Ear health - Tinnitus

What is tinnitus (ringing in ears)?

Tinnitus (ringing in ears) is a condition where you hear noises coming from inside your ears, even when there are no sounds around you. The noise you hear when you have tinnitus isn't caused by an external sound, and other people can't hear it because it’s typically caused by an internal condition. Tinnitus can occur in one ear (unilateral tinnitus) or both ears at once, and it can begin suddenly or come on gradually, depending on the cause and type of tinnitus.

How common is tinnitus?

Tinnitus is very common and can occur in people of all ages. About 30% of people will experience short-term tinnitus at some point in their lives, and approximately 13% of people live with persistent tinnitus symptoms.1 Although tinnitus is more common in people who have hearing loss or other ear problems, it can also affect people with healthy hearing.

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What does tinnitus sound like?

Here are some examples of tinnitus sounds, supplied by the British Tinnitus Association. Many people commonly describe tinnitus as a ringing in the ears, however the different types of sound can vary from patient to patient.

Please make sure your volume is set at a comfortable listening level. 

If you are experiencing something similar alongside changes in your hearing, our hearing experts can test your hearing and discuss what options are available and what you can do next.

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Tinnitus Sound 1

Tinnitus Sound 2

Tinnitus Sound 3

Tinnitus Sound 4

Tinnitus Sound 5

Tinnitus Sound 6

Different types of tinnitus

Subjective tinnitus

This is the most common type of tinnitus. It refers to sounds heard inside the ear and only by the sufferer, and is usually experienced as a buzzing, pulsing or ringing in the ears. This can be caused by problems in your ear and the way your hearing nerve is communicating with the brain.

Objective tinnitus

Very rarely, people in close proximity to the sufferer can also hear their tinnitus sounds. This is usually caused by something that produces sound, like a narrowing of blood vessels in the ear, or muscle contractions.

Pulsatile tinnitus

Occasionally, people will hear tinnitus noises that beat in time with their pulse — like they are hearing a heartbeat in their ear. This is usually linked to disturbances in the blood flow around your head or neck.

Find out more about pulsatile tinnitus

Tinnitus causes

Although it’s a common condition, we still don’t fully understand exactly what causes the sounds we identify as tinnitus. Possible causes of tinnitus include:

Earwax build-up Cholesteatoma Cancer Perforated eardrum Ménière’s Disease Multiple sclerosis Noise-induced tinnitus Age-related tinnitus Ear infections COVID-19 tinnitus

Earwax build-up

Earwax protects the ear by trapping bacteria and dirt in the ear canal before they can reach the eardrum. However, too much earwax can block the ear canal, preventing normal hearing, disturbing the eardrum and causing tinnitus.

If you think you have tinnitus due to earwax, we recommend booking an appointment with an audiologist to confirm the cause. In selected stores, you can also take advantage of our earwax removal service without having to see a GP.

Will tinnitus go away after removing earwax?

If your tinnitus has been caused by the compacted earwax then yes, there is a possibility that removing the wax will resolve the tinnitus symptoms. If you have other symptoms related to the build-up of earwax and your tinnitus started around the same time, there is a higher chance your tinnitus is earwax related. It’s important that you don’t try to remove impacted wax yourself, though, as this could cause damage to the inside of your ear. Trying to clean or wash out your ears yourself can not only be painful, but it can also lead to further impaction and potential damage to the eardrum.

Cholesteatoma

Cholesteatoma is a benign growth of skin cells behind the eardrum, often triggered by ear infections, which can cause hearing loss and tinnitus in the affected ear. If left untreated, the growth can erode the middle ear bones, causing hearing loss. Cholesteatomas can be treated by Ear Nose and Throat doctors, who will perform a procedure to remove the growth

Cancer

If you have been diagnosed with cancer or are currently undergoing treatment for cancer, you may notice symptoms of tinnitus in just one ear, known as unilateral tinnitus. 

Cancer that occurs in the ear, the nose, the throat or the brain can cause unilateral tinnitus. If you think you may be experiencing symptoms of unilateral tinnitus, it's best to visit your GP to check for any underlying causes. There are many treatments available, and your doctor will be able to advise you on the best one for you.

