tinnitus

File:Tinnitus Simulation.mp3

Tinnitus is often described as ringing, but it may also sound like clicking, buzzing, hissing, or roaring. It may be soft or loud, low- or high-pitched, and may seem to come from either one or both ears, or from the head itself. It may be intermittent or continuous. In some individuals, its intensity may be changed by shoulder, neck, head, tongue, jaw, or eye movements.{{cite journal |last1=Simmons |first1=R |last2=Dambra |first2=C |last3=Lobarinas |first3=E |last4=Stocking |first4=C |last5=Salvi |first5=R |title=Head, Neck, and Eye Movements That Modulate Tinnitus |pmid=19183705 |journal=Seminars in Hearing |pmc=2633109 |doi=10.1055/s-0028-1095895 |volume=29 |issue=4 |year=2008 |pages=361–370}}

Due to variations in study designs, data on the course of tinnitus shows few consistent results. Generally, prevalence increases with age in adults, and the ratings of annoyance increase with persistence at follow up.{{Cite book |author1=Baguley D |author2=Andersson g |author3=McFerran D |author4=McKenna L |title=Tinnitus: A Multidisciplinary Approach |edition= 2nd |publisher=Blackwell Publishing Ltd. |pages=16–17 |year=2013| isbn=978-1-118-48870-6 }}{{cite journal | vauthors = Gopinath B, McMahon CM, Rochtchina E, Karpa MJ, Mitchell P | title = Incidence, persistence, and progression of tinnitus symptoms in older adults: the Blue Mountains Hearing Study | journal = Ear and Hearing | volume = 31 | issue = 3 | pages = 407–412 | year = 2010 | pmid = 20124901 | doi = 10.1097/AUD.0b013e3181cdb2a2 | s2cid = 23601127 }}{{cite journal | vauthors = Shargorodsky J, Curhan GC, Farwell WR | title = Prevalence and characteristics of tinnitus among US adults | journal = The American Journal of Medicine | volume = 123 | issue = 8 | pages = 711–718 | year = 2010 | pmid = 20670725 | doi = 10.1016/j.amjmed.2010.02.015 }}

Although it is an annoying condition to which most people adapt, persistent tinnitus may cause anxiety and depression in some people.{{cite journal | vauthors = Andersson G | title = Psychological aspects of tinnitus and the application of cognitive-behavioral therapy | journal = Clinical Psychology Review | volume = 22 | issue = 7 | pages = 977–990 | year = 2002 | pmid = 12238249 | doi = 10.1016/s0272-7358(01)00124-6}}{{cite journal | vauthors = Reiss M, Reiss G | title = Some psychological aspects of tinnitus | journal = Perceptual and Motor Skills | volume = 88 | issue = 3 Pt 1 | pages = 790–792 | year = 1999 | pmid = 10407886 | doi = 10.2466/pms.1999.88.3.790 | s2cid = 41610361 }} Tinnitus annoyance is more strongly associated with the psychological condition of the person than the loudness or frequency range of the perceived sound.{{Cite journal |author=Baguley DM |title=Mechanisms of tinnitus |journal=British Medical Bulletin |volume=63 |pages=195–212 |year=2002 |pmid=12324394 |doi=10.1093/bmb/63.1.195|doi-access=free }}{{cite journal |last1=Henry |first1=James A. |last2=Meikle |first2=Mary B. |title=Pulsed versus Continuous Tones for Evaluating the Loudness of Tinnitus |journal=Journal of the American Academy of Audiology |date=May 1999 |volume=10 |issue=5 |pages=261–272 |doi=10.1055/s-0042-1748497 |pmid=10331618 |s2cid=18675226 }} Psychological problems such as depression, anxiety, sleep disturbances, and concentration difficulties are common in those with strongly annoying tinnitus.{{Cite book |vauthors=Davies A, Rafie EA |chapter=Epidemiology of Tinnitus |editor=Tyler, RS |title=Tinnitus Handbook |location=San Diego |publisher=Singular |pages=1–23 |year=2000 |oclc=42771695}} 45% of people with tinnitus have an anxiety disorder at some time in their lives.{{cite journal |vauthors=Pattyn T, Van Den Eede F, Vanneste S, Cassiers L, Veltman DJ, Van De Heyning P, Sabbe BC |title=Tinnitus and anxiety disorders: A review |journal=Hearing Research |volume= 333 |pages= 255–265 |year=2015 |pmid=26342399 |doi=10.1016/j.heares.2015.08.014|hdl=10067/1273140151162165141 |s2cid=205103174 |url=https://repository.uantwerpen.be/docman/irua/b0770b/10705.pdf |hdl-access=free }}

Psychological research has focused on the tinnitus distress reaction to account for differences in tinnitus severity.{{Cite journal |vauthors=Henry JA, Dennis KC, Schechter MA |title=General review of tinnitus: Prevalence, mechanisms, effects, and management |journal=Journal of Speech, Language, and Hearing Research |volume=48 |pages=1204–1235 |year=2005 |pmid=16411806 |doi=10.1044/1092-4388(2005/084) |issue=5}}{{Cite book |vauthors=Henry JA, Wilson P |contribution=Psychological management of tinnitus |editor=R.S. Tyler |title=Tinnitus Handbook |location=San Diego |publisher=Singular |pages=263–279 |year=2000 |oclc=42771695}}{{Cite journal |vauthors=Andersson G, Westin V |title=Understanding tinnitus distress: Introducing the concepts of moderators and mediators |journal=International Journal of Audiology |volume=47 |issue=Suppl. 2 |pages=S106–111 |year=2008 |pmid=19012118 |doi=10.1080/14992020802301670|s2cid=19389202 }}{{Cite journal |vauthors=Weise C, Hesser H, Andersson G, Nyenhuis N, Zastrutzki S, Kröner-Herwig B, Jäger B |title=The role of catastrophizing in recent onset tinnitus: its nature and association with tinnitus distress and medical utilization |journal=International Journal of Audiology |volume=52 |pages=177–188 |year=2013 |pmid=23301660 |doi=10.3109/14992027.2012.752111 |issue=3|s2cid=24297897 }} The research indicates that conditioning at the initial perception of tinnitus linked it with negative emotions, such as fear and anxiety.{{Cite book |last1=Jastreboff |first1=PJ |last2=Hazell |first2=JWP |title=Tinnitus Retraining Therapy: Implementing the neurophysiological model |year=2004 |publisher=Cambridge University Press |location=Cambridge |oclc=237191959 }}

Commonly tinnitus is classified into "subjective and objective tinnitus". Tinnitus is usually subjective, meaning that the sounds the person hears are not detectable by means currently available to physicians and hearing technicians. Subjective tinnitus has also been called "tinnitus aurium", "non-auditory", or "non-vibratory" tinnitus. In rare cases, tinnitus can be heard by someone else using a stethoscope. Even more rarely, in some cases it can be measured as a spontaneous otoacoustic emission (SOAE) in the ear canal. This is classified as objective tinnitus, also called "pseudo-tinnitus" or "vibratory" tinnitus.

Subjective tinnitus is the most frequent type. It can have many causes, but most commonly it results from hearing loss. When it is caused by disorders of the inner ear or auditory nerve, it can be called "otic" (from the Greek word for ear).{{cite journal|last1=Robert Aaron Levine|title=Somatic (craniocervical) tinnitus and the dorsal cochlear nucleus hypothesis|journal=American Journal of Otolaryngology|date=1999|doi=10.1016/S0196-0709(99)90074-1|pmid=10609479|volume=20|issue=6|pages=351–362|citeseerx=10.1.1.22.2488}} These otological or neurological disorders include those triggered by infections, drugs, or trauma.{{cite journal |author=Chan Y |title=Tinnitus: etiology, classification, characteristics, and treatment |journal=Discovery Medicine |volume=8 |issue=42 |year=2009 |pages=133–136 |url=http://www.discoverymedicine.com/Yvonne-Chan/2009/10/10/tinnitus-etiology-classification-characteristics-and-treatment/ |pmid=19833060}} A cause is traumatic noise exposure that damages hair cells in the inner ear.{{cite journal | last1=Vijayakumar | first1=Karthikeyan A | last2=Cho | first2=Gwang-Won | last3=Maharajan | first3=Nagarajan | last4=Jang | first4=Chul Ho | title=A Review on Peripheral Tinnitus, Causes, and Treatments from the Perspective of Autophagy | journal=Experimental Neurobiology | volume=31 | issue=4 | date=2022-08-31 | issn=1226-2560 | pmid=36050223 | pmc=9471415 | doi=10.5607/en22002 | doi-access=free | pages=232–242}} Some evidence suggests that long-term exposure to noise pollution from heavy traffic may increase the risk of developing tinnitus.{{cite journal | first=Marianne |last=Lie Becker|display-authors=etal |title= Transportation Noise and Risk of Tinnitus: A Nationwide Cohort Study from Denmark|journal=Environmental Health Perspectives |date=2023 |volume=131 |issue=2 |page=27001 |doi=10.1289/EHP11248|pmid=36722980 |pmc=9891135 |bibcode=2023EnvHP.131b7001C }}

When there does not seem to be a connection with a disorder of the inner ear or auditory nerve, tinnitus can be called "non-otic". In 30% of cases, tinnitus is influenced by the somatosensory system; for instance, people can increase or decrease their tinnitus by moving their face, head, jaw, or neck.{{cite journal|last1=Barbara Rubinstein |display-authors=etal |title=Prevalence of Signs and Symptoms of Craniomandibular Disorders in Tinnitus Patients|journal=Journal of Craniomandibular Disorders|date=1990|volume=4|issue=3|pages=186–192|pmid=2098394}} This type is called somatic or craniocervical tinnitus, since it is only head or neck movements that have an effect.

