Tinnitus

What is tinnitus?

Tinnitus means hearing a sound, such as ringing, buzzing, hissing, humming, or whistling, that isn't coming from anywhere outside you. You might notice it on one side, on both sides, or somewhere in the middle of your head, and it can be constant or come and go, and it can be quiet or so loud it overpowers everything else.

It's genuinely common, thought to affect around one in eight people at some point, with roughly one in seven living with it on an ongoing basis. Tinnitus itself isn't a disease, more a sign that something in your hearing system, or occasionally elsewhere, needs a closer look.

What are the common causes of tinnitus?

Some degree of hearing loss, particularly the kind that comes with age, is behind the great majority of long-term cases. Other frequent causes include:

• exposure to loud noise, whether a single event like a concert or gig, or years spent around machinery, power tools or loud headphones
• excess earwax, or an infection in the ear, which can make you more aware of sounds your body already makes
• certain medicines, including some antibiotics, chemotherapy drugs, and anti-inflammatories such as aspirin, especially at higher doses
• stress, anxiety, or low mood, which can also make existing tinnitus feel worse
• jaw or dental problems, since issues with your bite or jaw joint sometimes play a part

Less commonly, tinnitus is linked to Ménière's disease, otosclerosis (a bone change in the middle ear), thyroid problems, diabetes, multiple sclerosis, or an injury to your head or your neck.

Are there different types of tinnitus?

Most tinnitus falls into one of these categories:

• Short-lived tinnitus: This is the kind almost everyone experiences after a loud event like a concert, usually settles within hours or days as your hearing recovers
• Persistent tinnitus: This lasts for months or longer and is the type most closely tied to underlying hearing loss.
• Pulsatile tinnitus: This has a different rhythm altogether – you hear a beat that matches your own heartbeat, caused by how blood is moving nearby rather than by your hearing pathways, and it's worth mentioning to a doctor urgently if it's new.

How is tinnitus diagnosed?

Your GP will usually start by looking inside your ears for anything treatable, such as an infection or excess wax, and check your hearing. They'll also ask what the sound is like, whether it stays steady or comes in waves, and about any medicines you take or noise you're regularly exposed to.

If needed, you'll be referred to an audiologist for detailed hearing tests, or on to a specialist in ear and hearing conditions if something else seems to be going on. Pulsatile tinnitus in particular sometimes warrants an urgent MRI or CT scan, to check for a cause related to blood flow rather than hearing.

How is tinnitus treated?

There's no single treatment that works for everyone, and no medicine, herbal remedy, or supplement has been shown to help more than a placebo would.

Where a specific trigger is identified, whether that's wax in the ear canal, an infection, or a medicine that's responsible, treating that often eases things considerably.

When no clear cause can be treated, the focus shifts to helping you cope day to day:

• Sound therapy: This involves using background noise like music, a fan, or white noise, rather than sitting in total silence
• Cognitive behavioural therapy (CBT): This can help change how you respond to the sound and reduce the distress around it
• Tinnitus retraining therapy: This pairs counselling with a wearable sound generator to help your brain gradually tune the noise out
• Hearing aids: These may be needed if you also have hearing loss, since amplifying outside sounds can make tinnitus far less noticeable.

Alongside these, looking after your general wellbeing genuinely helps – keeping to a regular sleep routine, cutting back on caffeine, managing stress through relaxation or breathing exercises, and staying busy with things you enjoy rather than fixating on the noise.

Many people also find real value in talking to others who understand, whether through a support group or a tinnitus charity's helpline.

When should you see a doctor?

See your GP if tinnitus is happening regularly or constantly, seems to be getting worse, or is bothering you enough to affect your sleep, concentration or mood.

Book an urgent same-day appointment if your tinnitus keeps rhythm with your own pulse. Head to your nearest emergency department, or dial 999, if tinnitus follows a knock to the head, or arrives suddenly together with hearing loss, facial muscle weakness, or a sensation that the room is spinning.