Tinnitus is a condition when a person hears a ringing sound or a different variety of sound when no corresponding external sound is present and other people cannot hear it. Nearly everyone experiences faint "normal tinnitus" in a completely quiet room; but this is of concern only if it is bothersome, interferes with normal hearing, or is associated with other problems. The word ''tinnitus'' comes from the

Latin Latin ( or ) is a classical language belonging to the Italic languages, Italic branch of the Indo-European languages. Latin was originally spoken by the Latins (Italic tribe), Latins in Latium (now known as Lazio), the lower Tiber area aroun ...

'' tinnire'', "to ring." In some people, it interferes with concentration, and can be associated with anxiety and depression. Tinnitus is usually associated with

hearing loss Hearing loss is a partial or total inability to hear. Hearing loss may be present at birth or acquired at any time afterwards. Hearing loss may occur in one or both ears. In children, hearing problems can affect the ability to acquire spo ...

and decreased comprehension of speech in noisy environments. It is common, affecting about 10–15% of people. Most tolerate it well, and it is a significant (severe) problem in only 1–2% of people. It can trigger a

fight-or-flight response The fight-or-flight or the fight-flight-freeze-or-fawn (also called hyperarousal or the acute stress response) is a physiological reaction that occurs in response to a perceived harmful event, attack, or threat to survival. It was first describ ...

, as the brain may perceive it as dangerous and important. Rather than a disease, tinnitus is a symptom that may result from a variety of underlying causes and may be generated at any level of the auditory system as well as outside that system. The most common causes are hearing damage,

noise-induced hearing loss Noise-induced hearing loss (NIHL) is a Hearing loss, hearing impairment resulting from exposure to loud sound. People may have a loss of perception of a narrow range of Frequency, frequencies or impaired perception of sound including hyperacusi ...

, or age-related hearing loss, known as presbycusis. Other causes include ear infections, disease of the heart or blood vessels, Ménière's disease,

brain tumor A brain tumor (sometimes referred to as brain cancer) occurs when a group of cells within the Human brain, brain turn cancerous and grow out of control, creating a mass. There are two main types of tumors: malignant (cancerous) tumors and benign ...

s, acoustic neuromas (tumors on the auditory nerves of the ear), migraines, temporomandibular joint disorders, exposure to certain medications, a previous head injury, and

earwax Earwax, also known by the medical term cerumen, is a waxy substance secreted in the ear canal of humans and other mammals. Earwax can be many colors, including brown, orange, red, yellowish, and gray. Earwax protects the skin of the human ear ...

. It can suddenly emerge during a period of

emotional stress In psychology, stress is a feeling of emotional strain and pressure. Stress is a form of psychological and mental discomfort. Small amounts of stress may be beneficial, as it can improve athletic performance, motivation and reaction to the env ...

. It is more common in those with depression. The diagnosis of tinnitus is usually based on a patient's description of the symptoms they are experiencing. Such a diagnosis is commonly supported by an audiogram, and an otolaryngological and

neurological examination A neurological examination is the assessment of sensory neuron and motor responses, especially reflexes, to determine whether the nervous system is impaired. This typically includes a physical examination and a review of the patient's medical his ...

. How much tinnitus interferes with a person's life may be quantified with questionnaires. If certain problems are found,

medical imaging Medical imaging is the technique and process of imaging the interior of a body for clinical analysis and medical intervention, as well as visual representation of the function of some organs or tissues (physiology). Medical imaging seeks to revea ...

, such as

magnetic resonance imaging Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to generate pictures of the anatomy and the physiological processes inside the body. MRI scanners use strong magnetic fields, magnetic field gradients, and ...

(MRI), may be performed. Other tests are suitable when tinnitus occurs with the same rhythm as the heartbeat. Rarely, the sound may be heard by someone other than the patient by using a

stethoscope The stethoscope is a medicine, medical device for auscultation, or listening to internal sounds of an animal or human body. It typically has a small disc-shaped resonator that is placed against the skin, with either one or two tubes connected t ...

, in which case it is known as "objective tinnitus". Occasionally, spontaneous otoacoustic emissions, sounds produced normally by the

inner ear The inner ear (internal ear, auris interna) is the innermost part of the vertebrate ear. In vertebrates, the inner ear is mainly responsible for sound detection and balance. In mammals, it consists of the bony labyrinth, a hollow cavity in the ...