Some tinnitus may be caused by neuroplastic changes in the central auditory pathway. In this theory, the disturbance of sensory input caused by hearing loss results in such changes as a homeostatic response of neurons in the central auditory system, causing tinnitus.{{cite journal |last1=Schaette |first1=R |last2=McAlpine |first2=D |title=Tinnitus with a Normal Audiogram: Physiological Evidence for Hidden Hearing Loss and Computational Model |journal=The Journal of Neuroscience |date=21 September 2011 |volume=31 |issue=38 |pages=13452–13457 |doi=10.1523/JNEUROSCI.2156-11.2011 |pmid=21940438|pmc=6623281 }} When some frequencies of sound are lost to hearing loss, the auditory system compensates by amplifying those frequencies, eventually producing sound sensations at those frequencies constantly even when there is no corresponding external sound.

The most common cause of tinnitus is hearing loss. Hearing loss may have many different causes, but among those with tinnitus, the major cause is cochlear injury.{{cite journal |last1=Schecklmann |first1=Martin |last2=Vielsmeier |first2=Veronika |last3=Steffens |first3=Thomas |last4=Landgrebe |first4=Michael |last5=Langguth |first5=Berthold |last6=Kleinjung |first6=Tobias |last7=Andersson |first7=Gerhard |title=Relationship between Audiometric Slope and Tinnitus Pitch in Tinnitus Patients: Insights into the Mechanisms of Tinnitus Generation |journal=PLOS ONE |date=18 April 2012 |volume=7 |issue=4 |page=e34878 |doi=10.1371/journal.pone.0034878 |pmid=22529949 |pmc=3329543|bibcode=2012PLoSO...734878S |doi-access=free }}

In many cases no underlying cause is identified.{{cite journal |last1=Yew |first1=KS |title=Diagnostic approach to patients with tinnitus. |journal=American Family Physician |date=15 January 2014 |volume=89 |issue=2 |pages=106–113 |pmid=24444578}}

Ototoxic drugs also may cause subjective tinnitus, as they may cause hearing loss, or increase the damage done by exposure to loud noise.{{cite journal |vauthors=Theodoroff SM, Konrad-Martin D |title=Noise: Acoustic Trauma and Tinnitus, the US Military Experience |journal=Otolaryngologic Clinics of North America |volume=53 |issue=4 |pages=543–553 |date=August 2020 |pmid=32334867 |pmc=9015011 |doi=10.1016/j.otc.2020.03.004 |url=}} This damage may occur even at doses not considered ototoxic.{{cite book |doi=10.1002/9780470720677.ch9 |chapter=Ototoxic Drugs and Noise |title=Ciba Foundation Symposium 85 – Tinnitus |series=Novartis Foundation Symposia |year=2008 |last1=Don Brown |first1=R. |last2=Penny |first2=Joe E. |last3=Henley |first3=Charles M. |last4=Hodges |first4=Keri B. |last5=Kupetz |first5=Suzyjo A. |last6=Glenn |first6=David W. |last7=Jobe |first7=Phillip C. |volume=85 |pages=151–171 |pmid=7035098 |isbn=978-0-470-72067-7 }} More than 260 medications have been reported to cause tinnitus as a side effect.{{cite web |author=Stas Bekman |url=http://stason.org/TULARC/health/body/tinnitus-ringing-ears/6-What-are-some-ototoxic-drugs.html |title=6) What are some ototoxic drugs? |publisher=Stason.org |access-date=26 October 2012 |url-status=live |archive-url=https://web.archive.org/web/20121019184052/http://stason.org/TULARC/health/body/tinnitus-ringing-ears/6-What-are-some-ototoxic-drugs.html |archive-date=19 October 2012 }}

Tinnitus can also occur from the discontinuation of therapeutic doses of benzodiazepines. It can sometimes be a protracted symptom of benzodiazepine withdrawal and may persist for many months.{{Cite book |last1=Riba |first1=Michelle B |last2=Ravindranath |first2=Divy |title=Clinical manual of emergency psychiatry |url=https://books.google.com/books?id=l8veL1bDoF8C&pg=PA197 |year=2010 |publisher=American Psychiatric Publishing Inc |location=Washington, DC |isbn=978-1-58562-295-5 |page=197}}{{Cite book |last1=Delanty |first1=Norman |title=Seizures: medical causes and management |url=https://books.google.com/books?id=u2B3SdfE8-gC&pg=RA1-PA187 |year=2001 |publisher=Humana Press |location=Totowa, NJ |isbn=978-0-89603-827-1 |page=187 }}{{Dead link|date=August 2023 |bot=InternetArchiveBot |fix-attempted=yes }} Medications such as bupropion may also cause tinnitus.{{cite journal | vauthors = Fornaro M, Martino M | title = Tinnitus psychopharmacology: A comprehensive review of its pathomechanisms and management | journal = Neuropsychiatric Disease and Treatment | volume = 6 | pages = 209–218 | year = 2010 | pmid = 20628627 | pmc = 2898164 | doi = 10.2147/ndt.s10361 | doi-access = free }}

Factors associated with tinnitus include:{{Cite journal |vauthors=Crummer RW, Hassan GA |title=Diagnostic approach to tinnitus |journal=American Family Physician |volume=69 |issue=1 |pages=120–106 |year=2004 |pmid=14727828}}

• Ear problems and hearing loss:
• Conductive hearing loss
• Acoustic shock
• Loud noise or music{{Cite journal |vauthors=Passchier-Vermeer W, Passchier WF |title=Noise exposure and public health |journal=Environmental Health Perspectives |volume=108 |issue=Suppl 1 |pages=123–131 |year=2000 |pmid=10698728 |doi=10.1289/ehp.00108s1123 |pmc=1637786 |jstor=3454637|bibcode=2000EnvHP.108S.123P }}
• Middle ear effusion
• Otitis
• Otosclerosis
• Eustachian tube dysfunction
• Sensorineural hearing loss
• Excessive or loud noise; e.g. acoustic trauma
• Presbycusis (age-associated hearing loss)
• Ménière's disease
• Endolymphatic hydrops
• Superior canal dehiscence
• Acoustic neuroma
• Mercury or lead poisoning
• Ototoxic medications
• Neurologic disorders:
• Chiari malformation
• Multiple sclerosis
• Head injury
• Giant cell arteritis
• Temporomandibular joint dysfunction
• Metabolic disorders:
• Vitamin B₁₂ deficiency{{cite book |editor-last1=Zempleni |editor-first1=Janos |editor2-last=Suttie |editor2-first=John W |editor3-last=Gregory|editor3-first=Jesse F |editor4-last=Stover |editor4-first=Patrick J |title=Handbook of vitamins |date=2014 |publisher=CRC Press |location=Hoboken |isbn=978-1-4665-1557-4 |page=477 |edition= 5th|url=https://books.google.com/books?id=IEHSBQAAQBAJ&pg=PA477 |url-status=live |archive-url=https://web.archive.org/web/20160817155016/https://books.google.it/books?id=IEHSBQAAQBAJ&pg=PA477 |archive-date=17 August 2016 }}
• Iron deficiency anemia
• Psychiatric disorders
• Depression
• Anxiety disorders
• Other factors:
• Vasculitis
• Some psychedelic drugs can produce temporary tinnitus-like symptoms as a side effect:
• 5-MeO-DET{{cite book |last1=Shulgin |first1=Alexander |author-link1=Alexander Shulgin |last2=Shulgin |first2=Ann |author-link2=Ann Shulgin |title=TiHKAL: the continuation |url=http://www.erowid.org/library/books_online/tihkal/tihkal.shtml |access-date=27 October 2012 |year=1997 |publisher=Transform Press |location=Berkeley, CA |isbn=978-0-9630096-9-2 |oclc=38503252 |chapter=#36. 5-MEO-DET |chapter-url=http://www.erowid.org/library/books_online/tihkal/tihkal36.shtml |url-status=live |archive-url=https://web.archive.org/web/20121031144030/http://www.erowid.org/library/books_online/tihkal/tihkal.shtml |archive-date=31 October 2012 }}
• Diisopropyltryptamine (DiPT){{cite web |url=https://www.erowid.org/experiences/exp.php?ID=26540 |title=Erowid Experience Vaults: DiPT – More Tripping & Revelations – 26540 |url-status=live |archive-url=https://web.archive.org/web/20141102115409/https://www.erowid.org/experiences/exp.php?ID=26540 |archive-date=2 November 2014 }}
• Benzodiazepine withdrawal
• Intracranial hyper or hypotension caused by, for example, encephalitis or a cerebrospinal fluid leak

A specific type of tinnitus, objective tinnitus, is characterized by hearing the sounds of one's own muscle contractions or pulse, typically a result of sounds that have been created by the movement of jaw muscles or sounds related to blood flow in the neck or face.{{cite web |date=18 August 2021 |title=MEM, Tinnitus and Ear Drum Spasms |url=https://tinnitusandyou.com/mem-tinnitus-and-ear-drum-spasms/ |url-status=live |archive-url=https://web.archive.org/web/20210820064413/https://tinnitusandyou.com/mem-tinnitus-and-ear-drum-spasms/ |archive-date=20 August 2021 |access-date=24 May 2022 |website=Tinnitus And You}} It is sometimes caused by an involuntary twitching of a muscle or a group of muscles (myoclonus) or by a vascular condition. In some cases, tinnitus is generated by muscle spasms around the middle ear.

