Learning Center: TINNITUS

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Last reviewed: October 4, 2026

Introduction

Tinnitus is very common. A meta-analysis of studies from around the world found that about 14% of adults have some tinnitus, rising to about 24% of those age 65 and older, while about 2% have severe tinnitus [1]. In a United States survey, about 1 in 10 adults had tinnitus in the past year; more than a third heard it almost constantly, and about 7% said it was a big or very big problem [2]. For most people tinnitus is a nuisance rather than a sign of serious disease, and it often becomes less bothersome over time as the brain learns to tune it out.

This page covers the types of tinnitus, its link with hearing loss, what evaluation is recommended, and which treatments have good evidence, following the American Academy of Otolaryngology–Head and Neck Surgery tinnitus guideline [3]. A numbered reference list is at the end of the page.

Tinnitus is the perception of sound when no corresponding external sound is present. While often described as a ringing, it may also sound like a clicking, buzzing, hiss, or roaring. Tinnitus is usually, but not always associated with hearing loss, and may be considered as a low signal-to-noise ratio from the ears.

Tinnitus may have no cure, but there are several treatments for this vexing problem. In brief, distracting noise (such as “white noise"), use of hearing aids, getting good sleep, getting daily exercise, and avoiding known dietary triggers (caffeine, ibuprofen and similar medications, apple cider vinegar, among others), alcohol, avoiding topical causes (sunscreen), and even undertaking cognitive behavioral therapy may help. Of course, prevention of tinnitus or its progression is important, and this is accomplished by avoiding excessive noise exposure and avoiding medications that hurt the inner ear (such as certain malaria medications and intravenous antibiotics called aminoglycosides).

• “How Can I Lessen the Impact of Tinnitus” at ENTHealth.org.

• Tinnitus information and resources from the American Speech and Language Association

Types of tinnitus

While people may experience various types of phantom sounds in their ears, including humming, buzzing, clicking, sound of crickets, etc., the two main categories are pulsatile tinnitus and non-pulsatile tinnitus. Pulsatile tinnitus has a rhythm that corresponds to one’s heartbeat. This can be tested at home, as shown in this video. Non-pulsatile tinnitus includes all other types of tinnitus (ringing, humming, whooshing, etc.), and is more common.

Unlike ordinary tinnitus, pulsatile tinnitus usually has a physical source of sound, such as turbulent blood flow in a nearby artery or vein, and a specific cause can often be found. Causes include narrowing or irregularity of the carotid artery, variations in the large veins next to the ear, abnormal connections between arteries and veins (dural arteriovenous fistulas), vascular tumors of the middle ear such as paragangliomas, raised pressure of the fluid around the brain (idiopathic intracranial hypertension), and middle ear fluid or inflammation that makes the normal pulse easier to hear [4]. For this reason pulsatile tinnitus is usually evaluated with an ear examination, a hearing test and imaging of the blood vessels [3, 4]. See the pulsatile tinnitus page and the notes linked at the bottom of this page.

Tinnitus can also be described as subjective (heard only by the patient, by far the most common) or objective (a sound an examiner can also hear, such as some pulsatile tinnitus or clicking from muscle spasm in the middle ear or palate), and as recent onset (less than six months) or persistent (six months or longer) [3].

Tinnitus and hearing loss

About 70% of people with tinnitus have hearing loss, and about 70% of people with hearing loss have tinnitus. In large part, hearing loss and tinnitus may be considered two sides of the same coin, as they often relate to dysfunction of the inner ear/cochlea.

The guideline recommends a prompt hearing test (audiogram) for tinnitus that is in one ear only, persistent (six months or more), or accompanied by hearing difficulty [3]. Imaging (usually MRI) is not recommended routinely, but is appropriate when tinnitus is in one ear, pulsatile, or accompanied by asymmetric hearing loss or neurologic findings, to look for causes such as an acoustic neuroma [3]. Noise exposure is the main preventable risk factor: in the U.S. survey, regular loud noise at work tripled the odds of tinnitus, and loud recreational noise more than doubled them [2]. More on hearing loss is on the hearing page.

treatment and management of tinnitus

While there is not a quick and ready “cure” for most types of tinnitus, methods for minimizing the nuisance of tinnitus do exist. There is not a single “one size fits all” technique for helping tinnitus, but several options exist that may be of use to the individual. These include the following:

  • Direct your mental focus elsewhere.