, may result in tinnitus. Measures to prevent tinnitus include avoiding chronic or extended exposure to loud noise, and limiting exposure to drugs and substances harmful to the ear ( ototoxic). If there is an underlying cause, treating that cause may lead to improvements. Otherwise, typically, tinnitus management involves psychoeducation or counseling, such as talk therapy. Sound generators or hearing aids may help. No medication directly targets tinnitus.

Signs and symptoms

Tinnitus is often described as ringing, but it may also sound like clicking, buzzing, hissing, or roaring. It may be soft or loud, low- or high- pitched, and may seem to come from either one or both ears, or from the head itself. It may be intermittent or continuous. In some individuals, its intensity may be changed by shoulder, neck, head, tongue, jaw, or eye movements.

Course

Due to variations in study designs, data on the course of tinnitus shows few consistent results. Generally, prevalence increases with age in adults, and the ratings of annoyance increase with persistence at follow up.

Psychological effects

Although it is an annoying condition to which most people adapt, persistent tinnitus may cause anxiety and depression in some people. Tinnitus annoyance is more strongly associated with the psychological condition of the person than the loudness or frequency range of the perceived sound. Psychological problems such as depression, anxiety, sleep disturbances, and concentration difficulties are common in those with strongly annoying tinnitus. Complications can also include cognitive decline and difficulty communicating. 45% of people with tinnitus have an

anxiety disorder Anxiety disorders are a group of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal functions are significantly impaired. Anxiety may cause phys ...

at some time in their lives. Severe cases may lead some to consider suicide-- while suicidal behavior is complex, tinnitus can be a risk factor. In a cross-sectional analysis, 15.75% of the 292 patients that attended a 2019 Tinnitus and Hyperacusis Clinic in the United Kingdom "expressed that they have been bothered by suicidal and self-harm ideations within the last 2 weeks." Psychological research has focused on the tinnitus distress reaction to account for differences in tinnitus severity. The research indicates that conditioning at the initial perception of tinnitus linked it with negative emotions, such as fear and anxiety.

Types

Commonly tinnitus is classified into "subjective and objective tinnitus". Tinnitus is usually subjective, meaning that the sounds the person hears are not detectable by means currently available to physicians and hearing technicians. Subjective tinnitus has also been called "tinnitus aurium", "non-auditory", or "non-vibratory" tinnitus. In rare cases, tinnitus can be heard by someone else using a

. Even more rarely, in some cases it can be measured as a spontaneous

otoacoustic emission An otoacoustic emission (OAE) is a sound that is generated from within the inner ear. Having been predicted by Austrian astrophysicist Thomas Gold in 1948, its existence was first demonstrated experimentally by British physicist David Kemp in 19 ...

(SOAE) in the ear canal. This is classified as objective tinnitus, also called "pseudo-tinnitus" or "vibratory" tinnitus.

Subjective tinnitus

Subjective tinnitus is the most frequent type. It can have many causes, but most commonly it results from hearing loss. When it is caused by disorders of the

or auditory nerve, it can be called "otic" (from the Greek word for ear). These otological or

neurological Neurology (from , "string, nerve" and the suffix -logia, "study of") is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the nervous system, which comprises the brain, the s ...

disorders include those triggered by infections, drugs, or trauma. A cause is traumatic noise exposure that damages

hair cells Hair cells are the sensory receptors of both the auditory system and the vestibular system in the ears of all vertebrates, and in the lateral line organ of fishes. Through mechanotransduction, hair cells detect movement in their environment. ...

in the inner ear. Some evidence suggests that long-term exposure to noise pollution from heavy traffic may increase the risk of developing tinnitus. When there does not seem to be a connection with a disorder of the inner ear or auditory nerve, tinnitus can be called "non-otic". In 30% of cases, tinnitus is influenced by the

somatosensory system The somatosensory system, or somatic sensory system is a subset of the sensory nervous system. The main functions of the somatosensory system are the perception of external stimuli, the perception of internal stimuli, and the regulation of bod ...