Spontaneous otoacoustic emissions (SOAEs)—faint high-frequency tones that are produced in the inner ear and can be measured in the ear canal with a sensitive microphone—may also cause tinnitus. About 8% of those with SOAEs and tinnitus have SOAE-linked tinnitus,{{Request quotation | date = October 2018}} while the percentage of all cases of tinnitus caused by SOAEs is estimated at 4%.{{cite journal |last1=Henry |first1=James A. |last2=Dennis |first2=Kyle C. |last3=Schechter |first3=Martin A. |title=General Review of Tinnitus: Prevalence, Mechanisms, Effects, and Management |journal=Journal of Speech, Language, and Hearing Research |date=October 2005 |volume=48 |issue=5 |pages=1204–1235 |doi=10.1044/1092-4388(2005/084) |pmid=16411806 }}

Children may be subject to pulsatile or continuous tinnitus, involving anomalies and variants of the vascular parts{{cite journal |last1=Kerr |first1=Rhorie |last2=Kang |first2=Elise |last3=Hopkins |first3=Brandon |last4=Anne |first4=Samantha |title=Pediatric tinnitus: Incidence of imaging anomalies and the impact of hearing loss |journal=International Journal of Pediatric Otorhinolaryngology |date=December 2017 |volume=103 |pages=147–149 |doi=10.1016/j.ijporl.2017.10.027 |pmid=29224758 }} affecting the middle/inner ear structures. CT scans may be used to check the integrity of the structures, and MR scans can evaluate nerves and potential masses or malformations. Early diagnosis can prevent long-term impairments to development.{{cite journal |last1=Salman |first1=Rida |last2=Chong |first2=Insun |last3=Amans |first3=Matthew |last4=Hui |first4=Ferdinand |last5=Desai |first5=Nilesh |last6=Huisman |first6=Thierry A. G. M. |last7=Tran |first7=Brandon |title=Pediatric tinnitus: The role of neuroimaging |journal=Journal of Neuroimaging |date=May 2022 |volume=32 |issue=3 |pages=400–411 |doi=10.1111/jon.12986 |pmid=35307901 |s2cid=247584230 }}

Some people experience a sound that beats in time with their pulse, known as pulsatile tinnitus or vascular tinnitus.{{cite web |last1=McFerran |first1=Don |last2=Magdalena |first2=Sereda |title=Pulsatile tinnitus |url=https://www.actiononhearingloss.org.uk/-/media/ahl/documents/publications/factsheets-and-leaflets/factsheets/tinnitus/factsheet-pulsatile-tinnitus.pdf |website=Action on Hearing Loss |publisher=Royal National Institute for Deaf People (RNID) |access-date=22 July 2018 |archive-date=22 July 2018 |archive-url=https://web.archive.org/web/20180722095632/https://www.actiononhearingloss.org.uk/-/media/ahl/documents/publications/factsheets-and-leaflets/factsheets/tinnitus/factsheet-pulsatile-tinnitus.pdf |url-status=dead }} Pulsatile tinnitus is usually objective in nature, resulting from altered blood flow or increased blood turbulence near the ear, such as from atherosclerosis or venous hum,{{Cite journal |author=Chandler JR |title=Diagnosis and cure of venous hum tinnitus |journal=The Laryngoscope |volume=93 |issue=7 |pages=892–895 |year=1983 |pmid=6865626 |doi=10.1288/00005537-198307000-00009|s2cid=33725476 }} but it can also arise as a subjective phenomenon from an increased awareness of blood flow in the ear.

The differential diagnosis for pulsatile tinnitus is wide and includes vascular etiologies, tumors, disorders of the middle ear or inner ear, and other intracranial pathologies.{{Cite journal |last1=Pegge |first1=Sjoert A. H. |last2=Steens |first2=Stefan C. A. |last3=Kunst |first3=Henricus P. M. |last4=Meijer |first4=Frederick J. A. |date=2017 |title=Pulsatile Tinnitus: Differential Diagnosis and Radiological Work-Up |journal=Current Radiology Reports |volume=5 |issue=1 |pages=5 |doi=10.1007/s40134-017-0199-7 |issn=2167-4825 |pmc=5263210 |pmid=28203490}} Vascular causes of pulsatile tinnitus include venous causes (e.g., high riding or dehiscent jugular bulb, sigmoid sinus diverticulum), arterial causes (e.g., cervical atherosclerosis, potentially life-threatening conditions such as carotid artery aneurysm{{Cite journal |vauthors=Moonis G, Hwang CJ, Ahmed T, Weigele JB, Hurst RW |title=Otologic manifestations of petrous carotid aneurysms |journal=American Journal of Neuroradiology |volume=26 |issue=6 |pages=1324–1327 |year=2005 |pmid=15956490 |pmc=8149044 }} or carotid artery dissection), or dural arteriovenous fistula or arteriovenous malformations.{{cite journal |last1=Selim |first1=Magdy |last2=Caplan |first2=Louis R. |title=Carotid artery dissection |journal=Current Treatment Options in Cardiovascular Medicine |date=June 2004 |volume=6 |issue=3 |pages=249–253 |doi=10.1007/s11936-996-0020-z |pmid=15096317 |s2cid=7503852 }}

Pulsatile tinnitus may also indicate vasculitis, or more specifically, giant cell arteritis. Pulsatile tinnitus may also be caused by tumors such as paragangliomas (e.g., glomus tympanicum, glomus jugulare) or hemangiomas (e.g., facial nerve or cavernous). Middle ear causes of pulsatile tinnitus include patulous eustachian tube, otosclerosis, or middle ear myoclonus (e.g., stapedial or tensor tympani myoclonus). The most common inner ear cause of pulsatile tinnitus is superior semicircular canal dehiscence.{{Cite journal |last1=Ward |first1=Bryan K. |last2=Carey |first2=John P. |last3=Minor |first3=Lloyd B. |date=2017-04-28 |title=Superior Canal Dehiscence Syndrome: Lessons from the First 20 Years |journal=Frontiers in Neurology |volume=8 |pages=177 |doi=10.3389/fneur.2017.00177 |issn=1664-2295 |pmc=5408023 |pmid=28503164 |doi-access=free }} Pulsatile tinnitus may also indicate idiopathic intracranial hypertension.{{cite journal |last1=Sismanis |first1=Aristides |last2=Butts |first2=Frank M. |last3=Hughes |first3=Gordon B. |title=Objective Tinnitus in Benign Intracranial Hypertension: An Update |journal=The Laryngoscope |date=January 1990 |volume=100 |issue=1 |pages=33–36 |doi=10.1288/00005537-199001000-00008 |pmid=2293699 |s2cid=20886638 }} Pulsatile tinnitus can be a symptom of intracranial vascular abnormalities and should be evaluated for irregular noises of blood flow (bruits).{{cite encyclopedia | vauthors = Diamond BJ, Mosley JE | title = Arteriovenous Malformation (AVM) | year = 2011 | encyclopedia = Encyclopedia of Clinical Neuropsychology | veditors = Kreutzer JS, DeLuca J, Caplan B | publisher = Springer | isbn = 978-0-387-79947-6 | doi = 10.1007/978-0-387-79948-3 | pages = 249–252 | doi-access = free }}

Tinnitus may be caused by increased neural activity in the auditory brainstem, where the brain processes sounds, causing some auditory nerve cells to become overexcited. The basis of this theory is that many with tinnitus also have hearing loss.{{cite journal |pmid=14763234 |last1=Nicolas-Puel |first1=C |last2=Faulconbridge |first2=RL |last3=Guitton |first3=M |last4=Puel |first4=JL |last5=Mondain |first5=M |last6=Uziel |first6=A |title=Characteristics of tinnitus and etiology of associated hearing loss: a study of 123 patients |journal=The International Tinnitus Journal |volume=8 |issue=1 |year=2002 |pages=37–44}}

Three reviews in 2016 emphasized the large range and possible combinations of pathologies involved in tinnitus, which result in a great variety of symptoms and specifically adapted therapies.{{cite journal | vauthors = Møller AR | title = Sensorineural Tinnitus: Its Pathology and Probable Therapies | journal = International Journal of Otolaryngology | volume = 2016 | pages = 1–13 | year = 2016 | pmid = 26977153 | pmc = 4761664 | doi = 10.1155/2016/2830157 | doi-access = free }}{{cite journal | vauthors = Sedley W, Friston KJ, Gander PE, Kumar S, Griffiths TD | title = An Integrative Tinnitus Model Based on Sensory Precision | journal = Trends in Neurosciences | volume = 39 | issue = 12 | pages = 799–812 | year = 2016 | pmid = 27871729 | pmc = 5152595 | doi = 10.1016/j.tins.2016.10.004 }}{{cite journal | vauthors = Shore SE, Roberts LE, Langguth B | title = Maladaptive plasticity in tinnitus – triggers, mechanisms and treatment | journal = Nature Reviews Neurology | volume = 12 | issue = 3 | pages = 150–160 | year = 2016 | pmid = 26868680 | pmc = 4895692 | doi = 10.1038/nrneurol.2016.12 }}{{cite journal |last1=Park |first1=Jung Mee |last2=Kim |first2=Woo Jin |last3=Han |first3=Jae Sang |last4=Park |first4=So Young |last5=Park |first5=Shi Nae |title=Management of palatal myoclonic tinnitus based on clinical characteristics: a large case series study |journal=Acta Oto-Laryngologica |date=2 July 2020 |volume=140 |issue=7 |pages=553–557 |doi=10.1080/00016489.2020.1749724 |pmid=32406274 |s2cid=218635840 }}