  • Use some other noise in your vicinity to help mask the tinnitus. This could be a fan, music, or any other comforting sound. Several smartphone apps have been developed for this purpose.

  • Very important: Get exercise daily, especially with at least some intense exercise.

  • Very important: Get good sleep. Minimize or manage stress.

  • Avoid exposure to loud sounds and prolonged exposure to even moderately loud sounds. This is preventative.

  • Identify if any of your medications cause tinnitus, and discuss options with your prescribing physician.

  • Avoid some of the other products that can promote tinnitus, including

    • Stimulants such as caffeine and tobacco

    • Alcohol

    • Apple cider vinegar, certain sunscreens.

The guideline's main treatment statements are [3]:

  • Education and reassurance for everyone with persistent, bothersome tinnitus, including what tinnitus is and what management options exist.

  • Hearing aid evaluation for anyone with hearing loss and persistent, bothersome tinnitus (see below).

  • Cognitive behavioral therapy (CBT) is recommended. CBT does not make the sound quieter; it changes how a person reacts to it, reducing the distress, anxiety and sleep disruption it causes. In a Cochrane review of 28 studies with 2,733 participants, CBT reduced the impact of tinnitus on quality of life compared with no treatment, by about 11 points on the 100-point Tinnitus Handicap Inventory, more than the change patients notice as meaningful [5]. CBT may be delivered in person, in groups or online.

  • Sound therapy (background sound, sound generators, masking apps) is an option that many people find helpful, particularly at night [3].

  • Not recommended: routine prescription of antidepressants, anticonvulsants, anti-anxiety drugs or injections into the ear for tinnitus itself; and dietary supplements such as ginkgo biloba, melatonin or zinc, which have not been shown to work in controlled trials. Transcranial magnetic stimulation is not recommended routinely. Anxiety, depression and insomnia, which often accompany severe tinnitus, should still be treated in their own right [3].

HEARING AIDS and tinnitus

The most effective measure to minimize tinnitus worldwide is the use of hearing aids. Since about 70% of people with tinnitus that is not due to one’s heartbeat also have hearing loss, the benefit is twofold. By amplifying the sound in one’s environment, the user hears more of the sound that is present and doing so helps minimize the perception of tinnitus. Some hearing aids also have a program within them to present mild brief static noise randomly throughout the day in order to train the brain to ignore tinnitus, which is a benefit extending to times in which the hearing aids are not in use, such as while sleeping.

The evidence for hearing aids and sound generators for tinnitus comes mostly from small trials. A Cochrane review of eight studies found that hearing aids, sound generators and combination devices were each associated with a meaningful reduction in tinnitus severity, but that there were no good comparisons with no treatment, so the quality of the evidence is low [6]. For people who have hearing loss, hearing aids are still recommended because they improve hearing and communication regardless of their effect on tinnitus [3]. More on hearing aids is on the hearing treatment and tinnitus treatment pages.

ear pressure, ear infection, or Ear fluid and tinnitus

Many people have a low level of tinnitus that goes unnoticed unless something occurs to reduce hearing. When outside sounds are diminished, any low level of tinnitus may then become more apparent. Placing ear plugs or going to an especially quiet environment are scenarios this may be demonstrated. If an individual were to have fluid behind the tympanic membrane or even if the air pressure behind the tympanic membrane were significantly different from the surrounding air pressure, decreased conduction of sound waves temporarily leads to less hearing, which also can “unmask” or reveal tinnitus that is no longer out competed by other sounds.

This kind of tinnitus usually fades once the fluid clears or the pressure equalizes. Causes and treatment are covered on the ear pressure and ear infections pages.

Auditory Processing Disorder

Auditory processing disorder (APD), rarely known as King-Kopetzky syndrome or auditory disability with normal hearing (ADN), is an umbrella term for a variety of disorders that affect the way the brain processes auditory information. Individuals with APD usually have normal structure and function of the outer, middle, and inner ear (peripheral hearing). However, they cannot process the information they hear in the same way as others do, which leads to difficulties in recognizing and interpreting sounds, especially the sounds composing speech. It is thought that these difficulties arise from dysfunction in the brain.