; for instance, people can increase or decrease their tinnitus by moving their face, head, jaw, or neck. This type is called somatic or craniocervical tinnitus, since it is only head or neck movements that have an effect. Some tinnitus may be caused by neuroplastic changes in the central auditory pathway. In this theory, the disturbance of sensory input caused by hearing loss results in such changes as a homeostatic response of neurons in the central auditory system, causing tinnitus. When some frequencies of sound are lost to hearing loss, the auditory system compensates by amplifying those frequencies, eventually producing sound sensations at those frequencies constantly even when there is no corresponding external sound.

Hearing loss

The most common cause of tinnitus is

. Hearing loss may have many different causes, but among those with tinnitus, the major cause is

cochlea The cochlea is the part of the inner ear involved in hearing. It is a spiral-shaped cavity in the bony labyrinth, in humans making 2.75 turns around its axis, the modiolus (cochlea), modiolus. A core component of the cochlea is the organ of Cort ...

r injury. In many cases no underlying cause is identified. Ototoxic drugs also may cause subjective tinnitus, as they may cause hearing loss, or increase the damage done by exposure to loud noise. This damage may occur even at doses not considered ototoxic. More than 260 medications have been reported to cause tinnitus as a side effect. Tinnitus can also occur from the discontinuation of therapeutic doses of

benzodiazepine Benzodiazepines (BZD, BDZ, BZs), colloquially known as "benzos", are a class of central nervous system (CNS) depressant, depressant drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring. They are prescribed t ...

s. It can sometimes be a protracted symptom of benzodiazepine withdrawal and may persist for many months. Medications such as bupropion may also cause tinnitus.

Associated factors

Factors associated with tinnitus include: * Ear problems and

: ** Conductive hearing loss *** Acoustic shock *** Loud noise or music *** Middle ear effusion *** Otitis *** Otosclerosis ***

Eustachian tube The Eustachian tube (), also called the auditory tube or pharyngotympanic tube, is a tube that links the nasopharynx to the middle ear, of which it is also a part. In adult humans, the Eustachian tube is approximately long and in diameter. It ...

dysfunction **

Sensorineural hearing loss Sensorineural hearing loss (SNHL) is a type of hearing loss in which the root cause lies in the inner ear, sensory organ (cochlea and associated structures), or the vestibulocochlear nerve (Cranial nerves, cranial nerve VIII). SNHL accounts for a ...

*** Excessive or loud noise; e.g. acoustic trauma *** Presbycusis (age-associated hearing loss) *** Ménière's disease *** Endolymphatic hydrops *** Superior canal dehiscence *** Acoustic neuroma *** Mercury or

lead poisoning Lead poisoning, also known as plumbism and saturnism, is a type of metal poisoning caused by lead in the body. Symptoms may include abdominal pain, constipation, headaches, irritability, memory problems, infertility, numbness and paresthesia, t ...

*** Ototoxic medications * Neurologic disorders: ** Chiari malformation **

Multiple sclerosis Multiple sclerosis (MS) is an autoimmune disease resulting in damage to myelinthe insulating covers of nerve cellsin the brain and spinal cord. As a demyelinating disease, MS disrupts the nervous system's ability to Action potential, transmit ...

** Head injury **

Giant cell arteritis Giant cell arteritis (GCA), also called temporal arteritis, is an inflammatory autoimmune disease of large blood vessels. Symptoms may include headache, pain over the temples, flu-like symptoms, double vision, and difficulty opening the mout ...

Temporomandibular joint dysfunction Temporomandibular joint dysfunction (TMD, TMJD) is an umbrella term covering pain and dysfunction of the muscles of mastication (the muscles that move the jaw) and the temporomandibular joints (the joints which connect the Human mandible, mand ...

Metabolic Metabolism (, from ''metabolē'', "change") is the set of life-sustaining chemical reactions in organisms. The three main functions of metabolism are: the conversion of the energy in food to energy available to run cellular processes; the ...

disorders: ** Vitamin B₁₂ deficiency ** Iron deficiency anemia * Psychiatric disorders ** Depression **

Anxiety disorders Anxiety disorders are a group of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal functions are significantly impaired. Anxiety may cause phys ...

* Other factors: **

Vasculitis Vasculitis is a group of disorders that destroy blood vessels by inflammation. Both artery, arteries and veins are affected. Lymphangitis (inflammation of lymphatic vessels) is sometimes considered a type of vasculitis. Vasculitis is primarily c ...