Perforated eardrum

It’s possible to rupture your eardrum by injuring your outer or middle ear. A perforated eardrum can cause pain, hearing loss, fluid drainage and tinnitus.

Infections can sometimes cause a perforated eardrum. A small eardrum perforation will usually heal by itself, but a larger eardrum perforation may require surgery to repair it.

Ménière’s Disease

In Ménière’s disease, fluid pressure builds up in the inner ear, which can distort hair-cells and cause unilateral tinnitus that is usually low-pitched. Other symptoms of Ménière’s disease include dizziness and hearing loss

Multiple sclerosis

Multiple sclerosis (MS) is a neurological disorder where the immune system attacks the protective sheath of nerve fibres, causing communication problems inside and outside of the brain. Common neurological symptoms of MS include muscle weakness and numbness of the extremities, vision problems, coordination problems and fatigue. Unilateral tinnitus can also occur in MS. There are many treatments, such as anti-inflammatory steroids, that can slow down the progression of the neurological symptoms of MS.

Noise-induced tinnitus

It’s thought that exposure to loud noise, such as at a gig or concert, can trigger tinnitus. If you were recently exposed to loud noises like these, you may just have temporary tinnitus, which should go away within a few days. People with noise-induced hearing loss can have trouble understanding conversations in places where there is lots of background noise, because the damaged auditory system can no longer separate different sounds as easily. Noise-induced hearing loss often worsens when you continue to spend time in loud environments without protecting your ears.

If you are often in noisy environments, Specsavers can custom-make earplugs to fit your ear size and shape, ensuring the maximum amount of protection. 

Find out more about hearing protection here

Age-related tinnitus

As people grow older, they may find they start to gradually lose their hearing, often starting with high-pitch sounds.

Some research suggests that the loss of sensitivity to certain frequencies of sound, such as the highest frequencies, can lead to changes in how the brain perceives these sounds.6 It’s thought that because the brain can no longer sense the high-frequency noises, it replaces the missing sound impulses with the ‘phantom sounds’ associated with tinnitus.

Ear infections

These are usually caused by fluid becoming trapped in the ear following a throat infection, cold, or allergies. Infections in the middle ear can sometimes cause temporary tinnitus as the increase in fluid muffles sound. This causes the brain to re-interpret the sounds, resulting in tinnitus. This type of tinnitus should disappear once the ear infection has been resolved.

Symptoms of an ear infection include pain in the ear, a feeling of fullness, hearing loss and dizziness, as well as the presence of a thick, yellow liquid coming from the ear. An ear infection is usually easily treatable by antibiotics or ear drops.

COVID-19 tinnitus

There is some evidence that links tinnitus to coronavirus. For example, a survey by the Manchester University Hospitals NHS Trust found that 13.2% of patients reported a change of hearing and/or tinnitus after being diagnosed with COVID-19, and just over 5% reported developing tinnitus.²⁵ A more recent analysis of 24 coronavirus studies found that 14.8% experienced tinnitus as a symptom.²⁶

Side effects of tinnitus

Tinnitus can have a number of knock-on effects on quality of life, including:

Sleep problems

Sleep is essential for restoring energy, but people who have tinnitus may have difficulty sleeping due to the constant ringing or humming sound in their ears.

Decrease in concentration

 If you suffer from tinnitus, it can be difficult to focus on other things. As a result, tinnitus can disturb work performance and make activities such as reading and studying more difficult. If you find that tinnitus is affecting your ability to carry out everyday activities like reading or watching TV, it’s best to seek advice from a hearing expert, who can advise you on what steps to take.

Tinnitus and dizziness

People who experience ringing in their ears often also report having symptoms of dizziness. This is quite common, as both these conditions are closely related to your ear health, though in different ways.

Why am I dizzy?

Dizzy spells are usually characterised by feeling unsteady or lightheaded, and are most commonly caused by medications, migraines or alcohol. However, sometimes an undiagnosed issue with your inner ear can cause dizziness.

