What is Tinnitus?

Tinnitus is defined as the perception of sound, in the absence of any corresponding external sound.
This can present itself in a number of ways.

LOCATION – It is difficult to pinpoint a location for the sound of tinnitus! The sound can be perceived to be coming from one ear, both ears or even from the middle of your head.

DURATION – For some people their tinnitus can be heard continuously, while for others their tinnitus is more intermittent.

Who gets Tinnitus?

All age groups, including children can be affected by tinnitus. On average it is estimated that 30% of people will experience tinnitus at some stage in their life.

Tinnitus, while more prevalent in individuals with hearing loss or ear problems, does nevertheless occur in individuals who have normal hearing.

Who gets Tinnitus?

All age groups, including children can be affected by tinnitus. On average it is estimated that 30% of people will experience tinnitus at some stage in their life.

Tinnitus, while more prevalent in individuals with hearing loss or ear problems, does nevertheless occur in individuals who have normal hearing.


Numerous factors can contribute to a person experiencing tinnitus so it is often difficult to know what is the exact cause. Mental or physical change in an individual is usually what gives rise to the onset of tinnitus. Of this we can be sure! According to the British Tinnitus Association, some causes may include:

Hair cells in the inner ear become damaged or deplete due to ‘wear and tear’ over the years. This may cause hearing loss, which may make the tinnitus sound louder, as it is not being masked by environmental sounds.

It is uncertain as to whether stress/anxiety causes tinnitus; however, many patients do notice that their tinnitus becomes exacerbated during times of stress.

Individuals build up different amounts of wax depending on the shape and size of the ear canals. This can cause impacted wax which can essentially act as an ear plug, and cause a ‘conductive hearing loss’, making it more difficult to hear external sounds to mask the tinnitus.  See Wax Removal Page for more info

Also known as otitis media with effusion (or OME), often affecting children, where there is a build up of fluid in the middle ear due to a malfunction of the Eustachian tube. In many cases, glue ear manages to resolve itself without any need of medical interventions. In other cases however, intervention such as grommets may be required.

This can be caused by acute or chronic infections, sudden change in air pressure (such as when diving), trauma (such as cotton buds in the ear) or extremely loud sounds. This is usually accompanied by pain in the ear.

Hair cells damaged by loud sounds gradually over a long period of time, or due to a short burst of a very loud noise. If you are exposed to loud noises on a daily basis, it is important to protect your ears from any permanent damage by using ear protection.

Ear infections are a common cause of hearing loss and/or tinnitus. This can usually be resolved through prescription medication from a doctor.

This is a balance disorder which causes sudden attacks of tinnitus, hearing loss, vertigo (feeling like the room around you is spinning) and a sensation of pressure in the ear.

This is when there is abnormal bone growth of the middle ear bones (ossicles), more specifically the stapes (AKA stirrup). The stapes becomes fused with the surrounding bone, preventing sounds from efficiently transmitting to the cochlea (Web link to Hearing). This means that the individual may suffer with a degree of hearing loss. Treatment options may include fitting a hearing aid to compensate for the hearing loss, or other means such as surgery.

Head trauma, changes in blood flow (e.g. anaemia, high blood pressure), medication, acoustic neuroma (a growth on the hearing nerve), diabetes and thyroid disorders.

Tinnitus Management

The outlook for people with tinnitus is usually very good. Even though, tinnitus can be an unwelcome, uninvited annoyance, the good news is that with the correct help and time, the intrusive and distressing nature of tinnitus can be greatly reduced or even totally eliminated enabling one to lead a happy and tinnitus free life.

Tinnitus develops when some change occurs in the auditory pathway. There are many causes that can bring about this change, for example illness, though this would be considered rare. However if you experience tinnitus, it is certainly worth having a medical check-up just to put one’s mind at ease. More often than not, tinnitus develops with general ‘wear and tear’ or proceeding/during a period of deep stress in one’s life. As there are many different causes the management of tinnitus will vary greatly from person to person. The main objective will be to reduce the distress and annoyance associated with it.

For example, let’s take ear wax as a likely cause of tinnitus! When the individual has the ear wax removed, they often notice an improvement immediately.
It is not always easy to pinpoint what is causing the tinnitus. That is why one often finds it more helpful to manage the tinnitus itself as a secondary symptom of the initial condition. There are a variety of methods and devices which can be used to achieve this but usually a combination is used. Here below, are some of the more common methods.

Hearing Aids

Hearing aids are used for individuals with a hearing loss. Environmental sounds will be amplified with these aids so that the individual will hear everything with the ‘normal’ range. As this happens, more sound from the outside environment will be allowed to enter the hearing pathway. The tinnitus sounds can be partially covered by this and thus become less prominent. Hearing aid usage can also result in a person having to strain less to hear. Hearing, on the whole, becomes less tiring for the person and the tinnitus less debilitating.

