Tinnitus: Why that ringing in your ears won't go away
[5 min read]
In this article:
- Tinnitus becomes more common as we reach age 40, with a sharp rise after age 65.
- There are several types of tinnitus, with the most common form linked to hearing loss or damage to the auditory nerves.
- Treating the condition is challenging, but there are several effective options that can help patients find relief.
- A Providence Swedish otolaryngology and neurotology expert offers more information about the diagnosis and treatment of tinnitus.
If you’ve ever noticed a ringing, buzzing, or humming sound in your ears when everything around you is quiet, you’re not alone. That experience—called tinnitus—is surprisingly common and often misunderstood. While it’s sometimes brushed off as a minor annoyance, tinnitus can be persistent, disruptive, and difficult to treat.
“Tinnitus is poorly understood and a lot of conditions get mixed up with it, like [needing] hearing aids and such,” says neurotologist Sachin Gupta, M.D., director of the cochlear implant and acoustic neuroma programs at Providence Swedish. “The most common form, subjective tinnitus, is basically a sound that we can hear that others cannot hear.”
Is tinnitus common?
Tinnitus affects roughly 25–50 million people in the United States. Studies show it becomes more common with age, particularly after age 40, and prevalence rises sharply among adults over 65.
Noise exposure is one of the strongest risk factors for tinnitus. The condition disproportionately affects veterans and is of the most common service-related disabilities reported by former military members.
Previously, it was thought that men are slightly more likely than women to experience tinnitus, but a recent study found no discernable differences between the sexes. Women report onset or worsening symptoms during perimenopause and menopause. In fact, a 2018 study showed the reduction of tinnitus among participants who were prescribed hormone replacement therapy.
“The thinking is that estrogen decline may affect brain signaling, which causes tinnitus. The condition is also strongly affected by emotional regulation,” says Dr. Gupta. “Sleep disruption can amplify tinnitus as well.”
“It can help with symptoms but [because of hormonal fluctuation] there is not consistent improvement.”
When and how tinnitus starts
Tinnitus often develops gradually, especially alongside age-related or noise-induced hearing loss. The condition can also begin suddenly after a loud event, ear infection, head or neck injury, or medication change. Many people notice tinnitus most clearly at night or in quiet environments, when there’s less background sound to mask it.
“Most commonly, the sound doesn’t change, but the intensity does,” says Dr. Gupta. “Some days patients notice that it’s louder than others. They may also report fatigue or lack of sleep make it worse.”
“Patients also commonly describe neck pain associated with tinnitus. They describe neck pain, neck movement. Or they might describe that changing their neck position affects the sound of the tinnitus.”
For some, tinnitus fades over time. For others, it becomes chronic—defined as lasting longer than three months.
Types of tinnitus
Not all tinnitus is the same, and identifying the type can guide evaluation and treatment:
- Subjective tinnitus is by far the most common form. Only the person experiencing it can hear the sound. It’s often linked to hearing loss or damage to the inner ear and auditory nerves.
- Objective tinnitus is rare and can sometimes be heard by a clinician during an exam. It’s usually caused by physical issues such as muscle contractions or blood flow changes near the ear.
- Pulsatile tinnitus sounds rhythmic, often matching the heartbeat. This type may be related to blood vessel conditions, increased pressure in the skull, or other circulatory issues and should always be medically evaluated.
Why tinnitus is difficult to treat
One of the biggest challenges with tinnitus is that it isn’t a disease—it’s a symptom. It can signal dozens of different underlying issues, including hearing loss, ear infections, jaw disorders (TMJ), cardiovascular conditions, thyroid disease, medication side effects, or neurological changes. Tinnitus isn’t just an ear problem—it’s also a brain problem. When the auditory system loses input (for example, from damaged hearing cells), the brain may try to “fill in the gaps,” creating phantom sounds.
What treatments can help
“We don’t have a single curative therapy, but there are things we can do to lessen it or markedly decrease it—sometimes to the point where people don’t notice it,” says Dr. Gupta.
Current treatments can reduce how noticeable or distressing it feels:
- Hearing aids often help people with hearing loss by restoring sound input and reducing contrast with tinnitus.
- Sound therapy uses background noise or specialized devices to make tinnitus less prominent. This involves working with an audiologist.
- Cognitive behavioral therapy (CBT) has strong evidence for helping people cope with tinnitus by reducing stress, anxiety, and emotional reactions.
- Tinnitus retraining therapy (TRT) combines counseling with sound therapy to help the brain gradually tune tinnitus out.
- Medical treatment may be effective when tinnitus is caused by an identifiable condition, such as high blood pressure, earwax blockage, or medication side effects.
- Transcranial magnetic stimulation changes the hypersensitivity of the auditory portion of the brain, the auditory cortex.
- LENIRE is a treatment that stimulates the trigeminal nerve through the tongue while the patient is wearing headphones. The auditory stimulation helps reduce the severity of the tinnitus. It’s 30 to 60 minutes a day for several months, so it is a commitment.
What Research Is Discovering
Current research is focused on understanding how the brain and auditory nerves change in tinnitus—and how those changes might be reversed. For now, tinnitus remains a common, frustrating—but manageable—condition for most people. If ringing in your ears is persistent, worsening, or affecting your quality of life, it’s important to be evaluated to protect your hearing.
“It’s critical that if you’re going to be a round loud noise—like a concert or heavy machinery—that you wear hearing protection. Concerts can be quite loud, and that amount of time can result in hearing loss. People don’t want to wear earplugs, but deconditioning can happen [which endangers our hearing] and increases our tinnitus risk.”
Learn more and find a physician or advanced practice clinician
The experts at Swedish Otolaryngology understand that ear, nose and throat conditions can affect your ability to breathe, communicate, eat, sleep and complete other daily activities. Our team of clinicians offers advanced, evidence-based care to diagnose and treat you, and help you improve your quality of life.
Think you may be experiencing some hearing loss? See a Swedish audiologist for an evaluation if your hearing has changed. If you are exposed to loud noise regularly, get an annual hearing checkup. Learn about hearing services at Swedish or call 1-800-793-3474 for an appointment.
Whether you require an in-person visit or want to consult a doctor virtually, you have options. Contact Swedish Primary Care to schedule an appointment with a primary care provider. You can also connect virtually with your provider to review your symptoms, provide instruction and follow up as needed. And with Swedish ExpressCare Virtual, you can receive treatment in minutes for common conditions such as colds, flu, urinary tract infections and more. You can use our provider directory to find a specialist or primary care physician near you.
Information for patients and visitors
Additional resources
Newfound sounds: cochlear implants help patients hear the world, often for the first time
Understanding acoustic neuromas
Do you wear hearing aids? Here are 5 tips to help you protect them this summer
What to know about over-the-counter hearing aids
Listen up! October is National Protect Your Hearing Month
This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.
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