Our sense of balance relies on input from our inner ears, eyes, and joints. Any disorder that affects these areas of the body and the coordination of their signals in the brain may cause dizziness.2  The structures in our inner ears play an especially important role in maintaining our sense of balance. Feelings of dizziness can occur when the fine hairs and fluid in the inner ear are affected by a change in pressure. Some conditions which can cause this include:

  • Ménière’s disease
  • Benign paroxysmal positional vertigo (where head movements cause vertigo)
  • Labyrinthitis
  • Low blood pressure
  • Anaemia (fatigue due to your body lacking enough healthy red blood cells)
  • Dehydration
  • Orthostatic hypotension (where your blood pressure falls rapidly when you stand up)
  • Multiple sclerosis
  • Autoimmune inner ear disease

If you have been having dizzy spells, your first step is to see your GP. If you experience dizziness frequently, you should avoid driving or operating heavy machinery, get up slowly from a sitting position and be careful on uneven surfaces.

What can cause dizziness and ringing in the ears?

Dizziness and tinnitus can be symptoms of Ménière’s disease3. People with Ménière’s disease experience vertigo — a spinning sensation — that lasts anywhere from 20 minutes to several hours. Additional symptoms include fluctuating hearing loss, tinnitus, and a feeling of pressure in the ear.

Ménière’s disease stems from increased levels of endolymphatic fluid in the inner ear, so treatment options focus on reducing fluid levels in the ear. Your doctor may recommend one or more of these approaches:

  • A low-salt diet
  • Diuretic medication
  • Surgery, in severe cases

Along with treatment to reduce the frequency and severity of Ménière’s disease episodes, your doctor might suggest that you try hearing aids. Hearing aid technology may be programmed with several different modes so that you can adjust them as your hearing levels fluctuate.

Tinnitus diagnosis

If you’re experiencing problems with your hearing, contact your audiologist or GP. They will likely ask some questions about your symptoms to help them diagnose you, such as:

  • Is the sound you’re hearing in both ears?
  • Is the sound constantly there or does it come and go?
  • Have you noticed a change in your hearing as well?

They’ll also check for problems they may be able to treat, like an earwax build-up or an ear infection.

Tinnitus testing

Tinnitus tests are designed to diagnose and assess the severity of the condition. This can involve a hearing test for tinnitus, to evaluate the sound of different frequencies and volumes or a physical exam of the ears. Once the tinnitus tests have been carried out and the condition has been diagnosed, there are treatments available to help, such as earwax removal drops and hearing aids for tinnitus.

​Tinnitus treatment and relief

Is there a cure for tinnitus?

There is no single cure for tinnitus, but there are treatments that can help. The first step is to try and eliminate the cause of your tinnitus, so it’s important to find out why you are getting it. If tinnitus is a side effect of a medical condition, like an ear infection, then treating that condition may resolve the symptoms of tinnitus.

Fortunately, there are many ways to treat tinnitus, including the use of hearing aids, cochlear implants, and behavioural therapies such as tinnitus retraining therapy (TRT) and cognitive behavioural therapy (CBT). Aside from these traditional methods, there are also a number of alternative remedies that have been explored, including a range of vitamins and supplements like B12 and zinc.

Earwax removal and ear drops

If the cause of your tinnitus is excessive earwax, the safest and easiest way to treat this is by seeing a health professional qualified in wax removal to remove any impacted or excessive wax. If you have an ear infection, you may be prescribed some ear drops to help fight the infection and clear any blockage.

Find out more about earwax removal

Hearing aids for tinnitus

Some people don’t notice their tinnitus all the time, so they may benefit from hearing aids with a program change button, a remote, or the ability to connect to a smartphone app to adjust the tinnitus sounds. Hearing aids can help offer some relief from tinnitus symptoms, as well as accessing the underlying cause of any hearing changes.

