What causes tinnitus, and can it be treated?

Many people have experienced an occasional ringing, buzzing or roaring sound in their ears — but for people with tinnitus, these phantom noises persist, often for several weeks or months.

But what causes tinnitus? And are there ways to manage the symptoms?

Sabrina Lee, a licensed audiologist with HearUSA, a company that sells hearing aids, told Live Science that tinnitus triggers differ, but unsurprisingly, exposure to noise is a major risk factor. For example, the condition is more common in people who regularly attend loud music events and in people who experience a one-time, sudden burst of noise, like an explosion, she noted.

Lee said researchers remain unsure as to exactly what changes in the body lead to tinnitus. She believes the brain is usually the culprit, because the ears rarely show signs of malfunction in people with tinnitus and the condition can occur in people with otherwise perfect hearing. Some research suggests tinnitus may stem from subtle hearing loss that is not detectable on standard tests and that drives the brain to compensate by boosting the activity of neurons.

Related: What happens in our brains when we 'hear' our own thoughts?

That said, detectable hearing loss is frequently linked to tinnitus, and physical changes in the ear do correlate with the phantom sounds in some people. These changes include impacted earwax and Ménière's disease, a buildup of fluid in the inner ear that affects balance and hearing.

In addition, "hair cells" in the inner ear that detect sound can wear away over time and reduce hearing. "They're not able to send signals to the nerves and into the brain as well as they did before," Lee said. As it might do with more-subtle hearing loss, the brain expects to receive sound input from these sensory neurons in the ear, and when it doesn't receive it, it may compensate by generating phantom signals.

How prevalent is tinnitus, and how is it diagnosed?

Approximately 14% of adults experience tinnitus at some point in their lives. For some people, the symptoms can improve or disappear over time, but for others, they remain.

Often, there are no detectable signs of tinnitus in the ear, so a diagnosis is instead based on the symptoms the patient describes. But doctors still often examine whether the tinnitus is linked to physical changes in the ear or brain that are associated with hearing loss. They may conduct a hearing test in which patients report whether they detect sounds at different frequencies through headphones, or they may measure sound emissions that pass through the ear to determine if the hair cells are behaving normally.

What are the tried-and-true treatments for tinnitus?

Tinnitus has no cure, but there are several therapies available to help people cope with the condition. Lee reminds patients that "we are not looking to get rid of the tinnitus, but we're looking for it to go into the background."

One treatment is cognitive behavioral therapy (CBT), a type of therapy in which people challenge unhelpful thought patterns to bring about changes in behavior or mood. In tinnitus, CBT can help people think more positively about the condition and develop strategies for coping with it.

Tinnitus is often most noticeable in total silence, such as when people are trying to fall asleep, so sound therapy can help people cope. Sound therapy involves listening to noise or ambient sounds that mask the tinnitus. In much the same way a ticking watch can be heard in a silent room but not in a crowded stadium, playing sounds can sometimes drown out the bothersome phantom noises.

Which tinnitus treatments don't work?

Not all tinnitus remedies you find online are legitimate, Lee cautioned.

"I live my day-to-day on TikTok, and the amount of things I see on there is insane," she remarked. Over-the-counter ear drops marketed for tinnitus are one such bogus remedy with no scientific backing.

"A lot of tinnitus seems to be in the brain, and when you put an ear drop in your ear, that liquid can only go as far as your eardrum," she explained. "It's not getting all the way up to the brain system, and so those ear drops really aren't doing any significant change."

People have also tried repeatedly tapping the mastoid bone, the large bone just behind the ear. This may temporarily mask the phantom sounds, but the relief it brings fades once the tapping ceases, Lee said.

"A lot of people will have independent reports saying all of these things can work, and the reason why [they say that] is because tinnitus is so subjective," she said. There are myriad reasons people might report relief while using these techniques: The placebo effect might convince people that they've recovered, they could be undergoing CBT or sound therapy at the same time, or their tinnitus could naturally lapse, she said.

Lee hopes formal clinical trials will identify more effective therapies for the condition. "The world of tinnitus is wide open for innovation," she said. "I think there's tons more that could come out to help people with tinnitus; it's just the research needs to get there."

Editor's note: This story was updated at 9:20 a.m. on Feb. 29 to correct the description of HearUSA. It was first published at 5:00 a.m. the same day. 

This article is for informational purposes only and is not meant to offer medical advice.

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