Most people with tinnitus commonly refer to it as “ringing in the ears,” but the “ghost sounds” can also sound like whooshing, popping, buzzing, humming or clicking…or even musical melodies.

If you are among the estimated 45 million Americans affected by tinnitus (pronounced tin-EYE-tus or TIN-uh-tus), you quickly realize that the sounds you’re perceiving are not coming from any actual external source. You may also assume that you’re the only one who can hear the odd sounds you’re hearing. But that’s not always true.

An important distinction: For some tinnitus sufferers, the condition is caused by physical problems that can sometimes be heard by an examining physician. Quick treatment for this type of tinnitus may eliminate the bothersome sounds…and stop a potentially serious medical issue. What you need to know about the two main types…

SUBJECTIVE TINNITUS

This form of tinnitus accounts for more than 95% of all tinnitus cases. The ghost sounds, as described above, may come and go, but when present are continuous and audible only to you. Loudness and pitch tend to vary from time to time.

Main cause: Damaged cells in the cochlea, the spiral-shaped structure in the inner ear that converts external sound waves into electrochemical signals that you “hear” in the brain. These cells can produce false signals that the brain interprets as sounds.

Cell damage within the inner ear is usually due to long-term noise exposure or age-related hearing loss. Sometimes, the cause is as simple as a buildup of earwax. Tinnitus may also result from long-term use of aspirin or other medications that can damage the ears, such as chemotherapy drugs or diuretics.

Note: In rare cases, subjective tinnitus is associated with a benign tumor pressing on the auditory nerve. Hearing tinnitus sounds in only one ear can be a warning clue.

OBJECTIVE TINNITUS

Objective tinnitus is less ghost-like—it can be heard (and measured) by a doctor. It is much less common, affecting less than 5% of tinnitus sufferers.

The sound is mainly caused by the noisy movement of blood through abnormal veins/arteries in the head or neck. Doctors call these sounds pulsesynchronous because there’s one sound with each heartbeat.

Important: Pulsatile tinnitus, or vascular tinnitus, as this condition is often called, is worrisome because it typically signals an underlying vascular disease, such as atherosclerosis…brain aneurysm (a bulge in a weakened artery in the brain)…or a vascular tumor.

Much less often, clicking sounds, like those from a typewriter, can occur with objective tinnitus. Involuntary muscle contractions of the palate or middle ear could be the cause. This type of tinnitus is usually temporary and associated with stress or head trauma or, more rarely, with multiple sclerosis or a brain stem tumor.

TINNITUS TREATMENT

If you think you might have either type of tinnitus, see an otolaryngologist (an ear, nose and throat doctor) for an evaluation. The doctor will check your hearing and blood pressure. He/she will also listen for pulsatile tinnitus by pressing a stethoscope over the ear canal or major blood vessels in the head, neck or heart. If sounds are present, you’ll probably need an MRI or a CT scan. Just knowing that tinnitus is not caused by anything serious (as most often is the case) goes a long way toward relief.

Treatment for subjective tinnitus: This type of tinnitus can rarely be eliminated altogether, but it almost always can be reduced. Best approaches…

Deal with stress. Emotional stress is strongly linked to tinnitus. The fight-or-flight stress hormones enhance the transmission of nerve impulses, making the ghost sounds louder and more distressing. Patients with tinnitus should manage their stress with the help of a psychotherapist…self-help approaches such as exercise, yoga and/or meditation…and/or complementary therapies such as massage, biofeedback or acupuncture.

Consume less caffeine. Coffee, tea and caffeine-loaded soft drinks can make tinnitus much worse. Caffeine stimulates the nervous system and makes tinnitus louder. Some people notice a difference when they reduce their intake of caffeinated beverages to one or two a day, but avoiding caffeine altogether is usually more effective.

Improve sleep. Good sleep hygiene (going to bed at the same time every night and getting restful sleep) is beneficial for overall health and can help alleviate tinnitus. If you have trouble falling asleep or wake up during the night, try introducing more exercise into your routine so that you are more physically tired at night.

Limit the use of aspirin and other over-the-counter (OTC) pain relievers. Aspirin is known to cause reversible damage to the nerve cells in the cochlea of the inner ear. In addition, a Harvard study found that people who took ibuprofen (Motrin) or acetaminophen (Tylenol) most days of the week had a 20% increased risk for hearing loss, which increases the risk for tinnitus.

Low-dose aspirin therapy (81 mg daily) for heart health and occasional use of these other medications shouldn’t be a problem. Tinnitus usually occurs only with regular high doses. If you’re taking higher doses of aspirin or these other medications and develop tinnitus, stop taking them. The sounds will usually disappear within a day or two.

Sound therapy. Sound therapy uses external sources of sound to reduce the severity of tinnitus. By introducing a louder sound, the softer sound of tinnitus can be blocked out. Various methods…

Background sound masking. Tinnitus sounds become less noticeable when you’re listening to other sounds. Some people keep a fan running or listen to low-volume background music. You can buy inexpensive sound generators that produce birdsongs, the sounds of running water, white noise and other constant sounds. If you mainly notice tinnitus at night, you can buy inexpensive pillow speakers that will mask the noises without bothering your bed partner.  

Wearable maskers. Many people with tinnitus also have hearing loss. Using hearing aids can help reduce the tinnitus sounds by making surrounding sound louder…and there are some models that also include a masking component—they simultaneously enhance hearing and block tinnitus sounds.

Important: You can buy wearable maskers online, but it’s best to get a customized device from an audiologist. The audiologist will test different volumes/frequencies to find one that precisely matches your tinnitus. The device will then be adjusted as low as possible until it just covers up the tinnitus sounds but doesn’t interfere with normal hearing.

These combination devices are similar in appearance to hearing aids and cost about $1,000 to $2,500 for a pair. The cost is very rarely covered by insurance.

Some people use these devices indefinitely. Others find that masking gradually results in reduced loudness over time, even when the maskers are not in use. After a few months, some people discover that they no longer need the devices for tinnitus control.

Neurophysiology-based treatment. One of the most recent and effective treatments for tinnitus, neurophysiology-based treatment uses sound therapy along with intensive counseling to dampen the anxiety associated with tinnitus sound. The goal is for the patient to learn to ignore the tinnitus until it fades into the background.

In the past, surgeries were done to cut the hearing nerve with the hope of alleviating subjective tinnitus, but this did not improve the condition and sometimes made it worse. However, surgery may be needed in the rare case when a tumor is causing subjective tinnitus.

Treatment for objective tinnitus: Fewer than 5% of objective tinnitus cases require surgery to manage a serious underlying condition, such as severe narrowing of the carotid artery, an aneurysm or a vascular tumor. Botox is sometimes used to help spasms in the soft palate and one or both tiny muscles in the middle ear can be divided to stop spasms in the middle ear.