The diagnostic approach is based on a history of the condition and an examination of the head, neck, and neurological system. Typically an audiogram is done, and occasionally medical imaging or electronystagmography. Treatable conditions may include middle ear infection, acoustic neuroma,

concussion, and otosclerosis.{{cite journal |last1=Crummer |display-authors=etal |first1=RW |title=Diagnostic Approach to Tinnitus |journal=American Family Physician |date=2004 |volume=69 |issue=1 |pages=120–126|pmid=14727828 }}

Evaluation of tinnitus can include a hearing test (audiogram), measurement of acoustic parameters of the tinnitus like pitch and loudness, and psychological assessment of comorbid conditions like depression, anxiety, and stress that are associated with severity of the tinnitus.{{citation needed|date=December 2020}}

One definition of tinnitus, in contrast to normal ear noise experience, is that tinnitus lasts five minutes at least twice a week.{{cite journal |last=Davis |first=A |year=1989 |title=The prevalence of hearing impairment and reported hearing disability among adults in Great Britain |journal=International Journal of Epidemiology |volume=18 |issue= 4 |pages=911–917 |doi=10.1093/ije/18.4.911|pmid=2621028 }} However, people with tinnitus often experience the noise more frequently than this. Tinnitus can be present constantly or intermittently. Some people with constant tinnitus might not be aware of it all the time, but only, for example, during the night when there is less environmental noise to mask it. Chronic tinnitus can be defined as tinnitus with a duration of six months or more.{{cite journal | last=Henry | first=James A. | title="Measurement" of Tinnitus | journal=Otology & Neurotology | volume=37 | issue=8 | date=2016 | issn=1531-7129 | doi=10.1097/MAO.0000000000001070 | pages=e276–e285| pmid=27518136 }}

Since most people with tinnitus also have hearing loss, a pure tone hearing test resulting in an audiogram may help diagnose a cause. An audiogram may also facilitate fitting of a hearing aid in those cases where hearing loss is significant. The pitch of tinnitus is often in the range of the hearing loss.

Acoustic qualification of tinnitus includes measurement of several acoustic parameters like frequency in cases of monotone tinnitus or {{Clarify | text = frequency range and bandwidth in cases of narrow band noise tinnitus| date = December 2024 | reason = What is bandwidth, in addition to frequency range?}}, loudness in dB above hearing threshold at the indicated frequency, {{Clarify | text = mixing-point| date = December 2024}}, and minimum masking level.{{cite journal |last1=Henry |first1=JA |last2=Meikle |first2=MB |title=Psychoacoustic measures of tinnitus. |journal=Journal of the American Academy of Audiology |date=March 2000 |volume=11 |issue=3 |pages=138–155 |doi=10.1055/s-0042-1748040 |pmid=10755810 |s2cid=34933069 }} In most cases, tinnitus pitch or frequency range is between 5 kHz and 10 kHz,{{cite journal | vauthors = Vielsmeier V, Lehner A, Strutz J, Steffens T, Kreuzer PM, Schecklmann M, Landgrebe M, Langguth B, Kleinjung T | title = The Relevance of the High Frequency Audiometry in Tinnitus Patients with Normal Hearing in Conventional Pure-Tone Audiometry | journal = BioMed Research International | volume = 2015 | pages = 1–5 | year = 2015 | pmid = 26583098 | pmc = 4637018 | doi = 10.1155/2015/302515 | doi-access = free }} and loudness between 5 and 15 dB above the hearing threshold.{{cite journal | vauthors = Basile CÉ, Fournier P, Hutchins S, Hébert S | title = Psychoacoustic assessment to improve tinnitus diagnosis | journal = PLOS ONE | volume = 8 | issue = 12 | pages = e82995 | year = 2013 | pmid = 24349414 | pmc = 3861445 | doi = 10.1371/journal.pone.0082995 | bibcode = 2013PLoSO...882995B | doi-access = free }}

Another relevant parameter of tinnitus is residual inhibition: the temporary suppression or disappearance of tinnitus following a period of masking. The degree of residual inhibition may indicate how effective tinnitus maskers would be as treatment.{{cite book |doi=10.1016/S0079-6123(07)66047-6 |chapter=Residual inhibition |title=Tinnitus: Pathophysiology and Treatment |series=Progress in Brain Research |year=2007 |last1=Roberts |first1=Larry E. |volume=166 |pages=487–495 |pmid=17956813 |isbn=978-0-444-53167-4 }}{{cite journal | vauthors = Roberts LE, Moffat G, Baumann M, Ward LM, Bosnyak DJ | title = Residual inhibition functions overlap tinnitus spectra and the region of auditory threshold shift | journal = Journal of the Association for Research in Otolaryngology | volume = 9 | issue = 4 | pages = 417–435 | year = 2008 | pmid = 18712566 | pmc = 2580805 | doi = 10.1007/s10162-008-0136-9 }}

An assessment of hyperacusis, a frequent accompaniment of tinnitus,{{cite journal | vauthors = Knipper M, Van Dijk P, Nunes I, Rüttiger L, Zimmermann U | title = Advances in the neurobiology of hearing disorders: recent developments regarding the basis of tinnitus and hyperacusis | journal = Progress in Neurobiology | volume = 111 | pages = 17–33 | year = 2013 | pmid = 24012803 | doi = 10.1016/j.pneurobio.2013.08.002 | doi-access = free }} may also be made.{{cite journal |last1=Tyler |first1=Richard S. |last2=Pienkowski |first2=Martin |last3=Roncancio |first3=Eveling Rojas |last4=Jun |first4=Hyung Jin |last5=Brozoski |first5=Tom |last6=Dauman |first6=Nicolas |last7=Coelho |first7=Claudia Barros |last8=Andersson |first8=Gerhard |last9=Keiner |first9=Andrew J. |last10=Cacace |first10=Anthony T. |last11=Martin |first11=Nora |last12=Moore |first12=Brian C. J. |title=A Review of Hyperacusis and Future Directions: Part I. Definitions and Manifestations |journal=American Journal of Audiology |date=December 2014 |volume=23 |issue=4 |pages=402–419 |doi=10.1044/2014_AJA-14-0010 |pmid=25104073 }} Hyperacusis is related to negative reactions to sound and can take many forms. One parameter that can be measured is Loudness Discomfort Level (LDL) in dB, the subjective level of acute discomfort at specified frequencies over the frequency range of hearing. This defines a dynamic range between the hearing threshold at that frequency and the loudness discomfort level. A compressed dynamic range over a particular frequency range can be associated with hyperacusis. Normal hearing threshold is generally defined as 0–20 decibels (dB). Normal loudness discomfort levels are 85–90+ dB, with some authorities citing 100 dB. A dynamic range of 55 dB or less is indicative of hyperacusis.{{cite journal |last1=Sherlock |first1=LaGuinn P. |last2=Formby |first2=Craig |title=Estimates of Loudness, Loudness Discomfort, and the Auditory Dynamic Range: Normative Estimates, Comparison of Procedures, and Test-Retest Reliability |journal=Journal of the American Academy of Audiology |date=February 2005 |volume=16 |issue=2 |pages=85–100 |doi=10.3766/jaaa.16.2.4 |pmid=15807048 }}{{cite journal |last1=Pienkowski |first1=Martin |last2=Tyler |first2=Richard S. |last3=Roncancio |first3=Eveling Rojas |last4=Jun |first4=Hyung Jin |last5=Brozoski |first5=Tom |last6=Dauman |first6=Nicolas |last7=Coelho |first7=Claudia Barros |last8=Andersson |first8=Gerhard |last9=Keiner |first9=Andrew J. |last10=Cacace |first10=Anthony T. |last11=Martin |first11=Nora |last12=Moore |first12=Brian C. J. |title=A Review of Hyperacusis and Future Directions: Part II. Measurement, Mechanisms, and Treatment |journal=American Journal of Audiology |date=December 2014 |volume=23 |issue=4 |pages=420–436 |doi=10.1044/2014_AJA-13-0037 |pmid=25478787 }}

Tinnitus is often rated on a scale from "slight" to "severe" according to the effects it has, such as interference with sleep, quiet activities, and normal daily activities.{{cite journal |last1=McCombe |first1=A. |last2=Baguley |first2=D. |last3=Coles |first3=R. |last4=McKenna |first4=L. |last5=McKinney |first5=C. |last6=Windle-Taylor |first6=P. |title=Guidelines for the grading of tinnitus severity: the results of a working group commissioned by the British Association of Otolaryngologists, Head and Neck Surgeons, 1999 |journal=Clinical Otolaryngology and Allied Sciences |date=October 2001 |volume=26 |issue=5 |pages=388–393 |doi=10.1046/j.1365-2273.2001.00490.x |pmid=11678946 }}

