man wearing a hearing aid due to Hearing Loss or Tinnitus

Tinnitus

Tinnitus

Last Section Update: 08/2023

Contributor(s): Maureen Williams, ND; Shayna Sandhaus, PhD; Stephen Tapanes, PhD; Franco Melis

Table of Contents

  1. What is Tinnitus?
  2. The Experience of Tinnitus
  3. What are the Main Risk Factors for Tinnitus?
  4. How is Tinnitus Diagnosed?
  5. What Causes Tinnitus?
  6. Nutrients
  7. How is Tinnitus Treated?
  8. Dietary & Lifestyle Changes for Tinnitus
  9. Tinnitus: Frequently Asked Questions
  10. Update History
  11. References

1 What is Tinnitus?

Tinnitus is the perception of sound for which there is no identifiable corresponding sound source.1,2 It is often described as “ringing” in the ears, but does not necessarily involve a ringing sound. Tinnitus may be perceived as buzzing, hissing, grinding, or other similar sounds.3 While not a disease itself, chronic tinnitus is almost always a symptom of an underlying condition.4

An estimated 10–30% of adults have tinnitus, and the prevalence increases with age.2,5,6 In addition to older age, tinnitus is more likely in those with hearing loss, a history of loud noise exposure, and head or neck trauma.5,7,8

Although many people with tinnitus are not bothered by it, some tinnitus sufferers experience co-occurring symptoms such as anxiety, depression, insomnia, diminished hearing, or increased hearing sensitivity that diminish their quality of life.2 While emotional distress may be directly related to the perception of chronic noise in the ears,9 tinnitus may also interfere with normal sleep patterns, which could eventually contribute to cognitive and emotional problems.10

Although chronic tinnitus is not curable, several treatment strategies can help improve quality of life for people with tinnitus. The approach to treatment depends on the individual but may include cognitive behavioral therapy, hearing aids, various types of sound therapy, neuronal modulation, medication, or cochlear implants. In addition, nutritional supplements like ginkgo, melatonin, coenzyme Q10, zinc, and vitamin B12 have all shown positive effects as part of tinnitus treatment.

2 The Experience of Tinnitus

People with tinnitus perceive sound in one or both ears or in the head, despite the lack of an identifiable sound source. Various words can describe the phenomenon of tinnitus, including ringing, buzzing, whistling, hissing, rushing, crackling, beeping, or simply an unpleasant sound. The sound may be simple, as in a single tone, or complex, including multiple tones, and can change markedly from moment to moment. Although as many as 30% of individuals are estimated to experience tinnitus, only about 5% of adults report having troublesome tinnitus that negatively impacts their day-to-day life.11

The experience of tinnitus can vary substantially between people and with underlying cause; therefore, tinnitus is generally described and categorized according to its characteristics (Table 1). Most cases of tinnitus are subjective, chronic, non-pulsatile, tonal, and bilateral.

Table 1: Tinnitus Subtypes and Characteristics2,12-14
Type, by opposing characteristics Description
Primary vs. Secondary

Tinnitus with no readily identifiable cause aside from age-related hearing loss or noise-induced hearing loss is said to be “primary” tinnitus. Primary tinnitus is the more common type.

Tinnitus that can be attributed to an underlying cause other than hearing loss (age-related or noise-induced) is called “secondary” tinnitus. For instance, secondary tinnitus might be due to an infection, metabolic or neurological disease, head or neck injury, or medication use.

Subjective vs. Objective

Subjective tinnitus is strictly phantom sound perception. This is the main focus of this Protocol.

Objective tinnitus is actual noise produced inside the body by anatomic or physiologic phenomena and can be heard by an outsider.

Peripheral vs. Central

Peripheral tinnitus is caused by dysfunction of the peripheral auditory system (ie, the cochlea of the inner ear).

Central tinnitus is caused by dysfunction in the central auditory system of the brain.

Chronic vs. Acute

Tinnitus lasting for three months or longer is generally considered chronic. This Protocol is focused on chronic tinnitus.

Acute tinnitus usually refers to tinnitus that resolves on its own in less than three months.

Non-pulsatile vs. Pulsatile

In most cases of hearing loss or noise-induced tinnitus, the perceived sound is non-pulsatile (not pulsating), but some neurologic disorders can also cause non-pulsatile tinnitus. This Protocol is mainly about non-pulsatile tinnitus.