** Some

psychedelic drugs Psychedelics are a subclass of Hallucinogen, hallucinogenic drugs whose primary effect is to trigger psychoactive drug, non-ordinary mental states (known as psychedelic experiences or "trips") and a perceived "expansion of consciousness". Also ...

can produce temporary tinnitus-like symptoms as a side effect: *** 5-MeO-DET *** Diisopropyltryptamine (DiPT) ** Benzodiazepine withdrawal ** Intracranial hyper or hypotension caused by, for example,

encephalitis Encephalitis is inflammation of the Human brain, brain. The severity can be variable with symptoms including reduction or alteration in consciousness, aphasia, headache, fever, confusion, a stiff neck, and vomiting. Complications may include se ...

or a

cerebrospinal fluid Cerebrospinal fluid (CSF) is a clear, colorless Extracellular fluid#Transcellular fluid, transcellular body fluid found within the meninges, meningeal tissue that surrounds the vertebrate brain and spinal cord, and in the ventricular system, ven ...

leak

Objective tinnitus

A specific type of tinnitus, ''objective tinnitus'', is characterized by hearing the sounds of one's own muscle contractions or pulse, typically a result of sounds that have been created by the movement of jaw muscles or sounds related to blood flow in the neck or face. It is sometimes caused by an involuntary twitching of a muscle or a group of muscles ( myoclonus) or by a vascular condition. In some cases, tinnitus is generated by muscle spasms around the middle ear. Spontaneous otoacoustic emissions (SOAEs)—faint high-frequency tones that are produced in the inner ear and can be measured in the ear canal with a sensitive microphone—may also cause tinnitus. About 8% of those with SOAEs and tinnitus have SOAE-linked tinnitus, while the percentage of all cases of tinnitus caused by SOAEs is estimated at 4%.

Pediatric tinnitus

Children may be subject to pulsatile or continuous tinnitus, involving anomalies and variants of the vascular parts affecting the middle/inner ear structures. CT scans may be used to check the integrity of the structures, and MR scans can evaluate nerves and potential masses or malformations. Early diagnosis can prevent long-term impairments to development.

Pulsatile tinnitus

Some people experience a sound that beats in time with their pulse, known as ''pulsatile tinnitus'' or ''vascular tinnitus''. Pulsatile tinnitus is usually objective in nature, resulting from altered blood flow or increased blood turbulence near the ear, such as from

atherosclerosis Atherosclerosis is a pattern of the disease arteriosclerosis, characterized by development of abnormalities called lesions in walls of arteries. This is a chronic inflammatory disease involving many different cell types and is driven by eleva ...

or venous hum, but it can also arise as a subjective phenomenon from an increased awareness of blood flow in the ear. The differential diagnosis for pulsatile tinnitus is wide and includes vascular etiologies, tumors, disorders of the

middle ear The middle ear is the portion of the ear medial to the eardrum, and distal to the oval window of the cochlea (of the inner ear). The mammalian middle ear contains three ossicles (malleus, incus, and stapes), which transfer the vibrations ...

, and other intracranial pathologies. Vascular causes of pulsatile tinnitus include venous causes (e.g., high riding or dehiscent jugular bulb, sigmoid sinus diverticulum), arterial causes (e.g., cervical

, potentially life-threatening conditions such as carotid artery

aneurysm An aneurysm is an outward :wikt:bulge, bulging, likened to a bubble or balloon, caused by a localized, abnormal, weak spot on a blood vessel wall. Aneurysms may be a result of a hereditary condition or an acquired disease. Aneurysms can also b ...

or carotid artery dissection), or dural arteriovenous fistula or

arteriovenous malformation An arteriovenous malformation (AVM) is an abnormal connection between arteries and veins, bypassing the capillary system. Usually congenital, this vascular anomaly is widely known because of its occurrence in the central nervous system (usually ...

s. Pulsatile tinnitus may also indicate

vasculitis Vasculitis is a group of disorders that destroy blood vessels by inflammation. Both artery, arteries and veins are affected. Lymphangitis (inflammation of lymphatic vessels) is sometimes considered a type of vasculitis. Vasculitis is primarily c ...

, or more specifically,

giant cell arteritis Giant cell arteritis (GCA), also called temporal arteritis, is an inflammatory autoimmune disease of large blood vessels. Symptoms may include headache, pain over the temples, flu-like symptoms, double vision, and difficulty opening the mout ...