Assessment of psychological processes related to tinnitus involves measurement of tinnitus severity and distress, as measured subjectively by validated self-report tinnitus questionnaires. Such questionnaires measure the degree of psychological distress and handicap associated with tinnitus, including effects on hearing, lifestyle, health, and emotional functioning.{{cite book |doi=10.1016/S0079-6123(07)66050-6 |chapter=Consensus for tinnitus patient assessment and treatment outcome measurement: Tinnitus Research Initiative meeting, Regensburg, July 2006 |title=Tinnitus: Pathophysiology and Treatment |series=Progress in Brain Research |year=2007 |last1=Langguth |first1=B. |last2=Goodey |first2=R. |last3=Azevedo |first3=A. |last4=Bjorne |first4=A. |last5=Cacace |first5=A. |last6=Crocetti |first6=A. |last7=Del Bo |first7=L. |last8=De Ridder |first8=D. |last9=Diges |first9=I. |last10=Elbert |first10=T. |last11=Flor |first11=H. |last12=Herraiz |first12=C. |last13=Ganz Sanchez |first13=T. |last14=Eichhammer |first14=P. |last15=Figueiredo |first15=R. |last16=Hajak |first16=G. |last17=Kleinjung |first17=T. |last18=Landgrebe |first18=M. |last19=Londero |first19=A. |last20=Lainez |first20=M.J.A. |last21=Mazzoli |first21=M. |last22=Meikle |first22=M.B. |last23=Melcher |first23=J. |last24=Rauschecker |first24=J.P. |last25=Sand |first25=P.G. |last26=Struve |first26=M. |last27=Van De Heyning |first27=P. |last28=Van Dijk |first28=P. |last29=Vergara |first29=R. |volume=166 |pages=525–536 |pmid=17956816 |pmc=4283806 |isbn=978-0-444-53167-4 }}{{cite book |doi=10.1016/S0079-6123(07)66049-X |chapter=Assessment of tinnitus: Measurement of treatment outcomes |title=Tinnitus: Pathophysiology and Treatment |series=Progress in Brain Research |year=2007 |last1=Meikle |first1=M.B. |last2=Stewart |first2=B.J. |last3=Griest |first3=S.E. |last4=Martin |first4=W.H. |last5=Henry |first5=J.A. |last6=Abrams |first6=H.B. |last7=McArdle |first7=R. |last8=Newman |first8=C.W. |last9=Sandridge |first9=S.A. |volume=166 |pages=511–521 |pmid=17956815 |isbn=978-0-444-53167-4 }}{{cite journal |last1=Meikle |first1=Mary B. |last2=Henry |first2=James A. |last3=Griest |first3=Susan E. |last4=Stewart |first4=Barbara J. |last5=Abrams |first5=Harvey B. |last6=McArdle |first6=Rachel |last7=Myers |first7=Paula J. |last8=Newman |first8=Craig W. |last9=Sandridge |first9=Sharon |last10=Turk |first10=Dennis C. |last11=Folmer |first11=Robert L. |last12=Frederick |first12=Eric J. |last13=House |first13=John W. |last14=Jacobson |first14=Gary P. |last15=Kinney |first15=Sam E. |last16=Martin |first16=William H. |last17=Nagler |first17=Stephen M. |last18=Reich |first18=Gloria E. |last19=Searchfield |first19=Grant |last20=Sweetow |first20=Robert |last21=Vernon |first21=Jack A. |title=The Tinnitus Functional Index: Development of a New Clinical Measure for Chronic, Intrusive Tinnitus |journal=Ear & Hearing |date=March 2012 |volume=33 |issue=2 |pages=153–176 |doi=10.1097/AUD.0b013e31822f67c0 |pmid=22156949 |s2cid=587811 }} A broader assessment of general functioning, such as levels of anxiety, depression, stress, life stressors, and sleep difficulties, is also important in the assessment of tinnitus due to higher risk of negative well-being across these areas, which may be affected by or exacerbate the tinnitus symptoms.{{Cite book |last1=Henry |first1=J. L. |last2=Wilson |first2=PH |title= The Psychological Management of Chronic Tinnitus: A Cognitive Behavioural Approach |publisher=Allyn and Bacon |year=2000}}

Current assessment measures aim to identify levels of distress and interference, coping responses, and perceptions of tinnitus to inform treatment and monitor progress. However, wide variability, inconsistencies, and lack of consensus regarding assessment methodology are evidenced in the literature, limiting comparison of treatment effectiveness.{{Cite journal |vauthors=Landgrebe M, Azevedo A, Baguley D, Bauer C, Cacace A, Coelho C, etal |title=Methodological aspects of clinical trials in tinnitus: A proposal for international standard |journal=Journal of Psychosomatic Research |volume=73 |pages=112–121 |year=2012 |pmid=22789414 |doi=10.1016/j.jpsychores.2012.05.002 |issue=2 |pmc=3897200}} Developed to guide diagnosis or classify severity, most tinnitus questionnaires have been shown to be treatment-sensitive outcome measures.{{cite journal |last1=Martinez-Devesa |first1=Pablo |last2=Perera |first2=Rafael |last3=Theodoulou |first3=Megan |last4=Waddell |first4=Angus |title=Cognitive behavioural therapy for tinnitus |journal=Cochrane Database of Systematic Reviews |date=8 September 2010 |issue=9 |pages=CD005233 |doi=10.1002/14651858.CD005233.pub3 |pmid=20824844 | url = https://www.hopefortinnitus.com/storage/app/media/forms/cochrane-review-of-cbt.pdf | archive-url = https://archive.today/20241211090451/https://www.hopefortinnitus.com/storage/app/media/forms/cochrane-review-of-cbt.pdf | archive-date = 2024-12-11 | url-status = live}}{{Request quotation|date=December 2024|reason = Not obvious what statements are used to support this sentence.}}

If examination reveals a bruit (sound due to turbulent blood flow), imaging studies such as transcranial doppler (TCD) or magnetic resonance angiography (MRA) should be performed.{{cite journal | vauthors = Pegge S, Steens S, Kunst H, Meijer F | title = Pulsatile Tinnitus: Differential Diagnosis and Radiological Work-Up | journal = Current Radiology Reports | volume = 5 | issue = 1 | pages = 5 | year = 2017 | pmid = 28203490 | pmc = 5263210 | doi = 10.1007/s40134-017-0199-7 }}{{cite journal | vauthors = Hofmann E, Behr R, Neumann-Haefelin T, Schwager K | title = Pulsatile tinnitus: imaging and differential diagnosis | journal = Deutsches Ärzteblatt International | volume = 110 | issue = 26 | pages = 451–458 | year = 2013 | pmid = 23885280 | pmc = 3719451 | doi = 10.3238/arztebl.2013.0451 }}{{cite journal |last1=Sismanis |first1=Aristides |title=Pulsatile tinnitus: contemporary assessment and management |journal=Current Opinion in Otolaryngology & Head and Neck Surgery |date=October 2011 |volume=19 |issue=5 |pages=348–357 |doi=10.1097/MOO.0b013e3283493fd8 |pmid=22552697 |s2cid=22964919 }}

Other potential sources of the sounds normally associated with tinnitus should be ruled out. For instance, two recognized sources of high-pitched sounds might be electromagnetic fields common in modern wiring and various sound signal transmissions. A common and often misdiagnosed condition that mimics tinnitus is radio frequency (RF) hearing, in which subjects hear objectively audible high-pitched transmission frequencies that sound similar to tinnitus.{{cite journal |last=Elder |first=JA |author2=Chou, CK |title=Auditory response to pulsed radiofrequency energy |journal=Bioelectromagnetics |year=2003 |volume=6 |pages=S162–173 |pmid=14628312 |doi=10.1002/bem.10163|s2cid=9813447 |doi-access=free }}{{cite journal | vauthors = Lin JC, Wang Z | title = Hearing of microwave pulses by humans and animals: effects, mechanism, and thresholds | journal = Health Physics | volume = 92 | issue = 6 | pages = 621–628 | year = 2007 | pmid = 17495664 | doi = 10.1097/01.HP.0000250644.84530.e2 | bibcode = 2007HeaPh..92..621L | s2cid = 37236570 }}

File:HSR 1996 II 3.3c.svg

Prolonged exposure to loud sound or noise levels can lead to tinnitus.{{cite journal | vauthors = Tunkel DE, Bauer CA, Sun GH |display-authors=etal | title = Clinical practice guideline: tinnitus | journal = Otolaryngology–Head and Neck Surgery | volume = 151 | issue = 2 Suppl | pages = S1–40 | year = 2014 | pmid = 25273878 | doi = 10.1177/0194599814545325 |s2cid=206468767 }} Custom made ear plugs or other measures can help with prevention. Employers may use hearing loss prevention programs to help educate and prevent dangerous levels of exposure to noise. Government organizations set regulations to ensure employees, if following the protocol, should have minimal risk to permanent damage to their hearing.{{Cite web|url=https://www.cdc.gov/niosh/programs/hlp/default.html|title= NIOSH Program Portfolio : Hearing Loss Prevention : Program Description|date=5 February 2019|website=www.cdc.gov – CDC|language=en-us|access-date=26 March 2019}}