The perception of a pulsating sound (often described as rhythmic “thumping” or “whooshing”) can be an indicator of an underlying vascular problem, such as intracranial hypertension, systemic hypertension, or a vascular malformation or tumor. It can also be due to muscular contractions in or around the ears.

Tonal vs. Non-tonal

Tonal tinnitus, which is the more common type, involves tonal sounds such as ringing, whistling, or buzzing.

Non-tonal tinnitus involves non-tonal sounds such as crackling, clicking, or rumbling.

Constant vs. Intermittent

Constant tinnitus never abates.

Intermittent tinnitus includes periods without symptoms.

Bilateral vs. Unilateral

Bilateral tinnitus is experienced on both sides.

Unilateral tinnitus is experienced on one side only. Because unilateral tinnitus can be a symptom of stroke, tumor, or neurological disease, these possible causes should be investigated.

Subjective data collected from tinnitus sufferers indicates tinnitus loudness and related distress are increased during the nighttime and early morning hours.15 Tinnitus loudness has been closely correlated with tinnitus distress. Furthermore, the relationship between tinnitus loudness and the distress it causes appears to be stronger in the context of intense emotions, negative emotions, and high stress levels.16,17

In a study of 49 patients seeking care for tinnitus with a duration of less than 28 days, only nine (18.4%) became tinnitus-free within three to six months.18 Little is known about the progression of chronic tinnitus over time, but evidence suggests most tinnitus sufferers experience some gradual improvement.18,19 In chronic tinnitus sufferers for whom this type of improvement or habituation does not occur, it is thought anxiety triggered by tinnitus causes reinforcement of tinnitus perception, leading to more anxiety in a vicious cycle of distress and tinnitus.2

A meta-analysis that examined long-term outcomes in subjects assigned to “no intervention” or “waiting list” groups in controlled trials for tinnitus treatments showed self-reported measures of tinnitus improved over time. Tinnitus has been reported to resolve completely after years or even decades of persistence in some cases, but this appears to be rare.19

In an observational study that included 388 patients seen in a chronic tinnitus clinic (most of whom had tried at least one type of tinnitus treatment), a follow-up survey administered about one to six years later showed tinnitus distress had generally diminished. Improvements were seen in patient ratings of tinnitus severity, annoyance, unpleasantness, and discomfort; however, the characteristics of the tinnitus, presence of depression, and ratings of quality of life and overall health were unchanged.20 In another study, 300 patients who had received various individualized treatments (eg, hearing aids and internal or external sound generators) at a tinnitus clinic answered a questionnaire at their first clinic visit and again between six and 36 months later. The results indicated overall reductions in tinnitus loudness and severity, as well as tinnitus-related anxiety and the presence of depression. Patients whose sleep improved had greater reductions in tinnitus severity compared with those who continued to suffer from insomnia.21 On the other hand, a study that followed 4,746 individuals with tinnitus for four years found 18.3% of cases resolved, 9% improved, 9% worsened, and about 64% experienced no change,22 and a study in which a questionnaire was administered to 528 tinnitus patients found 25% reported the severity of their tinnitus had increased since its onset.23

3 What are the Main Risk Factors for Tinnitus?

Tinnitus is a symptom that has been associated with a number of factors and conditions. The most strongly correlated risk factors include4,24:

  • Hearing loss. Hearing loss is a well-established risk factor for tinnitus.7,24 Approximately 68% of individuals with tinnitus have some degree of hearing loss; in addition, tinnitus has been reported to be a symptom in 48% of people with hearing loss.4,7 The link between hearing loss and tinnitus has been suggested to be due to a compensatory effect: the brain compensates for decreased activation of the auditory nerve (which carries signals from the cochlea to the brain) by increasing “gain” or signal amplification in the auditory system of the brain, as well as decreasing auditory signal inhibition, which may result in tinnitus and possibly hypersensitivity to noise.2,25 Individuals with tinnitus should undergo a hearing test.
  • Older age. Older individuals have an increased risk of tinnitus.26 This may be due in part to age-related changes in cochlear structures and nerve function and connectivity.26,27 Older people are also more likely to experience tinnitus-related distress.28
  • Chronic and/or high-intensity noise exposure. Long-term exposure to loud noise, whether at work or during leisure activities (eg, listening to loud music, live or through headphones), is well known to increase the chance of developing tinnitus, but evidence also shows even a single exposure to extremely loud noise, such as during military combat, can cause chronic tinnitus.24 In fact, tinnitus is one of the most common disabilities among veterans.29 Workers in music and construction industries have also been found to have higher rates of tinnitus than those in quieter fields.30
  • Physical trauma. Ear, head, and neck trauma are frequently associated with tinnitus. As many as 53% of individuals who have experienced traumatic brain injury develop tinnitus.8
  • Smoking. A history of smoking has been shown to increase the risk of developing tinnitus.31
  • History of ear infections. Chronic ear infection (otitis media) in childhood has been linked to increased risk of tinnitus in adulthood.32