. Pulsatile tinnitus may also be caused by tumors such as

paraganglioma A paraganglioma is a rare neuroendocrine tumour, neuroendocrine neoplasm that may develop at various body sites (including the head, neck, thorax and abdomen). When the same type of tumor is found in the adrenal gland, they are referred to as a p ...

s (e.g., glomus tympanicum, glomus jugulare) or

hemangioma A hemangioma or haemangioma is a usually benign vascular tumor derived from blood vessel cell types. The most common form, seen in infants, is an infantile hemangioma, known colloquially as a "strawberry mark", most commonly presenting on the sk ...

s (e.g.,

facial nerve The facial nerve, also known as the seventh cranial nerve, cranial nerve VII, or simply CN VII, is a cranial nerve that emerges from the pons of the brainstem, controls the muscles of facial expression, and functions in the conveyance of ta ...

or cavernous).

Middle ear The middle ear is the portion of the ear medial to the eardrum, and distal to the oval window of the cochlea (of the inner ear). The mammalian middle ear contains three ossicles (malleus, incus, and stapes), which transfer the vibrations ...

causes of pulsatile tinnitus include patulous eustachian tube, otosclerosis, or middle ear myoclonus (e.g., stapedial or

tensor tympani The tensor tympani is a muscle within the middle ear, located in the bony canal above the bony part of the auditory tube, and connects to the malleus bone. Its role is to dampen loud sounds, such as those produced from chewing, shouting, or thun ...

myoclonus). The most common

cause of pulsatile tinnitus is superior semicircular canal dehiscence. Pulsatile tinnitus may also indicate idiopathic intracranial hypertension. Pulsatile tinnitus can be a symptom of intracranial vascular abnormalities and should be evaluated for ''irregular noises of blood flow'' ( bruits).

Pathophysiology

Tinnitus may be caused by increased neural activity in the auditory brainstem, where the brain processes sounds, causing some auditory nerve cells to become overexcited. The basis of this theory is that many with tinnitus also have

. Three reviews in 2016 emphasized the large range and possible combinations of pathologies involved in tinnitus, which result in a great variety of symptoms and specifically adapted therapies.

Diagnosis

The diagnostic approach is based on a history of the condition and an examination of the head, neck, and neurological system. Typically an audiogram is done, and occasionally

electronystagmography Electronystagmography (ENG) is a diagnostic test to record involuntary movements of the eye caused by a condition known as nystagmus. It can also be used to diagnose the cause of vertigo, dizziness or balance dysfunction by testing the vestibul ...

. Treatable conditions may include middle ear infection, acoustic neuroma, concussion, and otosclerosis. Evaluation of tinnitus can include a hearing test (audiogram), measurement of acoustic parameters of the tinnitus like pitch and loudness, and psychological assessment of comorbid conditions like depression, anxiety, and stress that are associated with severity of the tinnitus. One definition of tinnitus, in contrast to normal ear noise experience, is that tinnitus lasts five minutes at least twice a week. However, people with tinnitus often experience the noise more frequently than this. Tinnitus can be present constantly or intermittently. Some people with constant tinnitus might not be aware of it all the time, but only, for example, during the night when there is less environmental noise to mask it. Chronic tinnitus can be defined as tinnitus with a duration of six months or more.

Audiology

Since most people with tinnitus also have hearing loss, a pure tone hearing test resulting in an audiogram may help diagnose a cause. An audiogram may also facilitate fitting of a hearing aid in those cases where hearing loss is significant. The pitch of tinnitus is often in the range of the hearing loss.

Psychoacoustics

Acoustic qualification of tinnitus includes measurement of several acoustic parameters like frequency in cases of monotone tinnitus or , loudness in dB above hearing threshold at the indicated frequency, , and minimum masking level. In most cases, tinnitus pitch or frequency range is between 5 kHz and 10 kHz, and loudness between 5 and 15 dB above the hearing threshold. Another relevant parameter of tinnitus is residual inhibition: the temporary suppression or disappearance of tinnitus following a period of masking. The degree of residual inhibition may indicate how effective tinnitus maskers would be as treatment.

Hyperacusis

An assessment of

hyperacusis Hyperacusis is an increased Hearing, sensitivity to sound and a low tolerance for environmental noise. Definitions of hyperacusis can vary significantly; it often revolves around damage to or dysfunction of the Stapes, ''stapes'' bone, stapedius ...

