitus, according to the National Institute on Deafness and Other Communication Disorders (NIDCD).¹ 

Intensity. The negative impacts of tinnitus are well documented. In about 10 percent of chronic cases, the condition interferes with everyday life. For example, some people find that it affects their ability to sleep, concentrate, or hear external noise.¹ Research also shows that tinnitus can affect several key quality-of-life measures, including mobility, self-care, performance of usual activities, pain/discomfort, and anxiety and/or depression.^3,9

There are two types of tinnitus.^1,4,7,9 Most cases are subjective, meaning that only you can hear the noise. Objective tinnitus is the opposite. This type occurs when the sound is heard by both the affected person and the nonaffected person, usually using a stethoscope. One common example is pulsatile tinnitus, in which the noise, usually described as a rhythmic pulsing or whooshing sound, occurs in time with your heartbeat.⁹ Cases of objective tinnitus often have an identifiable cause and, thus, are treatable.¹

Causes and Risk Factors

When you run into danger or encounter a threat, your body engages its fight or flight response. With tinnitus, though, neither is an option.⁷ This is one of the reasons the condition is so distressing. Not much is understood about its causes or its pathophysiology. While the exact causes of tinnitus are not fully understood, experts have linked certain environmental exposures, health conditions, and risk factors to this condition. 

Loud noise. Many people experience temporary tinnitus after being exposed to loud noise, and regular, long-term occupational noise exposure has been associated with the development of tinnitus.³ For example, tinnitus has historically been one of the most common service-related disabilities among veterans because of loud noise they may have been exposed to during their time in the military (e.g., gunfire, machinery, bomb blasts).^1,3,11

Hearing loss. Hearing loss, which can be caused by aging and noise exposure, has been one of the most strongly associated risk factors for tinnitus.¹ In fact, people with a hearing impairment, which includes hearing loss, have a higher risk for this condition. This associated increase in risk is dependent on the severity of hearing impairment; worse hearing loss correlates to worse cases of tinnitus.^3,12

Head and neck injuries. Certain injuries can lead to the development of tinnitus symptoms. For example, an injury to your neck, head, or jaw can damage structures of the ear, the nerve that carries sound signals to the brain, or areas of the brain that process sound.^1,6–9 Ear infections and impacted ear wax can also impact this delicate system, causing tinnitus.

Medications. Not all cases of tinnitus are cumulative and develop over time; this condition can develop suddenly in people taking certain medications, especially if taken in high doses.^1,7,9 Some of these medicines include nonsteroidal anti-inflammatory drugs (NSAIDs), certain antibiotics, anticancer drugs, antimalarial medications, and antidepressants.¹

Health conditions. Chronic health conditions, such as diabetes, migraines, thyroid disorders, anemia, cardiovascular disease, and certain autoimmune disorders, have been linked to tinnitus.^1,13 Tinnitus is also a common symptom of Ménière’s disease, a relatively rare disorder that impacts the inner ear.¹⁴ 

Sex. Notably, sex might also be a risk factor for tinnitus. A 2016 study of more than 75,000 US citizens found that more slightly male individuals than female individuals reported tinnitus.³ Notably, this result is also consistent with earlier studies.^15,16

Tinnitus and Mental Health

Though the development and onset of tinnitus can be alarming, subjective tinnitus—the most common type—has no inherently negative consequences on your physical body.^1,2,6,7 Still, these episodes can negatively impact people’s mental health and wellbeing. There are different degrees of suffering, depending on the severity of symptoms, ranging from annoyance to concentration problems to sleep disturbances.¹⁷

Furthermore, numerous studies have demonstrated a strong positive correlation between tinnitus and mental disorders, including depression and anxiety.^6,18,19 For some, tinnitus episodes can trigger traumatic memories or other distressing feelings, which can increase the sound’s intrusiveness. This psychological loop often leads to what’s known as “bothersome tinnitus,” a condition that can exacerbate the symptoms of post-traumatic stress disorder, insomnia, anxiety, and depression.⁶ In other words, there is a circular relationship between negative emotions and tinnitus: tinnitus can cause anxiety, which makes tinnitus seem worse, which causes more anxiety, and so on.²⁰