Certain groups are advised to wear ear plugs to avoid the risk of tinnitus, such as that caused by overexposure to loud noises like wind noise for motorcycle riders.{{Cite web|url=https://www.carolenash.com/news/bike-news/detail/bikers-warned-wear-earplugs-avoid-lifetime-tinnitus|title= Bike news|date= |website=www.carolenash.com|language=en-us|access-date=28 June 2021}} This includes military personnel, musicians,{{cite journal |last1=Burns-O'Connell |first1=Georgina |last2=Stockdale |first2=David |last3=Cassidy |first3=Oscar |last4=Knowles |first4=Victoria |last5=Hoare |first5=Derek J. |title=Surrounded by Sound: The Impact of Tinnitus on Musicians |journal=International Journal of Environmental Research and Public Health |date=27 August 2021 |volume=18 |issue=17 |pages=9036 |doi=10.3390/ijerph18179036 |pmid=34501628 |pmc=8431046 |doi-access=free }} DJs,{{cite web |last=Boles |first=Benjamin |title=DJs Shouldn't Have to Live With Constant Ringing in Their Ears |website=VICE |date=9 August 2016 |url=https://www.vice.com/en/article/hearing-loss-tinnitus-laidback-luke-roger-sanchez-feature/ |access-date=22 July 2024}} agricultural workers,{{cite journal |last1=Couth |first1=Samuel |last2=Mazlan |first2=Naadia |last3=Moore |first3=David R. |last4=Munro |first4=Kevin J. |last5=Dawes |first5=Piers |title=Hearing Difficulties and Tinnitus in Construction, Agricultural, Music, and Finance Industries: Contributions of Demographic, Health, and Lifestyle Factors |journal=Trends in Hearing |date=January 2019 |volume=23 |doi=10.1177/2331216519885571 |pmid=31747526 |pmc=6868580 }} and construction workers{{cite web | url=https://www.cdc.gov/niosh/topics/ohl/construction.html | title=Construction Statistics – Occupational Hearing Loss Surveillance | NIOSH | CDC | date=12 November 2021 }} as people in those occupations are at a greater risk compared to the general population.

Several medicines have ototoxic effects, which can have a cumulative effect that increases the damage done by noise. If ototoxic medications must be administered, close attention by the physician to prescription details, such as dose and dosage interval, can reduce the damage done.{{cite journal |last1=Cianfrone |first1=G |last2=Pentangelo |first2=D |last3=Cianfrone |first3=F |last4=Mazzei |first4=F |last5=Turchetta |first5=R |last6=Orlando |first6=MP |last7=Altissimi |first7=G |title=Pharmacological drugs inducing ototoxicity, vestibular symptoms and tinnitus: a reasoned and updated guide. |journal=European Review for Medical and Pharmacological Sciences |date=June 2011 |volume=15 |issue=6 |pages=601–636 |pmid=21796866 }}{{cite journal |last=Palomar García |first=V |author2=Abdulghani Martínez, F |author3=Bodet Agustí, E |author4=Andreu Mencía, L |author5=Palomar Asenjo, V |title=Drug-induced otoxicity: current status |journal=Acta Oto-Laryngologica |date=July 2001 |volume=121 |issue=5 |pages=569–572 |pmid=11583387 |doi=10.1080/00016480121545|s2cid=218879738 }}{{cite journal | vauthors = Seligmann H, Podoshin L, Ben-David J, Fradis M, Goldsher M | title = Drug-induced tinnitus and other hearing disorders | journal = Drug Safety | volume = 14 | issue = 3 | pages = 198–212 | year = 1996 | pmid = 8934581 | doi = 10.2165/00002018-199614030-00006| s2cid = 23522352 }}

If a specific underlying cause is determined, treating it may lead to improvements. Otherwise, the primary treatment for tinnitus is talk therapy, sound therapy, or hearing aids. There are no effective drugs that treat tinnitus.{{Cite web |date=20 March 2015 |title=Drug Therapies |url=https://www.ata.org/managing-your-tinnitus/treatment-options/drug-therapies |access-date=3 March 2022 |website=American Tinnitus Association |language=en |quote=There are presently no FDA-approved drugs specifically for tinnitus, and no medications that have been shown to reverse the neural hyperactivity at the root of tinnitus. Drugs cannot cure tinnitus, but they may provide relief from some severe tinnitus symptoms.}}{{cite journal |last1=Kleinjung |first1=Tobias |last2=Langguth |first2=Berthold |title=Avenue for Future Tinnitus Treatments |journal=Otolaryngologic Clinics of North America |date=August 2020 |volume=53 |issue=4 |pages=667–683 |doi=10.1016/j.otc.2020.03.013 |pmid=32381341 |doi-access=free }}

The best-supported treatment for tinnitus is cognitive behavioral therapy (CBT). It decreases the stress those with tinnitus feel.{{Cite journal |vauthors=Hesser H, Weise C, Zetterquist Westin V, Andersson G |title=A systematic review and meta-analysis of randomized controlled trials of cognitive–behavioral therapy for tinnitus distress |journal=Clinical Psychology Review |volume=31 |pages=545–553 |year=2011 |doi= 10.1016/j.cpr.2010.12.006 |pmid=21237544 |issue=4}} This appears to be independent of any effect on depression or anxiety.{{Cite journal |vauthors=Hoare D, Kowalkowski V, Knag S, Hall D |title=Systematic review and meta-analyses of randomized controlled trials examining tinnitus management |journal=The Laryngoscope |volume=121 |issue=7 |pages=1555–1564 |year=2011 |doi= 10.1002/lary.21825 |pmid=21671234 |pmc=3477633}} Acceptance and commitment therapy (ACT) also shows promise in the treatment of tinnitus.{{cite journal |last1=Ost |first1=LG |title=The efficacy of Acceptance and Commitment Therapy: an updated systematic review and meta-analysis |journal=Behaviour Research and Therapy |date=October 2014 |volume=61 |pages=105–121 |pmid=25193001 |doi=10.1016/j.brat.2014.07.018}} Relaxation techniques may also help. A clinical protocol called Progressive Tinnitus Management has been developed by the United States Department of Veterans Affairs.{{Cite web |vauthors=Henry J, Zaugg T, Myers P, Kendall C |title=Chapter 9 – Level 5 Individualized Support |work=Progressive Tinnitus Management: Clinical Handbook for Audiologists |publisher=US Department of Veterans Affairs, National Center for Rehabilitative Auditory Research |url=http://www.ncrar.research.va.gov/Education/Documents/TinnitusDocuments/Index.asp |year=2012 |access-date=20 December 2013 |url-status=live |archive-url=https://web.archive.org/web/20131220223240/http://www.ncrar.research.va.gov/Education/Documents/TinnitusDocuments/Index.asp |archive-date=20 December 2013 }}

The application of sound therapy by either hearing aids or tinnitus maskers may help the brain ignore the specific tinnitus frequency. Although these methods are poorly supported by evidence, there are no negative effects.{{cite journal | vauthors = Hoare DJ, Searchfield GD, El Refaie A, Henry JA | title = Sound therapy for tinnitus management: practicable options | journal = Journal of the American Academy of Audiology | volume = 25 | issue = 1 | pages = 62–75 | year = 2014 | pmid = 24622861 | doi = 10.3766/jaaa.25.1.5}}{{cite journal |last1=Sereda |first1=Magdalena |last2=Xia |first2=Jun |last3=El Refaie |first3=Amr |last4=Hall |first4=Deborah A |last5=Hoare |first5=Derek J |title=Sound therapy (using amplification devices and/or sound generators) for tinnitus |journal=Cochrane Database of Systematic Reviews |date=27 December 2018 |volume=2018 |issue=12 |pages=CD013094 |doi=10.1002/14651858.CD013094.pub2 |pmid=30589445 |pmc=6517157 }} There are several approaches for tinnitus sound therapy. The first is sound modification to compensate for the individual's hearing loss. The second is tailored music therapy, notched at the tinnitus frequency, which may affect lateral inhibition of the notched neural region, suppressing tinnitus.{{cite journal |last1=Shore |first1=Susan E. |last2=Roberts |first2=Larry E. |last3=Langguth |first3=Berthold |title=Maladaptive plasticity in tinnitus – triggers, mechanisms and treatment |journal=Nature Reviews Neurology |date=March 2016 |volume=12 |issue=3 |pages=150–160 |doi=10.1038/nrneurol.2016.12 |pmid=26868680 |pmc=4895692 }}{{cite journal |last1=Hesse |first1=Gerhard |title=Evidence and evidence gaps in tinnitus therapy |journal=GMS Current Topics in Otorhinolaryngology – Head and Neck Surgery; 15:Doc04 |date=15 December 2016 |volume=15 |pages=Doc04 |doi=10.3205/cto000131 |pmid=28025604 |pmc=5169077 }}

There is some tentative evidence supporting tinnitus retraining therapy, which aims to reduce tinnitus-related neuronal activity.{{cite journal | vauthors = Phillips JS, McFerran D | title = Tinnitus Retraining Therapy (TRT) for tinnitus | journal = Cochrane Database of Systematic Reviews | issue = 3 | pages = CD007330 | year = 2010 | volume = 2010 | pmid = 20238353 | doi = 10.1002/14651858.CD007330.pub2 | pmc = 7209976 }} An alternative tinnitus treatment uses mobile applications that include various methods including masking, sound therapy, and relaxation exercises.{{cite journal |last1=Casale |first1=Manuele |last2=Costantino |first2=Andrea |last3=Rinaldi |first3=Vittorio |last4=Forte |first4=Antonio |last5=Grimaldi |first5=Marta |last6=Sabatino |first6=Lorenzo |last7=Oliveto |first7=Giuseppe |last8=Aloise |first8=Fabio |last9=Pontari |first9=Domenico |last10=Salvinelli |first10=Fabrizio |title=Mobile applications in otolaryngology for patients: An update: Otolaryngology Apps for Patients |journal=Laryngoscope Investigative Otolaryngology |date=December 2018 |volume=3 |issue=6 |pages=434–438 |doi=10.1002/lio2.201 |pmid=30599026 |pmc=6302723 }}{{cite journal |last1=Mosa |first1=Abu Saleh Mohammad |last2=Yoo |first2=Illhoi |last3=Sheets |first3=Lincoln |title=A Systematic Review of Healthcare Applications for Smartphones |journal=BMC Medical Informatics and Decision Making |date=December 2012 |volume=12 |issue=1 |pages=67 |doi=10.1186/1472-6947-12-67 |pmid=22781312 |pmc=3534499 |doi-access=free }} Such applications can work as a separate device or as a hearing aid control system.{{cite journal |last1=Kalle |first1=Sven |last2=Schlee |first2=Winfried |last3=Pryss |first3=Rüdiger C. |last4=Probst |first4=Thomas |last5=Reichert |first5=Manfred |last6=Langguth |first6=Berthold |last7=Spiliopoulou |first7=Myra |title=Review of Smart Services for Tinnitus Self-Help, Diagnostics and Treatments |journal=Frontiers in Neuroscience |date=20 August 2018 |volume=12 |pages=541 |doi=10.3389/fnins.2018.00541 |pmid=30177869 |pmc=6109754 |doi-access=free }}

