Bradley Kesser, MD
Bradley Kesser, MD, professor of otology and neurotology at The University of Virginia, Charlottesville. He is vice chair of UVA’s Otolaryngology–Head and Neck Surgery department.
UVAHealth.com
Few things are as frustrating as an annoying sound that won’t stop…or as disturbing as the realization that the sound is coming from inside your own head.
Tinnitus—a condition that causes a persistent ringing, buzzing, hissing, whooshing or comparable sound that only the individual can hear—affects around 15% of the US population. For some, the sound is just an annoyance…but for others, it’s so loud that it can’t be ignored and interferes with the ability to sleep and concentrate.
The bad news: There is no cure for tinnitus—in fact, there isn’t even scientific consensus about why it occurs.
But there is good news—tinnitus is rarely a sign of a serious underlying health issue…it tends to fade substantially over time—often within roughly three to four months, though this varies…and there are ways to reduce the impact it takes on your life.
Tinnitus is very poorly understood, but we do know that certain things can be triggers. The most common culprit is hearing loss—either age-related or stemming from long-term exposure to loud noise such as machinery, power tools, firearms or blaring music. The pitch of the sound that a tinnitus sufferer hears in his/her head tends to match the pitch that his ears have lost the ability to hear. Example: If hearing loss has deprived someone of his ability to hear high-frequency sound, the ringing or buzzing of his tinnitus is likely to be similarly high-pitched. One potential explanation for this is that tinnitus might be caused by the brain trying to fill in the frequency of sound that has been lost.
Even onetime exposure to very loud noise, such as being in the vicinity of a large explosion or sitting near the speakers at a loud rock concert, can trigger tinnitus. Tinnitus caused by a onetime exposure is likely to be relatively short term, generally lasting only a few days to a few weeks.
But loud-noise exposure and hearing loss aren’t responsible for all tinnitus. A wide range of other tinnitus triggers and contributing factors have been identified, including earwax buildup…infections, including sinus infections and the flu…stress…and the use of certain drugs, including over-the-counter painkillers. In some cases, the type of sound the tinnitus sufferer hears hints at a potential cause—particularly when this sound is not the ringing or buzzing that most tinnitus sufferers experience. Examples…
The sound of a heartbeat. Called pulsatile tinnitus, this tends to be caused by issues related to the blood vessels near the ear. The sound itself usually is not a beat but rather a whooshing that keeps pace with the person’s pulse. It is similar to the sound parents hear when an ultrasound allows them to hear their unborn child’s heart. Seek medical attention for this form of tinnitus—CT and/or MRI scans typically can pinpoint the problem, and most of the conditions that lead to pulsatile tinnitus can be treated, likely reducing or ending this tinnitus. Examples of treatable pulsatile tinnitus include a malformation of blood vessels in a part of the brain near the ear, a loss of bone over one of the large blood vessels that delivers blood from the brain back down to the heart and elevated intracranial pressure.
Clicking or thumping. Potential causes here include spasms of the tiny muscles in the middle ear…contractions in the soft palate (the flexible part of the roof of the mouth)…or issues related to the eustachian tubes—the passages that connect the middle ear to the back of the nose. The eustachian tubes make a clicking sound every time we swallow, but we generally don’t notice it. A blockage or infection might make this sound more noticeable. Treatments are available for many of the underlying conditions that lead to clicking/thumping tinnitus.
Any tinnitus sound only or largely in one ear. This could be caused by a vestibular schwannoma, a noncancerous tumor that may affect both hearing and balance. Options for managing vestibular schwannomas include observation with serial MRI imaging, radiation or surgical removal. Any of these treatment options can put hearing and balance functions at risk. Many times, doctors who treat patients with these tumors recommend observation—they are benign and very slow-growing.
An ear, nose and throat doctor might be able to identify a treatable underlying issue, such as excessive wax buildup in the ears. But there are some DIY strategies that can reduce tinnitus—or at least reduce the impact it takes on your life…
Cover the tinnitus with outside sound. Options worth trying include white noise from a fan, a sound machine or a white noise phone app, such as Rain Rain (available for iOS, Android or Amazon devices)…YouTube background noise videos, such as “Are Cricket Sounds the New Cure for Tinnitus?”…or simply letting a TV or radio play in the background. There also are in-ear hearing-aid–like devices called “tinnitus maskers” designed specifically for this purpose—these typically are programmed by an audiologist to mask the precise frequency of the patient’s tinnitus. Some hearing aids offer a tinnitus-masking function as well. Helpful: Tinnitus sufferers who own hearing aids should consider wearing those hearing aids more often. Being able to hear more outside sound tends to make tinnitus less troublesome.
Seek stress reduction. Emotional stress can trigger or worsen tinnitus. Some sufferers even end up trapped in a tinnitus/stress spiral—the endless noise and sleep problems caused by the tinnitus increases their stress…which increases their tinnitus…which further increases their stress…and so on. Potential stress treatments: Yoga, cognitive behavioral therapy and/or antianxiety medications—the same treatments that might be used to treat stress unrelated to tinnitus.
Also: The treatment tinnitus retraining therapy combines cognitive behavioral therapy with a noise-canceling device such as those mentioned above. Studies have found that this provides some relief for most people who try it.
Warning: Do not take any supplements that claim to cure tinnitus. No supplement has ever been proven to provide any tinnitus benefit beyond the placebo effect.
Reduce use of caffeine, nicotine, alcohol and/or certain painkillers. Heavy use of any of these can contribute to tinnitus, and cutting back could provide significant relief—or potentially make tinnitus disappear entirely. Helpful: When you need pain relief, lean toward Tylenol. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin or Advil), naproxen and aspirin, may cause or worsen tinnitus. Tylenol is not an NSAID and does not seem to contribute to tinnitus.
Ask your dentist if you might have a TMJ disorder. Problems with the temporomandibular joint (TMJ)—including chronic clenching of the jaw, a misaligned bite or other conditions that involve the muscles and ligaments of the jaw joints—sometimes lead to tinnitus. Other TMJ symptoms include jaw pain, headaches, difficulty opening the mouth or clicking sounds when the mouth is opened or shut. If TMJ is the cause of your tinnitus, a dentist should be able to propose treatments. Heat, a soft diet (e.g., soup, pasta, applesauce, mashed potatoes, and yogurt) and ibuprofen (but not too much!) can help the musculoskeletal strain of TMJ dysfunction. A bite guard can be helpful for those who grind their teeth at night.
Cannabidiol (CBD), a compound found in marijuana that does not cause impairment, is occasionally mentioned as a potential treatment for tinnitus. That makes some sense—it has been hypothesized that tinnitus might be a form of sensory epilepsy, and CBD has anti-epileptic properties.
But: The research that has been done has not produced encouraging results. A 2015 study on rats by researchers at New Zealand’s University of Otago suggested that CBD might make tinnitus worse…and a 2019 study by Stanford University researchers found that habitual marijuana use appears to increase risk for tinnitus. Several small studies have concluded that CBD does nothing to make tinnitus better or worse.
Given these findings, it is not reasonable to recommend CBD as a tinnitus treatment.
