Authored by Dr Roger Henderson, 28 Feb 2013

Reviewed by:
Dr Helen Huins, 28 Feb 2013

Patient professional reference

Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Ménière's Disease article more useful, or one of our other health articles.

Tinnitus is the perception of sound originating from within the head rather than from the external world.

It can be divided into two main types:


There is actually a noise to be heard being generated within the head. These can be:

  • Pulsatile: due to movement of blood - eg, carotid stenosis, vascular anomalies or tumours, valvular heart disease, high cardiac output states.
  • Muscular or anatomical: palatal myoclonus, spasm of tympanic muscles, patulous Eustachian tube.
  • Spontaneous: otoacoustic emissions.


There is no acoustic stimulus. Common causes are:

  • Otological: noise-induced and other forms of hearing loss, presbyacusis, otosclerosis, impacted cerumen, ear infection, Ménière's disease.
  • Neurological: head injury, multiple sclerosis, acoustic neuroma and other similar tumours.
  • Infectious: meningitis, syphilis.
  • Drug-related: salicylates, non-steroidal anti-inflammatory drugs (NSAIDs), aminoglycosides, loop diuretics, cytotoxicity.
  • Jaw disorders: temporomandibular joint dysfunction.

Tinnitus is a common complaint. The British Tinnitus Association estimates 1 in 10 people suffer from this symptom.[1]It is more common in males.


Patients often take a long time before seeking medical attention. Most common sounds are:

  • Ringing
  • Buzzing
  • Cricket-like
  • Hissing
  • Whistling
  • Humming

The condition is reported to be unilateral in 22%, equal in both ears in 34% and one side dominant in the rest, usually the left.[2]

  • Thorough examination of the head, neck, ears and jaw should be made.
  • Hearing test.
  • Other examinations suggested by clinical findings.

Although patients report sound as being loud, hearing tests demonstrate that they are at an intensity that is only just louder than the softest sound audible at that frequency - usually above 3 kHz.

NB: exclude an acoustic neuroma in unilateral tinnitus.

General measures

  • Explanation and reassurance that the condition will not progress and that there are no sinister findings.
  • There is a strong association between tinnitus and stress; relaxation techniques or relaxing background music can distract or mask some tinnitus.
  • Tinnitus retraining therapy shows improvement in 75-82% of patients. It links negative emotional associations with tinnitus-related neural activity.[3, 4]It may take over a year to complete the therapy, with a goal of habituating the patient to the tinnitus rather than abolishing it. Results are sustained in the long term.[5]
  • Masking devices can be used in those patients who obtained relief from masking during the hearing test. Tinnitus maskers create and deliver constant low-level white noise to the ear. Patients should be advised to wear the device during their waking hours, but successful wearers may wear the device while sleeping.[6]


There are few treatments with good quality evidence of efficacy.[7]

Consider antidepressants for associated depression, but SSRIs have been shown significantly to reduce tinnitus severity, as well as anxiety and depression symptoms.[8]


Microvascular decompression of auditory nerve/nerve resection is controversial.[9, 10]

As tinnitus is an integral part of Ménière's disease, treating that condition may provide relief from tinnitus.

Further reading and references

  1. Luxon LM; Tinnitus: its causes, diagnosis, and treatment, BMJ June 1993

  2. Axelsson A, Ringdahl A; Tinnitus--a study of its prevalence and characteristics. Br J Audiol. 1989 Feb23(1):53-62.

  3. Berry JA, Gold SL, Frederick EA, et al; Patient-based outcomes in patients with primary tinnitus undergoing tinnitus retraining therapy. Arch Otolaryngol Head Neck Surg. 2002 Oct128(10):1153-7.

  4. Herraiz C, Hernandez FJ, Plaza G, et al; Long-term clinical trial of tinnitus retraining therapy. Otolaryngol Head Neck Surg. 2005 Nov133(5):774-9.

  5. Seydel C, Haupt H, Szczepek AJ, et al; Long-Term Improvement in Tinnitus after Modified Tinnitus Retraining Therapy Enhanced by a Variety of Psychological Approaches. Audiol Neurootol. 2009 Aug 415(2):69-80.

  6. Folmer RL, Carroll JR; Long-term effectiveness of ear-level devices for tinnitus. Otolaryngol Head Neck Surg. 2006 Jan134(1):132-137.

  7. Langguth B, Salvi R, Elgoyhen AB; Emerging pharmacotherapy of tinnitus. Expert Opin Emerg Drugs. 2009 Aug 27.

  8. Zoger S, Svedlund J, Holgers KM; The effects of sertraline on severe tinnitus suffering--a randomized, double-blind, placebo-controlled study. J Clin Psychopharmacol. 2006 Feb26(1):32-9.

  9. Vasama JP, Moller MB, Moller AR; Microvascular decompression of the cochlear nerve in patients with severe tinnitus. Preoperative findings and operative outcome in 22 patients. Neurol Res. 1998 Apr20(3):242-8.

  10. De Ridder D, Ryu H, De Mulder G, et al; Frequency specific hearing improvement in microvascular decompression of the cochlear nerve. Acta Neurochir (Wien). 2005 May147(5):495-501

First off, l have some health issues but never had a problem with random hearing loss. Around an hour ago my left ear started to have muffled sound, l thought it was wax or something but it’s not...

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