Man suffering from tinnitus.

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An estimated 50 million Americans suffer from tinnitus, which causes a person to perceive noise in one or both ears when no external sound exists. The noise can occur intermittently or persistently and can interfere with sleep and concentration, and has been linked with stress and depression. The condition is often a result of a problem with the inner ear, but sometimes the underlying cause in unknown.

Tinnitus Forms

There are three types of tinnitus:

• Tonal tinnitus is often called “ringing in the ears.” This type produces a continuous sound, like a single note played over and over.
• Pulsatile tinnitus is when the sounds are intermittent, continuous, or pulsating in time with the heartbeat.
• Musical tinnitus is the perception of music or singing in a constant loop, but is the rarest form.

Causes of Tinnitus

Tinnitus sounds often originate from the inner ear. As you age, tiny sensory hair cells in the inner ear die off, or are damaged. This process may be accelerated by exposure to loud noises, poor cardiovascular health, and some medications, including aspirin and acetaminophen, diuretics, and antibiotics.

Middle ear infection symptoms and rare conditions that cause the ear bones to harden also may trigger tinnitus. Certain non-auditory conditions and lifestyle factors also are linked to tinnitus; among them: temporomandibular joint, or TMJ, disorders (which affect the hinge joint that attaches the jaw to the skull), depression, anxiety, insomnia, and muscular stress and fatigue. Tinnitus also can be the result of a head or neck injury.

Risk Factors

While anyone can experience tinnitus, these factors may increase your risk:

• Age. The number of functioning nerve fibers in your ears declines as you age, which may lead to hearing problems.
• Gender. Men are more likely to experience tinnitus.
• Loud noises. Long-term exposure can damage small sensory hair cells in that transmit sound to your brain.
• Cardiovascular problems. Conditions like high blood pressure or narrowed arteries can increase your risk by affecting your blood flow.

Tinnitus Symptoms and Screening

Screening involves a review of your medical history and an examination of the outer and inner ear. Your doctor then may apply one or more of the following tests:

• Hearing (audiological) exam. You sit in a soundproof room wearing earphones. Specific sounds are then played into one ear at a time. You indicate when you can hear the sound, and your results are compared with what is considered normal for your age.
• Movement. You are asked you to move your eyes, clench and unclench your jaw, and/or move your neck, arms, and legs in certain directions. If your tinnitus changes or worsens when you do these, it may help to identify an underlying problem.
• Imaging tests. You also may need tests, such as a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan.

Tinnitus Treatment and Prevention

If a specific cause has been identified, addressing it may eliminate the problem. If not, one or more of these strategies may offer relief.

• Identify and avoid triggers. Pinpoint anything that exacerbates the symptoms—for example, drinking caffeinated beverages, taking particular medications, or exposure to noise.
• Use hearing aids. If you have hearing loss, wearing a hearing aid may reduce tinnitus by reintroducing ambient sounds that mask it.
• Change your reaction. Cognitive behavioral therapy (CBT) can help recognize negative behaviors and thought patterns related to your tinnitus. You then focus on altering them to reduce any distress from the noises. A similar approach is tinnitus-retraining therapy, which uses counseling and sound therapy to retrain your brain to stop paying attention to the tinnitus.
• Seek out other sounds. Sound therapy fills that silence with a constant, neutral sound that distracts you from your tinnitus. Examples include tuning a radio into static sounds, or using a sound machine that plays “white noise,” or relaxing nature sounds.

Published in 2016 and regularly updated.