Tinnitus

Diagnosis

Your healthcare professional will typically diagnose you with tinnitus based on your symptoms alone. But to treat your symptoms, your health professional will try to find whether your tinnitus is caused by another condition. Sometimes a cause can't be found.

To help find the cause of your tinnitus, your healthcare professional will likely ask you about your medical history and check your ears, head and neck. Common tests include:

• Hearing or audiological exam. During the test, you'll sit in a soundproof room wearing earphones that send specific sounds into one ear at a time. You'll show when you can hear the sound, and your results will be compared with results considered typical for your age. This can help rule out or find possible causes of tinnitus.
• Movement. Your healthcare professional may ask you to move your eyes, clench your jaw, or move your neck, arms and legs. If your tinnitus changes or worsens, it may help find another condition that needs treatment.
• Imaging tests. Depending on the suspected cause of your tinnitus, you may need imaging tests such as CT or MRI scans. A computerized tomography (CT) scan is a type of imaging that uses X-ray techniques to make more detailed images of the body. Magnetic resonance imaging (MRI) is a medical imaging technique that uses a magnetic field and computer-generated radio waves to make detailed 3D images of the organs and tissues in the body.
• Lab tests. Your health professional may draw blood to check for anemia, thyroid conditions, heart disease or vitamins that the body does not have enough of.

Do your best to describe for your healthcare professional what kind of tinnitus noises you hear. The sounds you hear can help your healthcare professional find a possible cause.

• Clicking. This type of sound suggests that muscle contractions in and around your ear might be the cause of your tinnitus.
• Pulsing, rushing or humming. These sounds usually stem from blood vessel causes, also known as vascular conditions, such as high blood pressure. You may notice the sounds when you exercise or change positions, such as when you lie down or stand up.
• Low-pitched ringing. This type of sound may point to ear canal blockages, Meniere's disease or stiff inner ear bones, called otosclerosis.
• High-pitched ringing. This is the most common tinnitus sound. Likely causes include loud noise exposure, hearing loss or medicines. Acoustic neuroma can cause continuous, high-pitched ringing in one ear.

Treatment

Treatment for tinnitus depends on whether the cause of your tinnitus is another health condition. If so, your healthcare professional may be able to reduce your tinnitus symptoms by treating the other condition. Examples include:

• Earwax removal. Your healthcare professional can take excess wax out of the ear using a small, curved tool called a curet or by using suction techniques. A health professional also can flush out the wax using a syringe filled with warm water. Removing earwax can improve tinnitus symptoms.
• Treating a blood vessel condition. Blood vessel conditions may need medicine, surgery or another treatment to address the issue. For example, your healthcare professional may prescribe a blood pressure medicine to help lower your blood pressure and lessen tinnitus symptoms.
• Hearing aids. If your tinnitus is caused by noise-induced or age-related hearing loss, using hearing aids may improve your symptoms.
• Changing your medicine. If a medicine you're taking appears to be the cause of tinnitus, your healthcare professional may recommend stopping the medicine, lowering the dose or switching to a different medicine.

Noise suppression

Many times, tinnitus can't be cured. But there are treatments that can help make your symptoms less noticeable. Your healthcare professional may suggest using an electronic device to muffle or mask the noise. These devices include:

• White noise machines. These devices, which make a sound similar to static or environmental sounds such as falling rain or ocean waves, are often an effective treatment for tinnitus. You may want to try a white noise machine with pillow speakers to help you sleep. Fans, humidifiers, dehumidifiers and air conditioners in the bedroom also make white noise and may help make tinnitus less bothersome at night.
• Masking devices. Worn in the ear and similar to hearing aids, these devices are tuned by a person trained in hearing conditions. The devices make a continuous, low-level white noise that suppresses tinnitus symptoms.