Tinnitus Management and Treatment

There is no US Food and Drug Administration-approved drug treatment for subjective tinnitus, and controlled trials have not found any drug, supplement, or herb to be any more effective than a placebo.^6,20 There are several ways to lessen the impact of tinnitus. There is no one-size-fits-all approach, but people can find relief through a combination of techniques and tools.^1,20 

Noise suppression. Masking noise is an accessible approach to managing mild tinnitus. These tools can be as simple as listening to white noise on a smartphone or through headphones or hearing aids, which amplify external noise and, thus, make tinnitus less noticeable.¹

Medications. While there are no medications specifically designated for treating tinnitus, psychoactive drugs can provide relief from the negative distress caused by severe tinnitus.^1,3,6,20 Antidepressants and anti-anxiety medicines can address the stress, anxiety, and depression that are caused by—and can sometimes exacerbate—the condition and minimize its psychological burden.²¹

Surgical interventions. Severe cases of tinnitus might be most effectively treated through surgical intervention. Scientists have been studying how electrical simulation, namely cochlear implants, might be used to suppress tinnitus.^1,6,22 Bimodal neuromodulation, which targets the brain by stimulating two key sensory systems, is another new treatment approach. Experts are hopeful that this tool can “retrain the brain” and help quiet the brain activity that causes tinnitus.²³

Awareness and therapy. One of the best ways to manage tinnitus is to better understand the condition and develop neutral associations with the phantom noise.^{1–3,6–9,13,15} Education about tinnitus can reduce anxiety and empower people to seek the treatment that works best for them. Psychotherapy and mindfulness can also help reduce the psychological burden of tinnitus. Cognitive behavioral therapy (CBT) has been shown to be particularly effective.^1,24–27 The goal of CBT is to teach people how to identify negative thoughts that cause distress, change their response to them, and focus on positive changes they can make to reduce the impact of tinnitus.^1,27

Bottom Line

Most cases of tinnitus are not severe enough to impact everyday life. In fact, research shows that most people with the condition say it is a minor problem and do not discuss tinnitus or treatment options with their doctors.³ With cases expected to increase, however, people should prioritize prevention and treatment strategies for tinnitus. Losing the “sound of silence,” no matter the degree of severity, is troubling and should serve as a call to action for continued investment in addressing this public health issue. 

Sources

1. National Institute on Deafness and Other Communication Disorders. Fact Sheet | Tinnitus. 1 May 2023. Accessed 23 Sep 2024. https://www.nidcd.nih.gov/sites/default/files/tinnitus.pdf 
2. TEDEd. What’s that ringing in your ears? – Marc Fagelson. 17 Aug 2020. Accessed 23 Sep 2024. https://ed.ted.com/lessons/what-s-that-ringing-in-your-ears-marc-fagelson
3. Bhatt JM, Lin HW, Bhattacharyya N. Prevalence, severity, exposures, and treatment patterns of tinnitus in the United States. JAMA Otolaryngol Head Neck Surg. 2016;142(10):959–965
4. Baguley DM, Caimino C, Gilles A, Jacquemin L. The international vocabulary of tinnitus. Front Neurosci. 2022;16:887592.
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20. American Tinnitus Association.Therapy and treatment options. Accessed 26 Sep 2024. https://www.ata.org/about-tinnitus/therapy-and-treatment-options/
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23. Morris A, Steckelberg A. Scientists may have the key to treating tinnitus: retrain the brain. Washington Post. 19 Jan 2024. Accessed 26 Sep 2024.  https://www.washingtonpost.com/wellness/interactive/2024/tinnitus-treatment-lenire-bimodal-neuromodulation-duo/
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