, a frequent accompaniment of tinnitus, may also be made. Anari et al. (199) found that 86% of patients with hyperacusis also present with tinnitus. Hyperacusis is related to negative reactions to sound and can take many forms. One parameter that can be measured is Loudness Discomfort Level (LDL) in dB, the subjective level of acute discomfort at specified frequencies over the frequency range of hearing. This defines a dynamic range between the hearing threshold at that frequency and the loudness discomfort level. A compressed dynamic range over a particular frequency range can be associated with hyperacusis. Normal hearing threshold is generally defined as 0–20 decibels (dB). Normal loudness discomfort levels are 85–90+ dB, with some authorities citing 100 dB. A dynamic range of 55 dB or less is indicative of hyperacusis.

Severity

Tinnitus is often rated on a scale from "slight" to "severe" according to the effects it has, such as interference with sleep, quiet activities, and normal daily activities. Severe tinnitus has been associated with rarer variants. Assessment of psychological processes related to tinnitus involves measurement of tinnitus severity and distress, as measured subjectively by validated self-report tinnitus questionnaires. Such questionnaires measure the degree of psychological distress and handicap associated with tinnitus, including effects on hearing, lifestyle, health, and emotional functioning. A broader assessment of general functioning, such as levels of anxiety, depression, stress, life stressors, and sleep difficulties, is also important in the assessment of tinnitus due to higher risk of negative well-being across these areas, which may be affected by or exacerbate the tinnitus symptoms. Current assessment measures aim to identify levels of distress and interference, coping responses, and perceptions of tinnitus to inform treatment and monitor progress. However, wide variability, inconsistencies, and lack of consensus regarding assessment methodology are evidenced in the literature, limiting comparison of treatment effectiveness. Developed to guide diagnosis or classify severity, most tinnitus questionnaires have been shown to be treatment-sensitive outcome measures.

Pulsatile tinnitus

If examination reveals a bruit (sound due to turbulent blood flow), imaging studies such as transcranial doppler (TCD) or

magnetic resonance angiography Magnetic resonance angiography (MRA) is a group of techniques based on magnetic resonance imaging (MRI) to image blood vessels. Magnetic resonance angiography is used to generate images of arteries (and less commonly veins) in order to evaluate ...

(MRA) should be performed.

Differential diagnosis

Other potential sources of the sounds normally associated with tinnitus should be ruled out. For instance, two recognized sources of high-pitched sounds might be electromagnetic fields common in modern wiring and various sound signal transmissions. A common and often misdiagnosed condition that mimics tinnitus is radio frequency (RF) hearing, in which subjects hear objectively audible high-pitched transmission frequencies that sound similar to tinnitus.

Prevention

Prolonged exposure to loud sound or noise levels can lead to tinnitus. Custom made ear plugs or other measures can help with prevention. Employers may use hearing loss prevention programs to help educate and prevent dangerous levels of exposure to noise. Government organizations set regulations to ensure employees, if following the protocol, should have minimal risk to permanent damage to their hearing. Certain groups are advised to wear ear plugs to avoid the risk of tinnitus, such as that caused by overexposure to loud noises like wind noise for motorcycle riders. This includes military personnel, musicians, DJs, agricultural workers, and construction workers as people in those occupations are at a greater risk compared to the general population. Several medicines have ototoxic effects, which can have a cumulative effect that increases the damage done by noise. If ototoxic medications must be administered, close attention by the physician to prescription details, such as dose and dosage interval, can reduce the damage done.

Management

If a specific underlying cause is determined, treating it may lead to improvements. Otherwise, the primary treatment for tinnitus is talk therapy, sound therapy, or

hearing aid A hearing aid is a device designed to improve hearing by making sound audible to a person with hearing loss. Hearing aids are classified as medical devices in most countries, and regulated by the respective regulations. Small audio amplifiers ...

s. There are no effective drugs that treat tinnitus.

Psychological

The best-supported treatment for tinnitus is

cognitive behavioral therapy Cognitive behavioral therapy (CBT) is a form of psychotherapy that aims to reduce symptoms of various mental health conditions, primarily depression, PTSD, and anxiety disorders. Cognitive behavioral therapy focuses on challenging and chang ...

(CBT). It decreases the stress those with tinnitus feel. This appears to be independent of any effect on depression or anxiety.