Therapy methods to help tinnitus

Tinnitus therapy

If your tinnitus is not caused by a medical condition, there are options that can help you cope with the effects of it and find some relief from tinnitus symptoms — such as therapy. For example, many people find it helpful to use background noises, like music or television, to take the prominence away from the sound of their tinnitus. Here, we take a look at some of the types of tinnitus therapy available:

Tinnitus sound therapy

The most well-known type of sound therapy for tinnitus is the masking or distracting of tinnitus sounds made by a tinnitus hearing aid. The hearing aid will either amplify ambient sounds or create low-level sounds which make your tinnitus less noticeable. You don’t necessarily need a hearing aid though, radios, computers, and TVs are also very useful in providing background noises that make tinnitus less noticeable.

By distracting a person from tinnitus, hearing aids and sound therapies improve the quality of sleep and concentration. If you have hearing loss alongside having tinnitus then hearing aids can also amplify selective sounds such as a speaker’s voice during a conversation and sounds of TV and radio, making socialising and everyday activities more manageable.

Do behavioural therapies work for tinnitus?

There are two main types of behavioural therapies currently used to treat tinnitus: tinnitus retraining therapy (TRT) and cognitive behavioural therapy (CBT). They can be useful in treating tinnitus by reframing the way your brain reacts to tinnitus, but this will depend on the type of tinnitus present in your ear.

Tinnitus retraining therapy (TRT)

Tinnitus retraining therapy (TRT) reprograms the way your subconscious processes tinnitus. It teaches the brain to ignore the internal sound stimuli unless you purposely focus on them. Experts at a tinnitus centre administer the TRT.

There are different stages to tinnitus retraining therapy: initial counselling, sound therapy and psychological therapy. The initial evaluation explores your daily life and the type of tinnitus you have. The sound therapy uses a device to generate background noise to help you get used to the noises. Finally, psychological therapy teaches you how to ignore tinnitus through stress management and relaxation exercises.

The goal is to eliminate the anxiety that comes with tinnitus. TRT can work with any tinnitus, but often requires a long-term commitment.11 NHS-funded tinnitus retraining therapy may be for those people with severe or persistent tinnitus.12 Find out more here

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) changes the way a person thinks about and reacts to tinnitus and encourages you to stop viewing tinnitus as an annoying sound.

For people who have tinnitus, negative automatic thoughts come to their minds whenever they hear the sounds of their tinnitus. CBT for tinnitus works by changing the automatic thoughts that happen every time that tinnitus occurs. Again, CBT can work with any type of tinnitus, but also requires a time commitment.

Natural remedies for tinnitus

Natural remedies for tinnitus

Ginkgo biloba

Ginkgo biloba is a supplement that has sometimes been used as therapy for mental health problems such as anxiety, depression, and dementia. As it has antioxidant properties, it’s thought that it works by helping to improve blood flow and vascular tone (how much blood vessels constrict relative to their optimal dilated state). It is thought that vascular issues are a potential cause of tinnitus.13

Ultimately, however, studies vary on the effectiveness of the treatment due to how complex tinnitus as a condition is and, as a result, how much it can vary from person to person.13 More high quality studies should help clinicians to understand the effectiveness of ginkgo biloba in treating tinnitus.

Vitamin B12

It has been suggested in some studies that vitamin B12 deficiency is a potential cause of tinnitus. Low levels of folate and vitamin B12 could lead to the damage of small blood vessels going to the cochlea (part of the inner ear that translates sound to nerve impulses that are sent to the brain). If this is damaged, research strongly suggests that tinnitus may develop.15

One study that focused on vitamin B12 deficiency in tinnitus patients showed that supplementation of vitamin B12 actually reversed the tinnitus symptoms.14

Another recent study showed significant tinnitus improvement after vitamin B12 injections were given in those who had tinnitus and were vitamin B12 deficient.15

However, as with ginkgo biloba, there are also studies that do not find vitamin B12 supplement to be an effective treatment.16

Melatonin

Melatonin is a hormone that regulates the sleep-wake cycle secreted mainly by the pineal gland (small and pea-shaped, found in the brain; its function is yet to be fully understood). It’s traditionally a prescription-only supplement used to treat sleep difficulty from shift work or jet lag, and similar to ginkgo biloba, it has antioxidant properties and supposedly may help improve vascular health.

