“It’s a high-pitched ringing, sometimes louder and sometimes less loud,” describes Kathy Koehl. At 71 years old, Koehl is a retired pharmaceutical representative and a fitness trainer in Prairieville, LA. Five years ago, she was diagnosed with tinnitus in both ears and mild hearing loss. Her hearing loss was more severe on one side. This can sometimes signal a condition that is more serious than age-related hearing loss, such as Meniere’s disease or a tumor like vestibular schwannoma. Koehl had an MRI to rule out these conditions. Fortunately, all tests were negative.
Her hearing loss affects her in a crowded room with lots of people talking, but her tinnitus is often most bothersome when she is in a quiet room with no distractions.
Tinnitus gets its name from the Latin word for “ringing.” It can also sound like buzzing, hissing, whooshing, or chirping crickets. Most of the time, the sound is caused by errors in the brain’s auditory system. “You have hearing loss but structures in the nervous system are accustomed to getting nerve signals so they ramp up the receptors,” explains Terry Fife, MD, who recently retired as director of the Neuro-otology and Balance Program at the Barrow Neurological Institute in Phoenix, AZ. “That makes them hypersensitive, and sound is generated by this up-regulation of receptors.”
Chronic tinnitus affects between 10% and 15% of Americans. It is generally harmless—a symptom, not a disease—but can be debilitating. As many as 99% of cases are like Koehl’s—in both ears and perhaps triggered by age-related hearing loss. Sometimes it may be a sign of something more serious.
A whooshing sound in rhythm with your heartbeat? Get it checked out.
A whooshing sound in your ears may be pulsatile tinnitus if it’s in rhythm with your heartbeat. “If you have pulsatile tinnitus, especially on one side, there could be something wrong with the vascular system,” says Nicholas Hac, MD, a neurologist at Feinberg School of Medicine in Chicago. It could be a glomus tumor—a very rare and usually benign growth in the base of the skull near the inner ear. These tumors can be treated with surgery, radiation, or both. “But it could also be something wrong with the arteries or the veins in the neck and head,” explains Dr. Hac. In this case, he would refer a patient to an endovascular neurosurgeon for consultation.
If a person is experiencing pulsatile tinnitus and vision changes or headaches, Barrow Neurological Institute neurologist, Kamala Saha, MD, will check for a condition called idiopathic intracranial hypertension. This is a feeling of pressure caused by excess cerebrospinal fluid around the brain. If untreated, it can lead to vision loss. “We can treat it by lowering intracranial pressure with medications, which can be effective and relieve the tinnitus,” she says.
In many cases, though, pulsatile tinnitus is harmless. It can happen with pregnancy, which increases blood flow. “Some people have some blood flow turbulence, and the sound that [the] turbulence creates gets carried by the bones in the ear,” says Dr. Fife. He adds that if the MRI and other imaging studies look good, you don’t need to worry.
Meniere’s disease
Dr. Hac explains that if you have tinnitus in one ear and dizziness, that raises a concern for Meniere’s disease. This is a chronic inner ear disease that leads to hearing loss, tinnitus, and vertigo—feeling like the room is spinning. “Patients often also have a sense of aural fullness, a feeling like cotton stuck in the ear, and low frequency hearing loss in that ear.” Meniere’s disease is caused by an abnormal build-up of fluid in the inner ear. It can be treated with medications that suppress the vestibular (sensory) system in your inner ear so you feel less dizzy. Preventive therapies include a low-salt diet and diuretics to reduce fluid buildup. In severe cases, surgery is an option.
Vestibular paroxysmia
Quick episodes of dizziness with tinnitus “makes me wonder about vestibular paroxysmia,” says Dr. Hac. It’s caused by irritation of the eighth cranial nerve, which has two portions—one responsible for hearing, the other for balance. The dizziness and tinnitus may last less than a second, but you can have attacks 50, 100, or even 200 times a day. “A benign tumor pressing on the nerve is one possible cause, but another common cause is a vascular loop, a blood vessel pressing up against the nerve. This is very treatable,” says Dr. Hac. Typically, people notice an improvement after taking antiseizure medications for a few months. However, not all antiseizure medications are used to treat tinnitus.
Labyrinthitis
Deep inside the ear, behind the eardrum, is a small, winding structure called the labyrinth. It contains the cochlea, which helps you hear, and the vestibule, which helps your body keep its balance and sense of movement. When the labyrinth becomes inflamed or swollen, the condition is called labyrinthitis. “If you have one big episode of sudden hearing loss and tinnitus, with a persistent dizziness that can last for hours or days, that could be an attack of labyrinthitis,” says Dr. Hac. The inflammation may be caused by a virus or an autoimmune process. “You suddenly lose your hearing, develop a terrible tinnitus, and experience a terrible dizziness like the room is spinning.”
That’s what happened to 72-year-old Jean Huxtable-Hamersky of Green Bay, WI. One evening when she went to bed she recalls, “I had some funny sounds in my left ear, like someone clanging silverware. The next morning, I was so dizzy I couldn’t sit up. The room was swirling.” When her husband tried to sit her up, she threw up. “I told him, ‘I can’t hear out of my left ear.
