There is a strange sound that some people hear which nobody else can hear.
A ringing.
A buzzing.
A humming.
A high-pitched whistle.
Sometimes it sounds like a distant electrical appliance that you can’t find.
You check the room.
Nothing.
You ask someone sitting beside you:
“Can you hear that?”
They look at you rather strangely.
“No.”
And that’s when you realise the noise is coming from inside your own ears.
This is called tinnitus.
I have had plenty of people mention it in pharmacy, often almost as an afterthought.
“By the way, I’ve got this ringing in my ear. Is there anything I can take for it?”
The answer isn’t always straightforward.
Because tinnitus isn’t really a disease in itself.
It is a symptom.
What exactly is tinnitus?
Tinnitus is when you hear a sound without an external source producing it.
It can be heard in one ear, both ears or sometimes seem to come from somewhere inside the head.
For some people it is occasional and barely noticeable.
For others, it can be constant and extremely distracting.
The sound can vary enormously.
Ringing is probably the description we hear most often, but people also describe buzzing, hissing, humming, clicking, whooshing or even music-like sounds.
And tinnitus isn’t necessarily caused by a problem with the ear itself.
Hearing involves a complicated pathway involving the ear, the auditory nerve and areas of the brain that process sound. Changes somewhere along this pathway can contribute to tinnitus. (NIDCD)
The good news is that tinnitus is usually not a sign of something serious.
But persistent tinnitus should not simply be ignored.
Why does it happen?
One of the most common associations is hearing loss.
As hearing becomes less sensitive, particularly with age, the brain receives altered sound signals and tinnitus may become noticeable.
Exposure to loud noise is another important cause.
Years of working around machinery, attending loud concerts, using headphones at high volume or simply being exposed to very loud sounds can damage the delicate structures involved in hearing.
Sometimes tinnitus appears after a particularly loud noise.
You leave a concert and your ears are ringing.
That ringing may disappear after a while.
But repeated or intense noise exposure can cause permanent hearing damage and tinnitus. (NIDCD)
This is why protecting your hearing isn’t just something for factory workers.
What about earwax?
This is one of the more satisfying causes because sometimes there is a simple explanation.
A significant build-up of earwax can block the ear canal and affect hearing.
That change in hearing can sometimes be accompanied by tinnitus.
If the problem started after your ear became blocked or your hearing suddenly became muffled, it is worth having your ears examined rather than assuming you need a supplement for tinnitus.
And please don’t start attacking your ear with cotton buds.
You can push wax further into the ear canal and potentially injure the ear.
The ear is generally quite good at cleaning itself.
It doesn’t need us poking around inside it.
Earwax and ear infections are recognised causes of tinnitus, and checking the ear canal is therefore one of the straightforward things a healthcare professional may do when investigating it. (NIDCD)
Can medicines cause tinnitus?
Yes.
This is another reason I would ask about medication history before recommending anything.
Some medicines have been associated with tinnitus, including certain antibiotics, chemotherapy medicines, NSAID painkillers such as ibuprofen and naproxen, and aspirin. The risk can depend on the particular medicine and circumstances, including dose. (NIDCD)
But this does not mean you should stop a prescribed medicine because you have developed ringing in your ears.
Speak to your pharmacist or doctor first.
The medicine may be essential, and there may be another explanation.
A proper medication review is much safer than stopping treatment yourself.
Why is it worse at night?
This is something I hear quite often.
During the day, there is noise everywhere.
Cars.
Television.
People talking.
Fans.
Air conditioning.
Traffic.
Your brain has plenty of other sounds to process.
Then you go to bed.
The house becomes quiet.
And suddenly:
eeeeeeeeeeeeee…
There it is.
The tinnitus hasn’t necessarily become louder.
You simply notice it more because there is less external sound competing for your attention.
Some people find that having quiet background sound — such as gentle music, a fan or a sound generator — makes the tinnitus less intrusive at night. Sound therapy is one approach used to help people manage tinnitus. (NIDCD)
Complete silence isn’t always your friend.
Stress can make it feel worse
This is another frustrating part of tinnitus.
You notice the sound.
It annoys you.
You start concentrating on it.
You become anxious about it.
That makes you notice it even more.
And suddenly the tinnitus seems louder.
Stress and poor sleep can make tinnitus more intrusive for some people.
That doesn’t mean the tinnitus is imaginary.
The sound is real to the person experiencing it.
But how much attention the brain gives that sound can influence how distressing it becomes.
This is why approaches that help people reduce the distress and impact associated with tinnitus can be useful.
Cognitive behavioural therapy, for example, is one of the approaches used to help people cope with persistent, troublesome tinnitus. (NIDCD)
Is there a tablet that will make it disappear?
This is where I would be cautious.