Acceptance and commitment therapy Acceptance and commitment therapy (ACT, typically pronounced as the word "act") is a form of psychotherapy, as well as a branch of clinical behavior analysis. It is an empirically-based psychological intervention that uses acceptance and mindfu ...

(ACT) also shows promise in the treatment of tinnitus.

Relaxation technique A relaxation technique (also known as relaxation training) is any method, process, procedure, or activity that helps a person to relax; attain a state of increased calmness; or otherwise reduce levels of pain, anxiety, stress or anger. Relaxat ...

s may also help. A clinical protocol called Progressive Tinnitus Management has been developed by the

United States Department of Veterans Affairs The United States Department of Veterans Affairs (VA) is a Cabinet-level executive branch department of the federal government charged with providing lifelong healthcare services to eligible military veterans at the 170 VA medical centers an ...

Sound-based interventions

The application of sound therapy by either hearing aids or tinnitus maskers may help the brain ignore the specific tinnitus frequency. Although these methods are poorly supported by evidence, there are no negative effects. There are several approaches for tinnitus sound therapy. The first is sound modification to compensate for the individual's

. The second is tailored music therapy, notched at the tinnitus frequency, which may affect

lateral inhibition In neurobiology, lateral inhibition is the capacity of an excited neuron to reduce the activity of its neighbors. Lateral inhibition disables the spreading of action potentials An action potential (also known as a nerve impulse or "spike" w ...

of the notched neural region, suppressing tinnitus. There is some tentative evidence supporting tinnitus retraining therapy, which aims to reduce tinnitus-related neuronal activity. An alternative tinnitus treatment uses mobile applications that include various methods including masking, sound therapy, and relaxation exercises. Such applications can work as a separate device or as a

control system. Neuromonics is another sound-based intervention. Its protocol follows the principle of systematic desensitization and involves a structured rehabilitation program lasting 12 months. Neuromonics therapy employs customized sound signals delivered through a device worn by the patient, which aims to target the specific frequency range associated with their tinnitus perception.

Physical therapy

Physical therapy for tinnitus focuses on relaxing jaw and neck muscles that may contribute to symptoms. Muscle tension, particularly in the jaw muscles like the

masseter In anatomy, the masseter is one of the muscles of mastication. Found only in mammals, it is particularly powerful in herbivores to facilitate chewing of plant matter. The most obvious muscle of mastication is the masseter muscle, since it is the ...

and medial pterygoid, can radiate to the ears, leading to somatic tinnitus. Specialized physical therapists use neuromuscular techniques to alleviate tension in these areas, which may reduce tinnitus intensity and associated pain in connected areas, such as the jaw, teeth, and ears.

Medications

there were no medications effective for idiopathic tinnitus. There is not enough evidence to determine if

antidepressant Antidepressants are a class of medications used to treat major depressive disorder, anxiety disorders, chronic pain, and addiction. Common side effects of antidepressants include Xerostomia, dry mouth, weight gain, dizziness, headaches, akathi ...

s or acamprosate are useful. There are conflicting studies regarding the effectiveness of

benzodiazepines Benzodiazepines (BZD, BDZ, BZs), colloquially known as "benzos", are a class of central nervous system (CNS) depressant drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring. They are prescribed to treat co ...

for tinnitus. The usefulness of

melatonin Melatonin, an indoleamine, is a natural compound produced by various organisms, including bacteria and eukaryotes. Its discovery in 1958 by Aaron B. Lerner and colleagues stemmed from the isolation of a substance from the pineal gland of cow ...

, as of 2015, is unclear. It is unclear if

anticonvulsant Anticonvulsants (also known as antiepileptic drugs, antiseizure drugs, or anti-seizure medications (ASM)) are a diverse group of pharmacological agents used in the treatment of epileptic seizures. Anticonvulsants are also used in the treatme ...

s are useful for treating tinnitus. Steroid injections into the middle ear also do not seem to be effective. There is no evidence to suggest that the use of betahistine to treat tinnitus is effective.

Botulinum toxin Botulinum toxin, or botulinum neurotoxin (commonly called botox), is a neurotoxic protein produced by the bacterium ''Clostridium botulinum'' and related species. It prevents the release of the neurotransmitter acetylcholine from axon en ...

injection has succeeded in some of the rare cases of objective tinnitus from a palatal tremor. Caroverine is used in a few countries to treat tinnitus. The evidence for its usefulness is very weak.

