Deafness and hearing loss: Tinnitus (2025)

Tinnitus is the perception of a noise, such as ringing, buzzing, or hissing, in the ears when no external sound is present. It can be perceived in one ear, in both ears or inside the head. Tinnitus can be perceived as constant or intermittent. The sound perceived by a person experiencing tinnitus can be continuous, pulsatile (at the same time as the heartbeat), or rhythmic in nature. These different types of tinnitus can have different causes (1). Tinnitus can be acute (a duration of less than 3 months) or chronic (more than 3 months).

Tinnitus is not bothersome in all people who perceive it (2). When the perception of tinnitus is associated with emotional distress or cognitive dysfunction this is termed tinnitus disorder.

In other words, “tinnitus” describes the symptom and perception of it, whereas “tinnitus disorder” reflects the symptom and the associated suffering (1).

Tinnitus can be caused by many factors, and not all factors are known. Common causes are related to ear or hearing problems including:

• age-related hearing loss
• exposure to loud sounds
• ear infections
• earwax buildup
• medications that cause damage to the hearing organs (also known as ototoxic).
  

Other relevant causes are:

• head or neck injuries
• acoustic neuromas (also known as vestibular schwannoma, a benign tumour on the vestibular nerve)
• muscle tensions in the neck or jaw
• stress and emotional trauma
• certain medical conditions like Ménière’s disease.
  

In rare cases tinnitus can be caused by sounds that are generated inside the body, e.g. by blood flow or muscle contractions (3,4).

Yes, a doctor can help determine the cause and suggest appropriate treatments.

While tinnitus is in most cases benign, it can in rare circumstances indicate a more serious condition, such as vestibular schwannoma (a benign tumour on the vestibular nerve) or Ménière’s disease. If you experience sudden tinnitus, dizziness or hearing loss, you should see a doctor.

You should see a doctor especially if tinnitus:

• is sudden and is accompanied by hearing loss, dizziness or pain
• has persisted for over 3 months (chronic tinnitus)
• affects your quality of life (10).

Tinnitus may resolve on its own if caused by temporary factors, such as an ear infection or short-term exposure to loud noise. Occasionally, tinnitus may be caused by blockage of the ear canal by earwax. In such cases, wax removal can alleviate it.

Chronic tinnitus, on the other hand, is less likely to go away, though it can be managed effectively. There are also documented cases where tinnitus has disappeared, even after many years of being chronic (13).

There is no definitive cure for tinnitus, but there exist various treatments and strategies that can reduce tinnitus severity including

• tinnitus counselling
• cognitive-behavioural therapy (CBT)
• use of hearing aids and cochlear implants
• therapies such as tinnitus retraining therapy (TRT) and sound therapy
• neuromodulation (electrical or magnetic stimulation of the nervous system)
• stress management (5,11,12).

At this time no pharmacological treatments have been shown to be effective for the management or resolution of tinnitus.

Helpful strategies for tinnitus management aim to focus attention away from tinnitus (e.g. concentrating on work or any other activity) and to reduce the emotional reaction to tinnitus.

To achieve these goals, cognitive behavioural therapy, sound therapy, hearing aids, tinnitus retraining therapy (TRT) and techniques for stress management can be helpful.

Current research indicates that there is an association between stress and tinnitus, however there is not a clear causal link (14).

Stress management techniques such as relaxation exercises, mindfulness and cognitive behavioural therapy CBT can help reduce its impact (15). In some cases, lifestyle adjustments may also be beneficial.

Hearing aids can be effective for some people with tinnitus and hearing loss (16). They amplify external sounds, making tinnitus less noticeable and improving overall hearing. In persons with tinnitus and severe hearing loss or deafness, cochlear implants can be highly effective in terms of tinnitus suppression.

The most important risk factor for tinnitus is hearing loss. Protecting the ears from loud sounds is highly effective at preventing hearing loss and reduces the risk to develop tinnitus.

Smoking, alcohol consumption, obesity and coffee drinking and/or caffeine intake are examples of lifestyle-related risk factors thought to be related to tinnitus; however, there is no clear consensus on the nature of the relationship, or the extent to which they can influence a person’s tinnitus (17,19,20).

It is always worth consulting with your physician to see if any dietary changes are appropriate for you and your lifestyle.

Simple lifestyle changes that can help reduce tinnitus include:

• protecting your ears from loud sounds
• managing stress effectively
• eating a healthy diet and exercising regularly
• developing good sleep habits (sleep hygiene)
• collaborating with healthcare professionals for personalized guidance (17).

Tinnitus is in most of cases associated with hearing loss, especially age-related or sound-induced hearing loss. However, it can occur without hearing loss as well.

Exposure to loud sounds can damage the hair cells in the inner ear, which can lead to hearing loss and, in some cases, tinnitus. The extent of the damage depends on the noise level and the duration of exposure, and it can be temporary or permanent.

Smartphones and smartwatches now feature built-in sound level meters that can measure the loudness of your environment with reasonable accuracy.

The prevalence of tinnitus increases with age. This is partly explained by the fact that hearing loss, which the occurrence of tinnitus is associated with, also increases as a result of the natural ageing process (also referred to as presbycusis).

It is also understood that the tinnitus experience itself changes with age, especially in cases of chronic tinnitus, where older adults can experience subjectively louder, more troublesome and more distressing tinnitus than younger patients (18).

Tinnitus itself does not cause hearing loss but can be associated with damage to the hearing system. Tinnitus can also make it harder to focus on external sounds, which might seem like a decrease in hearing ability.

Many people with tinnitus experience difficulties falling asleep. To manage these issues several strategies can be helpful:

• relaxation techniques: techniques such as deep breathing, meditation, or progressive muscle relaxation can reduce stress and promote better sleep;
• sound therapy: using soothing sounds can mask the tinnitus, making it easier to fall asleep. White noise sounds from a sound pillow (a pillow with an integrated speaker), or earphones can be effective in alleviating the perception of tinnitus; and
• sleep hygiene: maintaining a regular sleep-wake schedule is crucial. It is also important to avoid stimulants such as coffee and alcohol in the evening, as well as heavy exercise close to bedtime. Establishing a consistent bedtime routine and ensuring a relaxing environment can improve sleep quality (17).