People often ask about vitamins, minerals and herbal products marketed specifically for tinnitus.
There is no magic tinnitus tablet that reliably makes tinnitus disappear.
Some products are heavily advertised with claims that sound very impressive.
“Cures ringing ears.”
“Restores hearing.”
“Flushes toxins.”
I would be very sceptical.
If somebody is selling you a miracle cure for a symptom that can have many different causes, my pharmacist alarm bells start ringing.
The National Institute on Deafness and Other Communication Disorders notes that although vitamins, herbal extracts and dietary supplements are commonly marketed as tinnitus cures, none has been proven to be effective for treating the condition. (NIDCD)
The important thing is to establish why the tinnitus is happening and whether there is an underlying hearing or medical problem that needs attention.
When should you get it checked?
If tinnitus is persistent, particularly if it is interfering with sleep, concentration or everyday life, speak to your doctor or an audiologist.
A hearing assessment can be particularly useful if you have noticed that your hearing isn’t as good as it used to be.
The NHS advises seeing a GP if tinnitus is regular or constant, getting worse, or affecting sleep, concentration or emotional wellbeing. (nhs.uk)
There are also certain forms of tinnitus that deserve quicker medical assessment.
One ear is different
If the tinnitus is consistently present in only one ear, particularly if it is persistent, it should be assessed.
The reason isn’t that one-sided tinnitus automatically means something serious.
It is simply a pattern that may need further investigation rather than being dismissed.
Then there is pulsatile tinnitus
This is when the sound seems to beat in time with your heartbeat.
People often describe it as a whooshing or pulsing noise:
“Whoosh… whoosh… whoosh…”
That is different from ordinary ringing tinnitus.
Because pulsatile tinnitus can sometimes be associated with blood-flow or vascular problems, it should be medically assessed. The NHS specifically recommends urgent GP assessment when tinnitus beats in time with your pulse. (nhs.uk)
When is it an emergency?
This is the part I would particularly want people to remember.
Sudden hearing loss accompanied by tinnitus needs urgent medical assessment.
Don’t simply wait several weeks hoping it will return to normal.
The NHS advises emergency assessment when tinnitus occurs with sudden hearing loss, facial weakness or vertigo. Tinnitus following a head injury also requires emergency assessment. (nhs.uk)
Similarly, sudden neurological symptoms such as facial weakness, difficulty speaking or weakness affecting one side of the body should never be put down to “just tinnitus”.
These are situations where you should seek urgent medical help.
What can actually help?
The right approach depends on the cause.
If earwax is responsible, treating the blockage may solve or improve the problem.
If hearing loss is present, hearing aids can sometimes make tinnitus less noticeable by improving the sounds around you. (NIDCD)
For people whose tinnitus is persistent and distressing, psychological therapies such as CBT may help reduce the impact it has on everyday life. Sound-based approaches can also help some people.
Good sleep habits, managing stress and avoiding prolonged exposure to loud noise are sensible measures too. (NIDCD)
And if you have significant hearing loss, don’t simply accept:
“I’m getting old. There’s nothing you can do.”
There may be.
Protect the hearing you still have
This is probably the part we don’t take seriously enough.
Once hearing is damaged, we cannot simply assume that a supplement or tablet will restore it.
So prevention matters.
Turn the volume down.
Give your ears a break from loud environments.
Move away from very loud noise where possible.
Use appropriate hearing protection when exposed to loud machinery, tools or other high noise levels.
And be careful with headphones.
If somebody standing beside you can hear exactly what you’re listening to through your headphones, that’s probably a sign the volume is too high.
The louder the noise and the longer you are exposed to it, the greater the risk of hearing damage. (NIDCD)
The good news
For many people, tinnitus is not a sign of something dangerous.
It may be related to age-related hearing changes, previous noise exposure, earwax or another relatively straightforward cause.
But persistent tinnitus shouldn’t simply be dismissed.
Especially if it is only on one side, beats with your heartbeat, or is associated with sudden hearing loss, significant dizziness, facial weakness or other neurological symptoms.
And perhaps the biggest mistake is assuming:
“It’s just ringing in my ears. I’ll take a vitamin and see what happens.”
Sometimes the answer really is that simple.
Sometimes it isn’t.
Your ears are doing something remarkable every second of the day — converting vibrations in the air into the sounds you experience as speech, music, traffic and conversation.
We tend to notice them only when something goes wrong.
So if your ears suddenly start talking to you when nobody else can hear them, don’t panic.
But don’t automatically ignore them either.
Listen to what they’re telling you.
Until next time, protect your hearing — because you don’t appreciate how precious it is until you start losing it.
This article is for general health education and is not intended to diagnose or treat an individual medical condition. Anyone with persistent, worsening or troublesome tinnitus should seek appropriate medical or audiological assessment.
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