Counseling

Behavioral treatment approaches aim to help you live with tinnitus by helping you change the way you think and feel about your symptoms. Over time, your tinnitus may bother you less. Types of counseling include:

• Tinnitus retraining therapy (TRT). This is a program designed just for you and your symptoms. A person specializing in treating hearing conditions, called an audiologist, may help you complete TRT, or you can receive therapy at a tinnitus treatment center. TRT combines sound masking and counseling from a trained professional. Typically, you wear a device in your ear that helps mask your tinnitus symptoms while you also get directive counseling. Over time, this treatment may help you notice tinnitus less and be less bothered by your symptoms.
• Cognitive behavioral therapy (CBT) or other forms of counseling. A licensed mental health professional or psychologist can help you learn coping techniques to make tinnitus symptoms less bothersome. Counseling also can help with other conditions often linked to tinnitus, such as anxiety and depression. Many mental health professionals offer CBT for tinnitus in individual or group sessions. Some programs also are offered online.

Medicines

Medicines can't cure tinnitus, but in some cases they may help reduce symptoms or complications. Still, medicines play only a small role in treating tinnitus. Many care guidelines advise against using medicines or alternative therapies to treat tinnitus. Your healthcare professional may prescribe medicine to treat another condition to help relieve your symptoms. Or you may receive medicines to help treat anxiety, depression and insomnia that many people with tinnitus have.

Potential future treatments

Researchers are studying new technologies and treatments to improve options for people with tinnitus. Some of these new approaches are:

• New masking devices using technology like that in noise-canceling headphones.
• Magnetic or electrical stimulation of the brain or the part of the inner ear called the cochlea. Techniques include transcranial magnetic stimulation and deep brain stimulation.
• Cochlear implant surgery has been shown to help some people with tinnitus and severe hearing loss.
• New medicines for the ear. Injecting medicines directly into the ear may help people with tinnitus who have sudden hearing loss, autoimmune inner ear disease or Meniere's disease.

Lifestyle and home remedies

Sometimes treatments for tinnitus don't work well or several treatments are needed. Sometimes people get used to tinnitus. For many people, making some lifestyle changes helps to make tinnitus symptoms less bothersome. These tips may help:

• Use hearing protection. Over time, exposure to loud sounds damages the nerves in the ears, causing hearing loss and tinnitus. To keep your tinnitus from getting worse, take steps to protect your hearing. If you use chain saws, are a musician, work in an industry that uses loud machinery, or use firearms such as pistols or shotguns, always wear over-the-ear hearing protection.
• Turn down the volume. Listening to music at very high volume through headphones can cause hearing loss and tinnitus.
• Use white noise. If tinnitus is worse in quiet settings, try using a white noise machine to mask the noise from tinnitus. If you don't have a white noise machine, a fan, soft music or low-volume radio static may help.
• Limit alcohol, caffeine and nicotine. These substances, especially when used in excess, can affect blood flow and worsen tinnitus.

Alternative medicine

There's little evidence that alternative medicine treatments work for tinnitus. Some alternative therapies that have been tried for tinnitus include:

• Acupuncture.
• Ginkgo biloba.
• Melatonin.
• Zinc supplements.

Coping and support

Besides any treatment options your healthcare professional offers, here are some suggestions to help you cope with tinnitus:

• Support groups. Sharing your experience with others who have tinnitus may be helpful. There are tinnitus groups that meet in person as well as internet forums. To make sure that the information you get in the group is correct, it's best to choose a group led by a doctor, audiologist or other qualified health professional.
• Education. Learning as much as you can about tinnitus and ways to ease symptoms can help. And understanding tinnitus better makes it less bothersome for some people.
• Stress management. Stress can make tinnitus worse. Stress management, whether through relaxation therapy, biofeedback or exercise, may give you some relief.

Preparing for your appointment

Be prepared to tell your healthcare professional about:

• Your signs and symptoms.
• Your medical history, including any other health conditions you have, such as hearing loss, high blood pressure or clogged arteries, called atherosclerosis.
• All medicines you take, including herbal remedies.

What to expect from your healthcare professional

Your healthcare professional is likely to ask you many questions, including:

• When did you begin experiencing symptoms?
• What does the noise you hear sound like?
• Do you hear it in one or both ears?
• Has the sound you hear been continuous, or does it come and go?
• How loud is the noise?
• How much does the noise bother you?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Have you been exposed to loud noises?
• Have you had an ear disease or head injury?

After you've been diagnosed with tinnitus, you may need to see an ear, nose and throat specialist called an otolaryngologist. You also may need to work with a hearing expert, also known as an audiologist.