One study found melatonin to be an effective treatment for tinnitus, especially in people who suffer from sleep problems as well as chronic tinnitus.17 Side effects are uncommon but may include drowsiness, headache, dizziness or nausea.

Zinc

Zinc is a metal element that exists in the body and is important for maintaining the balance of many bodily reactions — including supporting the nervous system and the cochlea. A zinc deficiency can have a number of effects on the body, including hair loss, diarrhoea and rashes, and zinc supplementation generally has few side effects, though this might include abdominal pain, nausea and vomiting. Tinnitus has been linked with zinc deficiency: some studies have evaluated the role of zinc supplements in people suffering from tinnitus and showed that zinc did benefit tinnitus symptoms.6 However, the jury is still out for zinc supplements, as other studies suggest that they have no real effect on those with tinnitus.18

Magnesium

Magnesium is a key element in supporting many body functions, such as the auditory pathway (how our brain interprets sound). Magnesium deficiency can cause symptoms like tremors, muscle spasms, poor coordination, seizures, and even cardiac arrest. Some studies have even shown that a decrease in blood magnesium levels can lead to tinnitus and that supplementing with magnesium can alleviate tinnitus symptoms.19

Yoga

Yoga is a practice that combines exercise, breathing techniques and meditation. It can help to reduce many psychological symptoms, such as stress, anxiety and depression and some of the physical benefits of yoga include increasing flexibility, elevating muscle tone and strength, improving cardiovascular health and also weight loss. What’s more, a recent study demonstrated that yoga could even help reduce the symptoms of subjective tinnitus symptoms.20 It’s important to remember that there’s still more research that needs to be carried out in order to understand the effectiveness of yoga in tinnitus treatment.

The bottom line

Ultimately, though some studies suggest that these alternative treatments may be helpful in the treatment of tinnitus, higher-quality studies are needed to prove the effectiveness of them.

If you have tinnitus, it’s best to take these alternative methods with a pinch of salt and to treat them as complementary components in treating tinnitus — not as a replacement to recommended therapies such as hearing aids and cognitive behavioural therapy. If you’re interested in learning more about your tinnitus treatment options take a look at the British Tinnitus Association for more information.

What’s the best tinnitus treatment for me?

Different therapies have different pros and cons. Hearing aids and sound therapies are the fastest and most convenient solutions. TRT and CBT work with any tinnitus, but they require time and long-term commitment. While there are many medications for tinnitus, each of them is usually effective for specific types of tinnitus and can have many side effects.

Tinnitus and hearing loss

Many people who suffer from tinnitus also have hearing difficulties. In this case, hearing aids can help, as amplified sounds help to keep the brain ‘busy’ and take the focus away from the tinnitus.

If the symptoms persist or you are concerned about your tinnitus, you should contact your GP who may refer you to an ear, nose and throat specialist. They’ll be able to suggest ways of dealing with the problem. If a specific cause can’t be established, the focus will be on helping you manage the condition.

What happens in a hearing test? How the ear works

Consult with a professional today

If you think you have tinnitus and hearing loss, you can book a hearing appointment with one of Specsavers’ audiologists. If you think you have tinnitus but don’t feel like you have a hearing loss you can contact the British Tinnitus Association for more information on support. If your tinnitus is pulsatile or unilateral (in one ear only), you should speak to your GP.

FAQs

What should I do if I have tinnitus in one ear?

It’s possible to experience tinnitus in one or both ears, depending on the causes. If you think tinnitus may be developing in one ear, go and see your GP. When tinnitus is apparent in one ear only, further testing such as head imaging with MRI or CT scan may be required to identify the cause.

How long does tinnitus last?

How long your tinnitus lasts will depend on a wide variety of factors, such as your general health and the underlying cause of your tinnitus. 

If your tinnitus is caused by a loud noise, symptoms will usually subside after 16 to 48 hours, although in some cases they can last up to a few weeks.  For ear infections, tinnitus will typically last until the infection has cleared.  For long-term underlying conditions, it's likely that your symptoms will persist, although there are treatments that can help ease them.

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References
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