Neuromonics is another sound-based intervention. Its protocol follows the principle of systematic desensitization and involves a structured rehabilitation program lasting 12 months. Neuromonics therapy employs customized sound signals delivered through a device worn by the patient, which aims to target the specific frequency range associated with their tinnitus perception.{{cite journal | last1=Hobson | first1=Jonathan | last2=Chisholm | first2=Edward | last3=El Refaie | first3=Amr | title=Sound therapy (masking) in the management of tinnitus in adults | journal=Cochrane Database of Systematic Reviews | date=2012-11-14 | volume=11 | issue=11 | pages=CD006371 | pmid=23152235 | pmc=7390392 | doi=10.1002/14651858.CD006371.pub3 | doi-access=free }}

Physical therapy for tinnitus focuses on relaxing jaw and neck muscles that may contribute to symptoms. Muscle tension, particularly in the jaw muscles like the masseter and medial pterygoid, can radiate to the ears, leading to somatic tinnitus. Specialized physical therapists use neuromuscular techniques to alleviate tension in these areas, which may reduce tinnitus intensity and associated pain in connected areas, such as the jaw, teeth, and ears.[https://doi.org/10.3390/jcm13123496 The Effect of Physical Therapy on Somatosensory Tinnitus]

{{As of|2018}} there were no medications effective for idiopathic tinnitus.{{cite journal |last1=Bauer |first1=CA |title=Tinnitus |journal=New England Journal of Medicine |date=March 2018 |volume=378 |issue=13 |pages=1224–1231 |doi=10.1056/NEJMcp1506631 |pmid=29601255}} There is not enough evidence to determine if antidepressants{{cite journal |last=Baldo |first=P |author2=Doree, C |author3=Molin, P |author4=McFerran, D |author5= Cecco, S |title=Antidepressants for patients with tinnitus |journal=Cochrane Database of Systematic Reviews |date=12 September 2012 |volume=2012 |issue=9 |page=CD003853 |pmid=22972065 |doi=10.1002/14651858.CD003853.pub3|pmc=7156891 }} or acamprosate are useful.{{cite journal |last=Savage |first=J |author2=Cook, S |author3=Waddell, A |title=Tinnitus |journal=BMJ Clinical Evidence |date=12 November 2009 |volume=2009 |pmid=21726476 |pmc=2907768}} There are conflicting studies regarding the effectiveness of benzodiazepines for tinnitus.{{cite journal |last1=Savage |first1=J |last2=Waddell |first2=A |title=Tinnitus |journal=BMJ Clinical Evidence |date=October 2014 |volume=2014 |pages=0506 |pmid=25328113 |pmc=4202663 }}{{cite journal |vauthors=Kim SH, Kim D, Lee JM, Lee SK, Kang HJ, Yeo SG |title=Review of Pharmacotherapy for Tinnitus |journal=Healthcare |volume=9 |issue=6 |date=June 2021 |page=779 |pmid=34205776 |pmc=8235102 |doi=10.3390/healthcare9060779|doi-access=free }} The usefulness of melatonin, as of 2015, is unclear.{{cite journal |last1=Miroddi |first1=M |last2=Bruno |first2=R |last3=Galletti |first3=F |last4=Calapai |first4=F |last5=Navarra |first5=M |last6=Gangemi |first6=S |last7=Calapai |first7=G |title=Clinical pharmacology of melatonin in the treatment of tinnitus: a review. |journal=European Journal of Clinical Pharmacology |date=March 2015 |volume=71 |issue=3 |pages=263–270 |doi=10.1007/s00228-015-1805-3 |pmid=25597877|s2cid=16466238 }} It is unclear if anticonvulsants are useful for treating tinnitus.{{cite journal |last1=Hoekstra |first1=Carlijn EL |last2=Rynja |first2=Sybren P |last3=van Zanten |first3=Gijsbert A |last4=Rovers |first4=Maroeska M |title=Anticonvulsants for tinnitus |journal=Cochrane Database of Systematic Reviews |date=6 July 2011 |volume=2011 |issue=7 |pages=CD007960 |doi=10.1002/14651858.CD007960.pub2 |pmid=21735419 |pmc=6599822 }} Steroid injections into the middle ear also do not seem to be effective.{{cite journal |last1=Pichora-Fuller |first1=M. Kathleen |last2=Santaguida |first2=Pasqualina |last3=Hammill |first3=Amanda |last4=Oremus |first4=Mark |last5=Westerberg |first5=Brian |last6=Ali |first6=Usman |last7=Patterson |first7=Christopher |last8=Raina |first8=Parminder |title=Evaluation and Treatment of Tinnitus: Comparative Effectiveness |journal=Comparative Effectiveness Reviews |series=AHRQ Comparative Effectiveness Reviews |issue=122 |date=2013 |url=https://www.ncbi.nlm.nih.gov/books/NBK158963/ |pmid=24049842 }}{{cite journal |last1=Lavigne |first1=P |last2=Lavigne |first2=F |last3=Saliba |first3=I |author-link3=Issam Saliba |date=23 June 2015 |title=Intratympanic corticosteroids injections: a systematic review of literature |journal=European Archives of Oto-Rhino-Laryngology |volume=273 |issue=9 |pages=2271–2278 |doi=10.1007/s00405-015-3689-3 |pmid=26100030 |s2cid=36037973}} There is no evidence to suggest that the use of betahistine to treat tinnitus is effective.{{Cite journal|last1=Hall|first1=Deborah A|last2=Wegner|first2=Inge|last3=Smit|first3=Adriana Leni|last4=McFerran|first4=Don|last5=Stegeman|first5=Inge|date=2018|editor-last=Cochrane ENT Group|title=Betahistine for tinnitus|journal=Cochrane Database of Systematic Reviews|language=en|volume=12|issue=8|pages=CD013093|doi=10.1002/14651858.CD013093|pmid=30908589|pmc=6513648}}

Botulinum toxin injection has succeeded in some of the rare cases of objective tinnitus from a palatal tremor.{{cite journal | vauthors = Slengerik-Hansen J, Ovesen T | title = Botulinum Toxin Treatment of Objective Tinnitus Because of Essential Palatal Tremor: A Systematic Review | journal = Otology & Neurotology | volume = 37 | issue = 7 | pages = 820–828 | year = 2016 | pmid = 27273401 | doi = 10.1097/MAO.0000000000001090 | s2cid = 23675169 }}

Caroverine is used in a few countries to treat tinnitus.{{cite book |editor1-last=Sweetman |editor1-first=Sean C. |title=Martindale |date=2009 |publisher=Pharmaceutical Press |isbn=978-0-85369-840-1 |page=2277 |edition= 36th}} The evidence for its usefulness is very weak.{{cite journal |last1=Langguth |first1=B |last2=Salvi |first2=R |last3=Elgoyhen |first3=AB |title=Emerging pharmacotherapy of tinnitus. |journal=Expert Opinion on Emerging Drugs |date=December 2009 |volume=14 |issue=4 |pages=687–702 |doi=10.1517/14728210903206975 |pmid=19712015 |pmc=2832848}}

In 2020, information about clinical trials indicated that bimodal neuromodulation may reduce the symptoms of tinnitus. It is a noninvasive technique that involves applying an electrical stimulus to the tongue while also administering sounds.{{cite journal |last1=Kwon |first1=Diana |title=New Tinnitus Treatment Alleviated Annoying Ringing in the Ears |journal=Scientific American |date=7 October 2020 |volume=2 |issue=6 |pages=None |url=https://www.scientificamerican.com/article/new-tinnitus-treatment-alleviates-annoying-ringing-in-the-ears1/ |publisher=Springer Nature America, Inc.|doi=10.1038/scientificamerican122020-2VzL6BO1nViUY4ozIqWxY8 |url-access=subscription }} Equipment associated with the treatments is available through physicians. Studies with it and similar devices continue in several research centers.{{citation needed|date=December 2020}}

In March 2023, the US Food and Drug Administration (FDA) approved Neuromod's Lenire device as a treatment option for tinnitus.{{cite web |last1=George |first1=Judy |title=First Bimodal Neuromodulation Device for Tinnitus Gets FDA Nod |website=MedPage Today |date=8 March 2023 |url=https://www.medpagetoday.com/surgery/otolaryngology/103453 |access-date=23 July 2024}}{{cite web |last=Everts |first=Quinn |title=FDA Grants De Novo Approval to Non-Invasive Tinnitus Treatment Device |website=Drug Topics |date=14 March 2023 |url=https://www.drugtopics.com/view/fda-grants-de-novo-approval-to-non-invasive-tinnitus-treatment-device |access-date=23 July 2024}}{{cite web |last=Philpott |first=Jenna | title=Neuromod inks contract to treat US veterans with tinnitus device |website=Medical Device Network |date=18 June 2024 |url=https://www.medicaldevice-network.com/news/neuromod-inks-contract-to-treat-us-veterans-with-tinnitus-device/ |access-date=23 July 2024}} In June 2024, the US Department of Veterans Affairs (VA) announced it would begin offering the treatment to veterans with tinnitus, making it the first bimodal neuromodulation device to be awarded a Federal Supply Schedule (FSS) contract from the US Government.