Neuromodulation

In 2020, information about clinical trials indicated that bimodal neuromodulation may reduce the symptoms of tinnitus. It is a noninvasive technique that involves applying an electrical stimulus to the tongue while also administering sounds. Equipment associated with the treatments is available through physicians. Studies with it and similar devices continue in several research centers. In March 2023, the US

Food and Drug Administration The United States Food and Drug Administration (FDA or US FDA) is a List of United States federal agencies, federal agency of the United States Department of Health and Human Services, Department of Health and Human Services. The FDA is respo ...

(FDA) approved Neuromod's Lenire device as a treatment option for tinnitus. In June 2024, the US Department of Veterans Affairs (VA) announced it would begin offering the treatment to veterans with tinnitus, making it the first bimodal neuromodulation device to be awarded a Federal Supply Schedule (FSS) contract from the US Government. Some evidence supports neuromodulation techniques such as

transcranial magnetic stimulation Transcranial magnetic stimulation (TMS) is a noninvasive neurostimulation technique in which a changing magnetic field is used to induce an electric current in a targeted area of the brain through electromagnetic induction. A device called a st ...

, transcranial direct current stimulation, and

neurofeedback Neurofeedback is a form of biofeedback that uses electrical potentials in the brain to reinforce desired brain states through operant conditioning. This process is non-invasive neurotherapy and typically collects brain activity data using elect ...

Alternative medicine

Ginkgo biloba ''Ginkgo biloba'', commonly known as ginkgo or gingko ( ), also known as the maidenhair tree, is a species of gymnosperm tree native to East Asia. It is the last living species in the order Ginkgoales, which first appeared over 290 million year ...

'' does not appear to be effective. The American Academy of Otolaryngology recommends against taking

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supplements to relieve symptoms of tinnitus, and reported that evidence for the efficacy of many dietary supplements (such as lipoflavonoids, garlic, traditional Chinese/Korean herbal medicine, honeybee larvae, and various other vitamins and minerals, as well as homeopathic preparations) did not exist. A 2016 Cochrane Review also concluded that evidence was not sufficient to support taking zinc supplements to reduce symptoms associated with tinnitus.

Prognosis

While there is no cure, most people with tinnitus get used to it over time; for a minority, it remains a significant problem.

Epidemiology

Adults

Tinnitus affects 1015% of people. About a third of North Americans over 55 experience it. It affects one third of adults at some time in their lives, whereas 10–15% are disturbed enough to seek medical evaluation. 70 million people in

Europe Europe is a continent located entirely in the Northern Hemisphere and mostly in the Eastern Hemisphere. It is bordered by the Arctic Ocean to the north, the Atlantic Ocean to the west, the Mediterranean Sea to the south, and Asia to the east ...

are estimated to have tinnitus.

Children

Tinnitus is commonly thought of as a symptom of adulthood, and is often overlooked in children. Children with hearing loss have a high incidence of pediatric tinnitus, even though they do not express the condition or its effect on their lives. Children do not generally report tinnitus spontaneously and their complaints may not be taken seriously. Among those who do complain, there is an increased likelihood of associated otological or neurological pathology such as migraine, juvenile Meniere's disease, or chronic suppurative otitis media. Its reported prevalence varies from 12 to 36% in children with normal hearing thresholds, and up to 66% in children with a hearing loss. Approximately 3–10% of children have been reported to be troubled by tinnitus.

References

External links

American Tinnitus Association

Tinnitus.org UK
{{Authority control Audiology Psychoacoustics Diseases of the ear and mastoid process Occupational hazards Wikipedia medicine articles ready to translate Wikipedia neurology articles ready to translate Symptoms

Signs and symptoms

Course

Psychological effects

Types

Subjective tinnitus

Hearing loss

Associated factors

Objective tinnitus

Pediatric tinnitus

Pulsatile tinnitus

Pathophysiology

Diagnosis

Audiology

Psychoacoustics

Hyperacusis

Severity

Pulsatile tinnitus

Differential diagnosis

Prevention

Management

Psychological

Sound-based interventions

Physical therapy

Medications

Neuromodulation

Alternative medicine

Prognosis

Epidemiology

Adults

Children

See also

References

Further reading

External links