Conditions Associated with Tinnitus

Tinnitus is a common symptom of conditions affecting the ears, such as:

  • Ménière disease, an inner ear disorder thought to be caused by abnormal ear fluid pressure33
  • Otosclerosis, a familial condition marked by abnormal growth and stiffening of the small bones in the middle ear34
  • Middle ear muscle spasms, which may occur without a known cause or may be due to an underlying condition such as multiple sclerosis35,36
  • Eustachian tube dysfunction, in which the tube that connects the middle ear to the throat does not maintain normal openness and function,37 possibly due to middle ear muscle spasms38
  • Temporomandibular joint (TMJ) disorders, which affect the joint(s) between the skull and the jawbone, in front of the ear(s)39
  • Acoustic neuroma, a benign tumor that occurs on the auditory or vestibular nerve (the two components of the vestibulocochlear nerve, or cranial nerve 8)40
  • Vascular disorders, such as atherosclerosis or vascular malformations, and anemia may be indicated by the presence of tinnitus, particularly pulsatile tinnitus41-43

In addition, a range of health conditions not directly related to the ears have been associated with tinnitus. These include:

  • Depression, anxiety, and high stress level. Tinnitus can be a trigger of mental distress leading to depression and anxiety.6,26,44 In addition, individuals with depression, anxiety, and stress may have a higher risk of tinnitus.45 The timing of tinnitus onset or worsening is frequently reported to coincide with times of high stress or periods of chronic stress.46
  • Sleep disturbance. Poor sleep quality has been reported by people with tinnitus, especially those with severe tinnitus.44,47 It is thought that tinnitus-related brain activity may interfere with sleep, while at the same time, deep sleep may help to suppress tinnitus.10 Some evidence suggests loud snoring in people with sleep apnea (a condition characterized by bouts of interrupted breathing during sleep and often accompanied by snoring) can contribute to the onset of tinnitus.48
  • Autoimmune conditions. Individuals with autoimmune disorders (eg, rheumatoid arthritis and systemic lupus erythematosus [SLE]) appear to have a higher incidence of hearing loss and tinnitus than the overall population.49 In addition, autoimmune processes can affect the inner ear alone, triggering chronic inner ear inflammation, hearing loss, and tinnitus without other systemic symptoms.50
  • Thyroid disease. The incidence of tinnitus was reported to be higher in patients with hypothyroidism, especially those who were older and those who also had vertigo, insomnia, anxiety, or hearing loss.51
  • Migraines. Some migraine sufferers experience intermittent tinnitus during migraine episodes.52 In addition, a review of observational studies indicated tinnitus was more likely among migraine sufferers, and migraine was more common in those with tinnitus, suggesting a possible common mechanism.53
  • Metabolic diseases. Tinnitus has been correlated with poor health in general, and metabolic diseases in particular show increased likelihood of co-occurring with tinnitus.
    • Hyperlipidemia. One study in 300 patients found individuals with high lipid (cholesterol and triglyceride) levels were twice as likely to have tinnitus as those with normal lipid levels.54 Another study found total cholesterol, LDL-cholesterol, and triglyceride levels were higher in 91 participants with tinnitus than in 65 healthy controls.55 In addition, some clinical evidence suggests using statin medications to lower lipid levels may improve the subjective experience of tinnitus.56,57
    • High blood pressure. Pulsatile tinnitus can be a symptom of intracranial hypertension, a potentially life-threatening emergency,58,59 but the relationship between tinnitus and systemic high blood pressure is less clear. Some evidence indicates high blood pressure is more common in those with than without tinnitus; however, tinnitus does not appear to occur more frequently in those with high blood pressure.60-62
    • Diabetes. Patients with diabetes have an increased risk of tinnitus, as well as hearing loss, due to damage to the small blood vessels of the inner ears.63
    • Obesity. Obesity is a risk factor for idiopathic (of unknown cause) intracranial hypertension, which is often marked by pulsatile tinnitus.59 Observational evidence has also indicated a higher risk of tinnitus in obese subjects more generally.64 One study in 83 teachers found a correlation between worsening tinnitus-related disability and rising body mass index (BMI).65 Furthermore, weight loss through diet and exercise has been found to improve tinnitus in clinical trials.66,67
    • Chronic kidney disease. Observational research has indicated people with chronic kidney disease may be more likely to have a previous diagnosis of tinnitus than controls.68 Chronic kidney disease patients have also been found to have a higher risk of developing tinnitus, as well as hearing loss.69 One study that examined the blood biochemistries of 200 people with tinnitus found approximately 50% had a low glomerular filtration rate (GFR), indicating poor kidney function.70