Visits to your audiologist can help greatly in attaining whether the use of a hearing aid may be helpful in reducing the effects of tinnitus, even if one is experiencing only a slight hearing loss. Built in white noise generators in hearing aids may help to partially mask the tinnitus.

Sound Enrichment Therapy

This is deliberate use of sounds that will help to reduce tinnitus awareness and the annoyance linked with it.

  • Environmental sounds such as a busy street, chatter of an office, desk fan and so on.

  • CDs and downloads

    • Relaxing sounds such as bird song or rainforest sounds.
    • White noise/pink noise/brown noise.
  • Bedside sound generators

    • These devices have built-in relaxing sounds which usually include a timer setting to turn off the sound automatically after a set period of time. These can be linked to a pillow speaker.
    • These devices are particularly good for night time use when going to sleep, waking up in the middle of the night and waking up in the morning.
  • Ear level sound generators/White Noise Generators (WNG)

    • Produce constant white noise.

Cognitive Behavioural Therapy (CBT)

CBT is a very useful talking therapy to treat depression. Results have found that this therapy is just as effective if not more effective than medication. Anxiety and an extensive number of physical disorders have also used this therapy successfully.

So What is Involved?

CBT involves examining how you discern your problems, what you actively do about them and how these factors influence the way you see your problem and how it affects you. The CBT therapist encourages you and offers support in changing how you perceive things and what you do so that your problem, or the effect of it, is greatly lessened. For over 30 years, CBT has been successfully used in tinnitus management. It does not eradicate tinnitus, but scientific research shows that tinnitus related distress can be quite significantly reduced by this therapy. This approach is shown to have the strongest evidence of benefit.

Tinnitus Retraining Therapy (TRT)

TRT states that tinnitus develops as a problem for someone as it is often linked with another stressful event in that person’s life. As a result of this association, the hearing system leads to tinnitus being given great importance. TRT involves educating people about that process and the workings of tinnitus. It then uses external sounds to partially mask the effects of tinnitus. This can include use of sound generators (look like hearing aids but do not amplify sound).

It is thought that this process will reduce the association built up between tinnitus and the stressful event and thereby allow tinnitus to become an emotionally neutral experience. Scientific research reviews for use of TRT suggest that the evidence needs to be strengthened but that many people have certainly found it a helpful approach.

Other Considerations

At present, there is no drug treatment for subjective tinnitus which is FDA recommended. Some people become anxious or depressed in response to tinnitus and are therefore offered antidepressant medicines. By relieving the symptoms of depression these medicines can help break the vicious cycle between these symptoms and tinnitus distress. Some people are also offered sleeping medicine. These will usually be prescribed by your GP. Some may increase tinnitus annoyance or intensity, and therefore these could be reduced after discussion with your GP.

Mindfulness Based Cognitive Therapy (MBCT) is one of the latest developments within CBT. It uses meditation exercises as a method for helping a person observe their physical, emotional and cognitive reactions to things. This observation can help us to respond more carefully to situations rather than automatically reacting to them. This can help us be less distressed. Learning MBCT skills usually takes a few months of regular practice; most people find the practice enjoyable. MBCT is part of the NICE guideline for the management of depression and is also used in many anxiety clinics. It is also increasingly used in physical medicine and has been used in a number of specialist tinnitus clinics for the past ten years. There is now a growing evidence base indicating that it is an effective way of managing tinnitus for many people.

Some people with tinnitus complain about difficulties sleeping. Not everyone with tinnitus, however, has a sleep problem. Many people with tinnitus actually sleep very well. The link between tinnitus and sleep problems is therefore not inevitable. The sleep problem is more closely linked to the anxiety or depression that tinnitus can cause. Research suggests that when sleep problems are present they are much the same as insomnia when it occurs without tinnitus. It is now thought that when tinnitus and sleep problems are both present the best approach is to focus on treating the sleep problem and that this will reduce the distress and intrusiveness of tinnitus. Medication can help in relieving sleep problems but they should be used only in the short term. The best way of treating longer standing insomnia is to use cognitive behaviour therapy (CBT).

There is a close link between tinnitus and stress. Many people find tinnitus stressful and find that tinnitus is more intrusive when they are stressed. Learning to relax can help to break the vicious cycle. According to the British Tinnitus Association, there are several activities which may help to relieve stress. These include exercise, socialising, changing things in your life which cause you stress (if possible); Other methods of relaxation include breathing exercises, aromatherapy, yoga and tai chi. These things can help you ‘relax’ in a general sense and as a result may reduce the intrusiveness of your tinnitus. “The purpose of relaxation is not to reduce tinnitus, but to deal with the consequences of it” (Andersson & Kaldo, 2006). In a more specific sense relaxation can be achieved by learning progressive muscle relaxation exercises. There is evidence in the scientific literature that these techniques can lead to a reduction in tinnitus related distress and to an improvement in psychological well-being.

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