Tinnitus: cause and treatment

Hear a whistling, clicking, buzzing, humming or hissing noise in your ears? Almost everyone is familiar with such noises. How can you tell if it’s tinnitus? 

What is tinnitus?

The Latin term “tinnitus aurium” (tinnitus for short) means ringing in the ears. “It’s not always the ringing tone or high-pitched whistling sound that is normally associated with tinnitus,” says Professor Tobias Kleinjung, senior physician at the Department of Otorhinolaryngology, Head and Neck Surgery at Zurich University Hospital.

Tinnitus symptoms: noise in the ear

Any noise in the ear or head that doesn’t originate from a real sound source is generally referred to as tinnitus. “But anyone who hears music or voices suffers from hallucinations. That’s different,” says Kleinjung. Some people with tinnitus can also experience dizziness or are sensitive to noise at the beginning.

However, it’s important to note that tinnitus isn’t a disease per se. Rather, the noises in the ear are a symptom – a side effect of age-related or acute hearing loss, for example – and are common. “At least 15% of the population hear ringing in the ears over a longer period of time. And it increases with age,” says Kleinjung.

“But only around 1% have severe symptoms.” Tinnitus only makes people ill when they develop psychological problems or sleep disorders due to the noise.

Tinnitus: acute or chronic?

After three months, the classification of tinnitus changes from acute to chronic. Kleinjung isn’t happy with this medical classification, because then people start to google their symptoms and have the impression that chronic means they’ll have tinnitus for the rest of their life. But that isn’t necessarily the case. Even chronic ringing in the ears can disappear again.  

Patients’ panic can make them do the strangest things. They run from doctor to doctor, order drops from the internet or try out esoteric treatments. But Kleinjung explains that obsessing over tinnitus is counterproductive,

because the more you focus on it, the greater the risk that the suffering will increase. It’s better to approach the whole thing as casually as possible and distract yourself instead of focusing on the strange sound. 

Causes and risk factors

What causes these irritating noises in the ear? The vast majority of people suffer from subjective tinnitus, which means that only the person themselves can hear the noise.

“In this case, it is assumed that too little input reaches the brain from the ear because the hearing has deteriorated or been damaged. The brain then tries to take countermeasures, reorganise itself and adapt by networking new areas of the brain,” explains Kleinjung. For most people, this happens imperceptibly.

However, the compensation sometimes results in permanent activity in the auditory centre of the brain, a kind of overcompensation, even if objectively nothing can be heard. This can be perceived as tinnitus.

Specifically, as we age, our hearing usually loses the higher frequency range first. As the brain tries to compensate, tinnitus sufferers often hear higher whistling tones.

However, the noises may also be due to a misaligned jaw. The middle ear is close to the temporomandibular joint. Faulty “input” from the musculoskeletal system as a result of grinding teeth, dentures, misalignment of the jaw or tension in the chewing and neck muscles can lead to interference with the central auditory system. Tinnitus may occur as a result.

Existing tinnitus can also change through manipulation of the muscles. Bacterial infections (such as middle ear infections) or diving accidents can also sometimes impair hearing, which can lead to tinnitus.

A very small group of patients suffer from objective tinnitus, which is caused by sounds within the body – usually from muscles or blood vessels, which is why this form of tinnitus sounds rhythmic and not constant. It is called “objective” because these sounds can sometimes also be heard by others if they stand very close to the person affected.

The good news is that this kind of tinnitus can be treated directly as soon as the cause of the noise is identified. In the case of muscles, this can be involuntary twitching of the palate muscles, which can then be heard as clicking noises in the ear. “One remedy, for example, is to inject Botox into the affected muscles. In some cases, operating on blood vessels close to the ear that have experienced changes in structure can make the tinnitus disappear completely,” says Kleinjung.