4 How is Tinnitus Diagnosed?

Because tinnitus is a perception disorder, there is currently no objective test to diagnose the condition. However, there are various tests and protocols audiologists can use to help evaluate and diagnose tinnitus.71 Questionnaires may be used to assess the effects and burden of tinnitus on daily life.71,72

The diagnostic workup for tinnitus begins with a comprehensive medical history evaluation. This will include a medication review and physical exam to identify treatable causes of tinnitus or danger signs in the nature of the tinnitus, such as if it is sudden onset, pulsatile, unilateral or asymmetric, or accompanied by hearing loss or other neurological changes. If danger signs are observed, immediate evaluation may be needed. Imaging tests may be ordered in cases with red flag signs; however, in patients with non-pulsatile bilateral tinnitus, with or without symmetric hearing loss, and an otherwise normal history and physical exam, imaging is not necessary.12

A comprehensive audiological exam may be appropriate in patients with tinnitus lasting six months or longer, those with one-sided tinnitus, accompanying hearing changes, and tinnitus-related distress.12 During audiological testing, the patient generally listens for and indicates when they hear tones of various frequencies and intensities, which may be transmitted through the air or through headphones. Such testing assesses the function of the middle and inner ear structures and can help detect and quantify hearing loss. It can also be used to identify tinnitus pitch, loudness, and other qualities that could help guide therapy.71,72

“Red-Flag” Manifestations of Tinnitus

Although most cases of tinnitus are related to non-urgent causes, acute tinnitus can be a symptom of a critical health problem requiring emergency care, such as stroke, hypertensive crisis, carotid artery dissection (tearing of the arterial wall), tumor, brain injury, aneurysm, or hemorrhage.2,73

Tinnitus that is abrupt in onset, pulsatile, and one-sided; accompanied by acute hearing loss or any neurological change; or accompanied by audible vascular sounds (often described as a rhythmic “thumping” or “whooshing” sound) is a red flag for a dangerous underlying cause.2 Tinnitus meeting any of these descriptions should be urgently investigated.

5 What Causes Tinnitus?

The cause of primary tinnitus is not known, but is thought to be multifactorial, involving multiple physiologic and possibly genetic mechanisms.4 Dysfunction of the cochlea (the inner ear structure responsible for turning vibrations into nerve signals), abnormal nerve signaling in the brain auditory system, or a combination of the two play a key role in tinnitus onset and persistence.4,74 In addition, networks that connect the auditory system with other brain regions may become involved. For example, activation of the limbic and paralimbic systems, which are responsible for behavioral and emotional responses, are thought to contribute to distress signaling and complications of tinnitus, such as cognitive, mood, and sleep disorders, in some individuals.2,75,76

Damage to hair cells in the cochlea has been suggested to trigger the onset of tinnitus in many cases. Hair cells detect movement in the environment and transform it into auditory and vestibular nerve signals, and can be damaged by factors such as aging, noise trauma, and toxicity.26,74 It is thought damaged hair cells release excessive amounts of glutamate, the main excitatory neurotransmitter, causing dysfunctional nerve activation that can result in tinnitus.26 Simultaneous increased activation of multiple auditory system nerve fibers is believed to be an important mechanisms underlying tinnitus. Loss of nerve transmission inhibition, leading to increased excitability of nerve fibers involved in auditory perception, may also play a role. Another possible contributing mechanism is maladaptive neuroplasticity, in which neuronal pathways adapt and conform pathologically to changes in auditory system nerve signaling.75

In secondary tinnitus, a known cause exists. Examples of causes of secondary tinnitus include12:

  • Vascular conditions that generate an internal perceivable sound
  • Musculoskeletal causes, such as head or neck injury or temporomandibular joint dysfunction
  • Use of ototoxic medications
  • Bacterial, viral, or fungal infections
  • Trauma to the auditory structure, such as the ear drum
  • Earwax impaction or improper earwax cleaning procedures77,78
  • Metabolic disturbance, such as diabetes or imbalanced lipid levels
  • Neurological conditions, such as intracranial hypertension or vestibular migraine
  • Other problems affecting the outer and middle ear, such as cerumen impaction, tumors, fusing of the middle ear bones, or dysfunction of the tympanic membrane or eustachian tubes

Medications that Can Cause Tinnitus

Many medications are known to have toxic effects on auditory tissues and can cause or worsen tinnitus (Table 2), especially when used long-term and/or at high doses. For most of these medications, tinnitus is an uncommon or rare potential side effect; nevertheless, if you experience tinnitus and are taking any of these medications, check with your doctor to see if your medications may be contributing to your tinnitus.12,79

Table 2: Medications that Can Cause Tinnitus
Medications Examples
Non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics80,81
  • Aspirin (although regular use of low-dose aspirin does not appear to be linked to tinnitus)
  • Acetaminophen (Tylenol)
  • Ibuprofen (Advil)
  • Naproxen (Aleve)
  • Indomethacin (Indocin), and others
Some blood pressure-lowering drugs60,81
  • Propranolol (Inderal)
  • Diuretics like hydrochlorothiazide (HCTZ, Microzide) and furosemide (Lasix)
  • Angiotensin converting enzyme inhibitors (ACEi) like lisinopril (Prinivil), enalapril (Vasotec), and ramipril (Altace)
  • Calcium channel blockers like amlodipine (Norvasc), diltiazem (Cardizem), and nifedipine (Procardia)
Phosphodiesterase type 5 inhibitors12
  • Sildenafil (Viagra)
  • Tadalafil (Cialis)
Some antibiotics81
  • Erythromycin (Erythrocin)
  • Azithromycin (Zithromax)
  • Neomycin
  • Streptomycin
  • Tobramycin (Tobrex)
  • Chloramphenicol (Chloroptic)
  • Doxycycline (Adoxa)
  • Minocycline (Minocin), and others
Some antiviral drugs12
  • Ribavirin (Rebetol)
  • Sofosbuvir (Sovaldi)
  • Telaprevir (Incivek)
Antimalarial drugs12,79,82
  • Quinine (Qualaquin)
  • Chloroquine (Aralen)
  • Hydroxychloroquine (Plaquenil)
Some antiseizure drugs12
  • Pregabalin (Lyrica)
  • Carbamazepine (Tegretol)
Immune suppressants12
  • Cyclosporine (Sandimmune)
  • Interferons, and others
Some anticancer drugs12,79,81
  • Cisplatin (Platinol)
  • Carboplatin (Paraplatin)
  • Oxaliplatin (Eloxatin)
  • Cyclophosphamide (Cytoxan)
  • Methotrexate (Trexall)
  • 5-fluorouricil (Adrucil)
  • Doxorubicin (Adriamycin)
  • Monoclonal antibodies like trastuzumab (Herceptin), and others
Oral contraceptives83
  • Combined oral estrogen-progesterone contraceptive pills
Miscellaneous drugs12
  • Antiarrhythmics
  • Dopamine agonists
  • Proton pump inhibitors
  • Anesthetics
  • Bupropion (Wellbutrin)
  • Risedronate (Actonel)
  • Varenicline (Chantix)

Headphone Use and Tinnitus

Listening to music through personal listening devices paired with headphones or earphones is increasingly common, but studies have shown listening to music through headphones can easily expose the listener to noise trauma-inducing sound levels.84 Frequent exposure to loud music, including through headphones, can cause auditory system damage that may lead to tinnitus and hearing loss.85

A systematic review found more than 58% of adolescents and young adults participating in 26 studies exceeded safe daily noise exposures by listening to loud music through headphones, and this habit was correlated with signs of damage to the auditory system.86

According to the U.S. National Institute for Occupational Safety and Health, there are two easily detectible signs that music–or any noise–levels are unsafe87:

  • If you have to raise your voice to talk to someone who is an arm’s length away because of the music or noise
  • If your ears are ringing or sounds seem dull or flat after the music or noise stops

In general, sounds that are at or below 70 A-weighted decibels (dBA, the unit used to describe loudness specifically for humans) are considered safe, while sounds at or above 85 dBA are more likely to cause damage over time. For context, gas-powered leaf blowers, lawn mowers, and city traffic (from inside a car) generate a noise level of 80–85 dB. Alarmingly, many headphones/earbuds/speakers can reach 94–110 dBA at their maximum volume. Fortunately, most modern phones and other listening devices have settings that allow the user to limit the maximum decibel output of their device.