Some evidence supports neuromodulation techniques such as transcranial magnetic stimulation,{{cite journal |last=Meng |first=Z |author2=Liu, S |author3=Zheng, Y |author4= Phillips, JS |title=Repetitive transcranial magnetic stimulation for tinnitus |journal=Cochrane Database of Systematic Reviews |date=5 October 2011 |issue=10 |pages=CD007946 |pmid=21975776 |doi=10.1002/14651858.CD007946.pub2}} transcranial direct current stimulation, and neurofeedback.{{cn|date=February 2025}}

Ginkgo biloba does not appear to be effective.{{cite journal |last=Hilton |first=MP |author2=Zimmermann, EF |author3=Hunt, WT |title=Ginkgo biloba for tinnitus |journal=Cochrane Database of Systematic Reviews |date=28 March 2013 |volume=2013 |issue=3 |pages=CD003852 |pmid=23543524 |doi=10.1002/14651858.CD003852.pub3|s2cid=205171459 |doi-access=free |pmc=11669941 }} The American Academy of Otolaryngology recommends against taking melatonin or zinc supplements to relieve symptoms of tinnitus, and reported that evidence for the efficacy of many dietary supplements (such as lipoflavonoids, garlic, traditional Chinese/Korean herbal medicine, honeybee larvae, and various other vitamins and minerals, as well as homeopathic preparations) did not exist. A 2016 Cochrane Review also concluded that evidence was not sufficient to support taking zinc supplements to reduce symptoms associated with tinnitus.{{Cite journal |last1=Person |first1=Osmar C |last2=Puga |first2=Maria ES |last3=da Silva |first3=Edina MK |last4=Torloni |first4=Maria R |date=23 November 2016 |title=Zinc supplements for tinnitus |journal=Cochrane Database of Systematic Reviews |volume=2016 |issue=11 |pages=CD009832 |doi=10.1002/14651858.cd009832.pub2 |pmid=27879981 |pmc=6464312 }}

While there is no cure, most people with tinnitus get used to it over time; for a minority, it remains a significant problem.

Tinnitus affects 10{{ndash}}15% of people. About a third of North Americans over 55 experience it.{{cite journal |vauthors=Sanchez TG, Rocha CB |title=Diagnosis and management of somatosensory tinnitus: review article |journal=Clinics |volume=66 |issue=6 |pages=1089–1094 |year=2011 |pmid=21808880 |pmc=3129953 |doi= 10.1590/S1807-59322011000600028}} It affects one third of adults at some time in their lives, whereas 10–15% are disturbed enough to seek medical evaluation.{{cite journal |author=Heller AJ |title=Classification and epidemiology of tinnitus |journal=Otolaryngologic Clinics of North America |volume=36 |issue=2 |year=2003 |pages=239–248 |pmid=12856294 |doi=10.1016/S0030-6665(02)00160-3}}

70 million people in Europe are estimated to have tinnitus.{{cite web|url=https://ki.se/forskning/transkribering-av-89-varfor-far-man-tinnitus|language= Swedish|title=Transkribering av #89: Varför får man tinnitus?|publisher=Karolinska Institutet|archive-url=https://web.archive.org/web/20221201111037/https://ki.se/forskning/transkribering-av-89-varfor-far-man-tinnitus|archive-date=2022-12-01}}{{cite web|url=https://cordis.europa.eu/article/id/435788-almost-15-of-europe-s-adults-have-a-ringing-in-their-ears-say-researchers|language= English|title=Almost 15% of Europe's adults have a ringing in their ears, say researchers|publisher=European Commission: CORDIS|date=|archive-url=https://web.archive.org/web/20221201105120/https://cordis.europa.eu/article/id/435788-almost-15-of-europe-s-adults-have-a-ringing-in-their-ears-say-researchers|archive-date=2022-12-01}}

Tinnitus is commonly thought of as a symptom of adulthood, and is often overlooked in children. Children with hearing loss have a high incidence of pediatric tinnitus, even though they do not express the condition or its effect on their lives.{{cite journal |last1=Celik |first1=N |last2=Bajin |first2=MD |last3=Aksoy |first3=S |year=2009 |title=Tinnitus incidence and characteristics in children with hearing loss |journal=Journal of International Advanced Otology |volume=5 |issue=3 |pages=363–369 |oclc=695291085 |hdl=11655/17046 }}{{cite journal |last1=Lee |first1=Doh Young |last2=Kim |first2=Young Ho |title=Risk factors of pediatric tinnitus: Systematic review and meta-analysis |journal=The Laryngoscope |date=June 2018 |volume=128 |issue=6 |pages=1462–1468 |doi=10.1002/lary.26924 |pmid=29094364 |s2cid=24633085 }} Children do not generally report tinnitus spontaneously and their complaints may not be taken seriously.{{cite journal | last1 = Mills | first1= RP | last2= Albert |first2=D | last3= Brain |first3= C |year = 1986 | title = Tinnitus in childhood | journal = Clinical Otolaryngology and Allied Sciences |volume = 11 | issue = 6 | pages = 431–434 | doi= 10.1111/j.1365-2273.1986.tb02033.x | pmid= 3815868 }} Among those who do complain, there is an increased likelihood of associated otological or neurological pathology such as migraine, juvenile Meniere's disease, or chronic suppurative otitis media.{{cite book |author=Ballantyne JC |editor1=Graham JM |editor2=Baguley D |year=2009 |title=Ballantyne's Deafness |edition= 7th |location=Chichester |publisher=Wiley-Blackwell |oclc=275152841 }} Its reported prevalence varies from 12 to 36% in children with normal hearing thresholds, and up to 66% in children with a hearing loss. Approximately 3–10% of children have been reported to be troubled by tinnitus.{{cite journal |last1=Shetye |first1=A. |last2=Kennedy |first2=V. |title=Tinnitus in children: an uncommon symptom? |journal=Archives of Disease in Childhood |date=1 August 2010 |volume=95 |issue=8 |pages=645–648 |doi=10.1136/adc.2009.168252 |pmid=20371585 |s2cid=34443303 }}

{{Portal|Medicine}}

• Audiology
• {{Annotated link|Auditory hallucination}}
• {{Annotated link|Health effects from noise}}
• Hearing protection
• Noise-induced hearing loss
• {{Annotated link|List of people with tinnitus}}
• {{Annotated link|List of unexplained sounds}}
• {{Annotated link|Phantom vibration syndrome}}
• {{Annotated link|Safe listening}}
• {{Annotated link|Zwicker tone}}

{{Reflist}}

• {{cite book |last1=Baguley |first1=David |last2=Andersson |first2=Gerhard |author-link2=Gerhard Andersson |last3=McFerran |first3=Don |last4=McKenna |first4=Laurence |title=Tinnitus: A Multidisciplinary Approach |edition= 2nd |orig-year=2004 |date= 2013 |publisher=Wiley-Blackwell |location=Indianapolis, IN |isbn=978-1-4051-9989-6 |oclc=712915603 |lccn=2012032714}}
• {{cite book |editor1-last=Langguth |editor1-first=B |editor2-last=Hajak |editor2-first=G |editor3-last=Kleinjung |editor3-first=T |editor4-last=Cacace |editor4-first=A |editor5-last=Møller |editor5-first=AR |title=Tinnitus: pathophysiology and treatment |edition= 1st |series=Progress in brain research no. 166 |date= 2007 |publisher=Elsevier |location=Amsterdam; Boston |isbn=978-0-444-53167-4 |oclc=648331153 |lccn=2012471552}} [https://books.google.com/books?id=XydUtbVHtdEC Alt URL]
• {{cite book |editor1-last=Møller |editor1-first=Aage R |editor2-last=Langguth |editor2-first=Berthold |editor3-last=Ridder |editor3-first=Dirk |display-editors = 3 |editor4-last=Kleinjung |editor4-first=Tobias |title=Textbook of Tinnitus |year=2011 |publisher=Springer |location=New York |isbn=978-1-60761-144-8 |lccn=2010934377 |doi=10.1007/978-1-60761-145-5 |id={{OCLC |695388693 |771366370 |724696022}} }}

• [https://ata.org American Tinnitus Association]
• [https://tinnitus.org.uk Tinnitus.org UK]

{{Medical condition classification and resources | DiseasesDB=27662

| ICD10={{ICD10|H|93|1|h|90}}

| ICD9={{ICD9|388.3}}

| ICDO=

| OMIM=

| MedlinePlus=003043

| eMedicineSubj=ent

| eMedicineTopic=235

| MeshID= D014012

}}

{{Diseases of the ear and mastoid process}}

{{Occupational safety and health}}

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