However, as tinnitus is in most cases not objective but subjective and an attempt by the brain to compensate for hearing loss, the most important rule to prevent whistling, hissing or buzzing in the ears is to wear ear protectors. “The only thing we can really do is protect our ears before tinnitus occurs,” says Kleinjung. Wear ear protection whenever it gets loud, for example while using a circular saw, at concerts or watching football in a stadium. Loud noises are proven to damage hearing.

Can stress cause tinnitus?

However, some people suffer from tinnitus without any noticeable loss of hearing. In this case, it’s a good idea to reduce stress levels: “When you ask these people, they often say that they are in a phase of life where they have a lot on their plate, are challenged professionally or are suffering from personal problems,” says Kleinjung.

So it seems like stress can trigger ringing in the ears. “This makes sense, because we know that the networks for stress, emotions, memory and attention in the brain can connect to the auditory centre.” In addition, tinnitus may be more noticeable during a stressful phase when you are feeling more sensitive.

Can tinnitus be cured?

“To be honest, there aren’t yet any effective treatments available to make subjective tinnitus just disappear,” says Kleinjung. “In most cases, there aren’t even tests we can do to prove its existence. To make a diagnosis, all we have to go on is a hearing test and the patient’s medical history.” Only in exceptional cases, for example when one ear works much better than the other, can we do an MRI to examine the auditory nerve.

So, tinnitus can’t be cured in the traditional sense. And there’s no miracle pill in the pipeline. However, research into neuromodulation is currently under way. “Researchers are using repetitive transcranial magnetic stimulation, transcranial electrical stimulation and neurofeedback to normalise brain activity with the aim of switching off tinnitus or making it quieter,” explains Kleinjung.

But these methods aren’t ready to be brought to market yet. “Manufacturer Lenire has brought out a device combining sound therapy with electrical tongue stimulation to help people focus less on the tinnitus. But I think it’s still too early to recommend this technology to all tinnitus patients.”

Kleinjung stresses that tinnitus can go away on its own. And if it doesn’t, most people can manage it in a way that avoids stress. But what exactly should you do if tinnitus occurs? You don’t have to take action immediately.

Be patient

Wait at least one or two weeks before going to an ENT specialist. “Some people worry that tinnitus may be an indication of a brain tumour or a stroke, but there’s no point in immediately assuming the worst. Only in extremely rare cases does tinnitus occur beforehand.”

Kleinjung advises keeping calm – but only internally: “Don’t panic! It’s best to distract yourself with other noises and don’t always seek silence so that you can always listen to see if the tinnitus is still there.”

However, if you experience a sudden loss of hearing, you should go to the doctor and have a hearing test within three to four days. “Sudden hearing loss is usually treated with cortisone,” says Kleinjung. “Tinnitus is sometimes also treated in the same way, but is very controversial because of the side effects and because cortisone’s effectiveness hasn’t been proven. I’m sceptical.”

Once tinnitus has been diagnosed and the patient reassured, it’s really just a waiting game. It helps to use distracting noises: “These don’t have to be specific frequencies, but can be anything that works for the person in question, such as music, white noise from an app, sounds coming through an open window, a little water feature, noises to help you sleep or a podcast.” Special tinnitus devices that send certain sounds into the ear are now outdated and are no longer needed in the age of smartphones that offer noise apps, streaming services, etc.

Psychological support in cases of excessive suffering

If tinnitus sufferers experience problems, such as difficulties falling asleep or concentrating or if they suffer from panic attacks, they should seek help from a psychiatrist or psychologist. “The doctor may then prescribe medication to help with sleep, anxiety or depression and/or initiate cognitive behavioural therapy. It’s about finding strategies to help manage the noise and relax again,” advises Kleinjung.

Treat tinnitus with home remedies and acupuncture?

“The effectiveness of home remedies and acupuncture hasn’t been proven scientifically, but this doesn’t mean that they don’t do some people good. It’s best to simply try them out cautiously.” 

In particular, acupuncture can alleviate accompanying symptoms such as restlessness or problems sleeping and concentrating. “However, in case of doubt, it is important to remember that less is more,” says Kleinjung. In other words: try to ignore the tinnitus as much as possible!