Sound intensity chart

6 Nutrients

Ginkgo

Ginkgo (Ginkgo biloba) leaves are widely used to enhance peripheral and cerebral blood flow and support brain health. Preclinical evidence suggests ginkgo has positive effects on tinnitus.88 For example, a study using an animal model of noise trauma-induced hearing loss and tinnitus found treatment with ginkgo restored hearing, reduced tinnitus-related behaviors, and normalized brain signaling.89

In a randomized controlled trial, 33 participants with tinnitus and hearing loss were treated for 90 days with 240 mg of ginkgo extract, hearing aids, or both; all three treatments led to reduced tinnitus loudness and severity after 90 days, and ginkgo was effective regardless of tinnitus duration.90 In another controlled trial, 86 tinnitus patients received either a single intratympanic injection of caroverine (Tinnitin) (a glutamate-blocking muscle-relaxing drug used in Austria and Switzerland to treat tinnitus), oral ginkgo extract for three months, a placebo injection, or oral placebo for three months. The dosage of gingko used in this study was 60 mg twice daily. Both ginkgo and caroverine were more effective than placebo. The initial response rate to caroverine was a bit better than that to ginkgo, but the response rates converged by six months. The authors concluded that, for severe tinnitus, an initial treatment with caroverine is warranted, followed by twice daily ginkgo for three months to provide lasting relief.91 In a three-month trial, 90 subjects with tinnitus were treated with ginkgo extract (60 mg twice daily), betahistine (Serc), or trimetazidine (Vastarel) (a drug that dilates coronary and other peripheral blood vessels, but is not available in the United States); all three treatments led to significant reductions in tinnitus severity, but ginkgo had the smallest effect.92

Despite a number of clinical trials finding ginkgo had positive effects on tinnitus, some clinical trials have found no benefit.93 A meta-analysis published in 2004 of findings from randomized placebo-controlled trials found 21.6% of subjects with tinnitus who were given ginkgo improved, while 18.4% of those given placebo improved, a difference that was not statistically significant.94 More recent reviews of the contradictory findings have concluded that ginkgo is not likely to be consistently beneficial as a treatment for tinnitus, although certain individuals may experience improvement.93,95

Individuals with tinnitus who also have dementia may be particularly likely to benefit from treatment with ginkgo. One analysis used pooled data from five randomized placebo-controlled trials in which ginkgo, at 240 mg daily for 22–26 weeks, was tested as a therapy for dementia; the analysis found, in a subset of 773 participants with tinnitus, ginkgo was more effective than placebo for reducing tinnitus severity.96 A similar study examined data from three randomized placebo-controlled trials investigating the effects of ginkgo extract, at a dose of 240 mg daily for 22–24 weeks, in subjects with mild-to-moderate dementia along with anxiety or depression; this study found, in the 594 participants who had tinnitus, ginkgo extract reduced tinnitus severity, reduced anxiety and depression, and improved cognition. After analyzing the data, the study authors estimated 60% of ginkgo’s effect on tinnitus was due to direct effects while the remaining 40% of its effect was related to improved mood and cognitive function.97

Melatonin

Melatonin is a hormone that regulates circadian cycles and scavenges free radicals.98 Melatonin is thought to reduce tinnitus by protecting hair cells (sensory cells in the ear responsible for hearing) from oxidative damage, promoting normal blood flow to inner ear structures, relaxing ear muscles, attenuating depression and anxiety, inhibiting the stress response, and supporting normal sleep patterns.99,100 Preclinical evidence suggests melatonin protects ear tissues against the ototoxic (toxic to the ear) effects of certain medications.101 In an observational study that included 139 elderly subjects, blood melatonin levels were lower in those with tinnitus than those without tinnitus.102

A review of the clinical evidence found melatonin therapy can improve sleep in individuals with tinnitus, but was unable to determine conclusively whether it can improve tinnitus.103 In one randomized clinical trial in 70 volunteers with chronic tinnitus, both 3 mg of melatonin daily and a standard dose of sertraline (Zoloft) (an antidepressant medication) for three months reduced tinnitus severity, but melatonin was more effective.104 Another randomized controlled trial in 60 subjects with acute tinnitus (of three months or shorter duration) found intratympanic dexamethasone enhanced the effectiveness of melatonin after three months of therapy.105