The American Academy of Audiology notes that APD is diagnosed by difficulties in one or more auditory processes known to reflect the function of the brain. It can affect both children and adults. Its prevalence is currently estimated to be 2–7% in children in US and UK populations. APD can continue into adulthood. Cooper and Gates (1991) estimated the prevalence of adult APD to be 10 to 20%. It has been reported that males are twice as likely to be affected by the disorder as females, and that prevalence is higher in the elderly and increases with age.

The figure for adults comes from the Framingham study, where tests of central auditory processing were abnormal in a substantial share of older participants and the rate rose with age [7]. Prevalence estimates vary widely because there is no single agreed test or definition, and a systematic review found that children diagnosed with APD often have difficulties with attention, language and memory as well as listening [8]. APD is discussed further on the hearing page.

Notes on pulsatile tinnitus- categorization, cause, history, physical, testing.

Related pages on this site: tinnitus, tinnitus treatment, make the most of your tinnitus appointment, pulsatile tinnitus, jugular occlusion test for venous hum, hearing and dizziness.

Summary

  • About 1 in 7 adults has tinnitus, and about 1 in 50 has severe tinnitus [1].

  • Tinnitus is closely linked with hearing loss and noise exposure; a hearing test is recommended when tinnitus is in one ear, persistent or accompanied by hearing difficulty [3, 2].

  • Pulsatile tinnitus often has a specific vascular or middle ear cause and is usually evaluated with imaging [4].

  • Cognitive behavioral therapy has the best evidence for reducing the burden of tinnitus; hearing aids help people with hearing loss; sound therapy is an option [5, 6, 3].

  • Supplements and routine medications are not recommended for tinnitus itself [3].

References

  1. Jarach CM, Lugo A, Scala M, et al. Global Prevalence and Incidence of Tinnitus: A Systematic Review and Meta-analysis. JAMA Neurol. 2022;79(9):888-900. doi:10.1001/jamaneurol.2022.2189 PubMed 35939312

  2. Bhatt JM, Lin HW, Bhattacharyya N. Prevalence, Severity, Exposures, and Treatment Patterns of Tinnitus in the United States. JAMA Otolaryngol Head Neck Surg. 2016;142(10):959-965. doi:10.1001/jamaoto.2016.1700 PubMed 27441392

  3. Tunkel DE, Bauer CA, Sun GH, et al. Clinical practice guideline: tinnitus. Otolaryngol Head Neck Surg. 2014;151(2 Suppl):S1-S40. doi:10.1177/0194599814545325 PubMed 25273878

  4. Hofmann E, Behr R, Neumann-Haefelin T, et al. Pulsatile tinnitus: imaging and differential diagnosis. Dtsch Arztebl Int. 2013;110(26):451-8. doi:10.3238/arztebl.2013.0451 PubMed 23885280

  5. Fuller T, Cima R, Langguth B, et al. Cognitive behavioural therapy for tinnitus. Cochrane Database Syst Rev. 2020;1(1):CD012614. doi:10.1002/14651858.CD012614.pub2 PubMed 31912887

  6. Sereda M, Xia J, El Refaie A, et al. Sound therapy (using amplification devices and/or sound generators) for tinnitus. Cochrane Database Syst Rev. 2018;12(12):CD013094. doi:10.1002/14651858.CD013094.pub2 PubMed 30589445

  7. Cooper JC Jr, Gates GA. Hearing in the elderly--the Framingham cohort, 1983-1985: Part II. Prevalence of central auditory processing disorders. Ear Hear. 1991;12(5):304-11. doi:10.1097/00003446-199110000-00002 PubMed 1783233

  8. de Wit E, Visser-Bochane MI, Steenbergen B, et al. Characteristics of Auditory Processing Disorders: A Systematic Review. J Speech Lang Hear Res. 2016;59(2):384-413. doi:10.1044/2015_JSLHR-H-15-0118 PubMed 27082630

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