At urgent care, she was given anti-nausea medication and a steroid. At an ear, nose, and throat appointment that day, an audiogram showed complete hearing loss in the left ear. The doctor gave her a steroid injection in her inner ear to reduce inflammation.
An MRI did not show anything abnormal pressing on the auditory nerves. She started vestibular rehab with a physical therapist and had five more weekly injections. “It was weeks before I could go to the grocery store because the sounds were overwhelming.” According to Dr. Hac, people with labyrinthitis sometimes have permanent hearing loss, but with vestibular physical therapy, dizziness goes away, “although they may have little episodes of imbalance from time to time.”
Temporomandibular joint disorders
If you put a finger right in front of each ear and open and close your mouth, you’ll feel your temporomandibular joint—the jaw joint. It acts like a sliding hinge, allowing your jaw to move side to side, up and down, and forward and back. But when it is misaligned, it can cause pain and other problems.
If non-pulsatile tinnitus—whooshing that is out of rhythm with your heartbeat—is accompanied by jaw discomfort, headache, or neck pain, Dr. Saha will consider a temporomandibular joint (TMJ) disorder to be the diagnosis. Treatments are available. “Every patient is different—some respond to medications, others to physical therapy for the head and neck, or wearing a mouth guard at night; even diet changes may help.” Surgery may be an option if the other treatments do not work. Dr. Saha will often refer the patient to a dentist who specializes in TMJ since treatment for TMJ can often relieve the tinnitus.
Managing tinnitus
Surprisingly, the serious cases of tinnitus are often treatable and the more common cases have few effective treatments. “Over 150 medicines have been studied for tinnitus, and none of them worked,” says Dr. Hac. Unfortunately, unproven “remedies” often rush in to fill this gap. “I’ve tried all the remedies…but nothing worked,” says Koehl. However, there are evidence-based approaches. A first step is to look in your medicine cabinet—chronic use of nonsteroidal anti-inflammatory drugs (NSAIDS) or some prescription medications, like bisphosphonates for osteoporosis, can make tinnitus worse. Some chemotherapies can also cause permanent hearing loss and tinnitus.
Hearing aids often help. “Try and aggressively treat any hearing loss—and discuss augmentation options with your audiologist,” says Dr. Saha. “Some hearing aids can really help with tinnitus.” Audiologists specializing in tinnitus can often provide tinnitus retraining therapy, which involves counseling and sound therapy often delivered through hearing aids.
Most people take hearing aids out to go to sleep, however, so the aids won’t help coping with the quiet of your bedroom. Some people find relief with machines that provide “masking sounds,” such as the sounds of ocean waves. “One cheap way to do this is simply to put a fan in your bedroom and point it to a corner of the room,” says Dr. Fife. It generates white noise to decrease the loudness of tinnitus.
Reducing stress can help. One evidence-based program is cognitive behavioral therapy, which has shown benefit for treating pain, anxiety, and depression. It is also sometimes used to help with tinnitus. The goal is to reduce unhelpful thoughts and learn coping skills like relaxation techniques. Cognitive behavioral therapy is usually provided by psychologists or other behavioral health professionals.
In 2023, the FDA approved Lenire, a neuromodulation device used to treat moderate-to-severe tinnitus. It delivers mild electrical pulses to the tongue while playing soothing sounds through headphones. The combination of stimulations lets the brain develop new pathways, so while you still have tinnitus, you pay less attention to it. Before beginning the treatment, a patient is evaluated by an audiologist or other health care professional. If the patient is approved, they may purchase the device for home use. Treatment is typically two 30-minute sessions a day for 12 weeks, then a re-evaluation to see if more sessions are needed. Many people find relief starting around the sixth session. However, the device costs several thousand dollars and is not currently covered by insurance.
Living with tinnitus
Some people, like Huxtable-Harmersky, use earplugs for concerts to reduce sound sensitivity. She worked with an audiologist monthly until her hearing aid was working optimally. She can listen to podcasts through her hearing aid directly into her ear, and “the sounds keep my brain stimulated so I don’t have tinnitus when I’m listening.”
Her dizziness has lessened considerably, and her balance has improved with physical therapy. “Every single morning, I do some balance exercises. But perhaps once a week I’ll be doing something like bending over to water plants and I’ll get a wave of dizziness for two or three seconds. Sometimes I’m a little off balance, but I haven’t fallen, thank goodness.” She still has tinnitus most of the time, even when wearing hearing aids. “It’s always there.”
She practices mindfulness meditation, which helps her shift her focus away from the tinnitus. When she’s going through her day, she’s not focusing on the tinnitus, but when she goes to bed and tries to sleep, it can be very loud. “I do a meditation in my head that usually puts me to sleep.”
The best way to prevent tinnitus is to minimize hearing loss. The American Tinnitus Association recommends limiting exposure to very loud noises, keeping the volume down on headphones or earbuds, and using hearing protection such as earplugs in noisy environments. It’s also helpful to take a break from noisy environments to let your ears rest.
If you do develop tinnitus, check with your doctor to make sure it’s not a sign of another medical condition. In most cases, no serious cause is found. And while there is no cure for most tinnitus, many people discover that it doesn’t greatly impact their daily lives. With hearing protection, treatment for hearing loss, and strategies that reduce stress and improve coping, it is possible to continue doing the activities you enjoy.
