Ringing in the ears: What can you do about tinnitus?

I hear a persistent ringing in my ears that drives me nuts and makes it hard for me to sleep. How can I make it go away?

Tinnitus is the experience of hearing phantom noises, typically in the form of ringing, buzzing or roaring sounds. It is a common and usually harmless condition. According to a 2024 analysis, about 11 per cent of American adults experience tinnitus, and 41 per cent of them hear noises constantly rather than intermittently.

It is rare for tinnitus to be cured, but a person’s prognosis depends on what is causing the symptoms. Even if it is not curable, “there are a lot of good ways to manage it”, said Dr Mohamed Elrakhawy, an ear, nose and throat (or ENT) doctor at Rush University Medical Center in Chicago.

Causes of tinnitus

Tinnitus can have a variety of causes, said Dr Zachary Schwam, an ENT doctor at the Icahn School of Medicine at Mount Sinai in New York City. Sometimes, he said, it can be a result of tumours, nerve problems, asymmetries in veins, holes in or fluid behind the eardrums, earwax or damage to the bones behind the eardrums.

In these cases, it is typical for tinnitus to occur in only one ear, and it can sometimes resemble the sound of a heartbeat. If your tinnitus presents this way, it is important to get it checked out by a doctor, Dr Schwam said.

But most of the time, tinnitus is a harmless by-product of hearing loss, said Dr Kenny Lin, an ENT doctor at Houston Methodist Hospital. “The hair cells of the cochlear nerve endings are damaged and send an altered signal to the brain, which is perceived as a ringing, humming, buzzing or static sound,” he added.

People who are regularly exposed to loud noises are also more likely to develop tinnitus, Dr Schwam said. “Enjoy your concerts, enjoy your work, but just make sure you’re using the proper ear protection,” he added.

Often, tinnitus is a minor annoyance that becomes less bothersome over time.

But in some cases, it can become debilitating, interfering with the ability to work and sleep, Dr Elrakhawy said. Tinnitus has been linked with anxiety, depression and, in rare cases, suicide.

Stress, anxiety and lack of sleep can make tinnitus worse, Dr Schwam said. “I often tell people that those things are not necessarily causing your tinnitus, but they’re certainly not helping,” he said.

Treatment depends on the cause

To determine the cause of tinnitus, a doctor will ask about a person’s clinical history and perform a physical examination.

“If it’s only in one ear or both ears, if it’s all the time or comes and goes, if there are certain triggers or situations that make it worse – those all really do help focus on what the next step would be,” Dr Elrakhawy said.

A doctor is likely to suggest a hearing test and may also request other types of tests, including magnetic resonance imaging or computed tomography scans.

If tinnitus is caused by a bone, nerve or circulatory issue, then treating the underlying problem may cure it, Dr Schwam said. But if hearing loss is the cause, then treatments can improve symptoms but may not eliminate them, he added.

Typically, tinnitus treatments for people with hearing loss are aimed at reducing the impact on their daily lives, particularly on sleep and their ability to work, Dr Lin said. One popular approach, he added, involves listening to masking sounds such as white noise, ocean or rain sounds, music and the sounds of fans or humidifiers, which can make tinnitus less noticeable.

“As long as the brain is able to hear outside sounds, it is less likely to hear the inside sounds,” he said.

A hearing aid may also help if a person’s hearing loss is significant enough to warrant one. “Hearing aids amplify sounds that you no longer hear well, so it is essentially a masking device that you wear throughout the day,” Dr Lin said.

Some hearing aids have special tinnitus-masking settings that may feed certain frequencies into the ear to optimise masking. Counselling and other forms of therapy can help too.

“We often meet patients who suffer terribly from tinnitus and the negative impact on mood, including anxiety and depression,” said Dr C. Matthew Stewart, an ENT doctor at Johns Hopkins Medicine.

But when physicians explain what is going on and assure patients that their tinnitus is not dangerous, it can help them cope, Dr Schwam said.

Some patients benefit from cognitive behavioural therapy, a form of psychotherapy that can help people better manage symptoms, or from tinnitus retraining therapy, which involves counselling along with sound therapy.

Be wary of miracle cures

If you are experiencing tinnitus, talk to your primary care provider or ask for a referral to an ENT specialist or audiologist who treats tinnitus, Dr Elrakhawy said. Although there are many over-the-counter supplements and eardrops marketed as tinnitus treatments, he does not know of any that are shown to work.

Some of Dr Schwam’s patients have taken over-the-counter eardrops containing heavy metals to their appointments, asking if they might help.

“I take a look at the drops, and they have ingredients that I would never put in a human body,” he said. NYTIMES