A combination of melatonin and sulodexide has been tested as a therapy for tinnitus. Sulodexide is a naturally occurring compound composed of heparin sulfate and dermatan sulfate. It is derived from the intestinal mucosa of pigs and is used in some parts of the world to prevent venous blood clots and treat chronic disorders of the veins.106 In an uncontrolled trial that included 30 tinnitus patients treated with 3 mg of melatonin nightly plus sulodexide twice daily, tinnitus improved in 90% of participants after 80 days of treatment.107 A randomized controlled trial included 102 tinnitus patients who received either melatonin (3 mg nightly) plus sulodexide, melatonin (3 mg nightly) alone, or no treatment for 80 days. Both treatment regimens resulted in tinnitus improvement compared with no treatment, but melatonin plus sulodexide was found to be more effective than melatonin alone.108

Coenzyme Q10

Coenzyme Q10 (CoQ10), an antioxidant enzyme needed for cellular energy production, has demonstrated anti-inflammatory, neuro-protective, cardio-protective, and other health-promoting properties.109 An observational study that included 200 participants with tinnitus found 38.5% had decreased blood levels of CoQ10.70 In addition, a clinical trial in 20 individuals with tinnitus found supplementing with CoQ10 (300 mg per day of ubiquinone formulated with ethyl alcohol and lecithin) for 12 weeks led to reductions in scores on a tinnitus questionnaire in a subset of participants whose blood CoQ10 levels were low at the beginning of the trial.110

Supplementing with CoQ10 has been shown to protect hair cells from noise trauma in animals and shorten the time needed for hearing recovery after experimental exposure to loud noise in humans.111,112 Taking a water-soluble CoQ10 (160 mg) plus other nutrients (B vitamins, vitamin E [36 mg], choline [100 mg], melatonin [1 mg], ginkgo phytosome [80 mg], and milk protein hydrolysate [150 mg]) appeared to protect against hearing damage and tinnitus in a pilot trial that included 26 cancer patients being treated with cisplatin (Platinol), a chemotherapy agent known to have ototoxicity.113 This same combination, but with 5 mg of melatonin, was given to 30 individuals in a separate clinical trial and was found to reduce duration of noise-induced tinnitus and shorten the time to hearing recovery after a 10-minute exposure to loud noise. The participants in this trial took the formulation once daily for 30 days and the second test occurred after the 30-day supplementation period.112

Zinc

Zinc is a micronutrient involved in numerous biological processes and found throughout the body.114 Among other things, it is necessary for normal immune function, control of oxidative stress, and modulation of the responsiveness of brain neurons.114,115

A study with 200 participants with tinnitus found zinc levels were low in 30.6% of the men in the study but not in the women.70 Another study that included 100 tinnitus patients found zinc levels declined with aging and low levels were associated with increased tinnitus loudness and severity.116 Nevertheless, several large observational studies have found, overall, that blood zinc levels were not significantly decreased in tinnitus sufferers.117,118

Clinical trials investigating zinc’s effects on tinnitus have yielded mixed results. An uncontrolled preliminary trial examined the effect of zinc on tinnitus and hearing in 20 individuals with noise-induced hearing loss and chronic tinnitus, 18 (90%) of whom continued to be exposed to loud noise in their work environment during the trial. After supplementing with 156 mg zinc gluconate (providing 20 mg of elemental zinc) twice daily for two months, scores on a standardized assessment of the impact of tinnitus on quality of life were found to have improved significantly in 17 (85%) of participants; however, zinc therapy had no effect on tinnitus loudness or intensity and did not improve hearing.119 Similarly, a randomized controlled trial in 41 tinnitus patients found 50 mg of zinc daily for two months resulted in reduced subjective assessment of tinnitus severity in 82% of those receiving zinc, but there was not a statistically significant reduction in tinnitus loudness.120 Several other trials have found zinc did not have a significant effect on tinnitus.121-123

Vitamin B12 and Other B-Complex Vitamins

Vitamin B12 is needed for healthy function of nerves and blood vessels, and B12 deficiency can cause nerve damage resulting in a range of neurological symptoms, including tinnitus.124 Low vitamin B12 levels and intake have been associated with increased risk of tinnitus in observational studies.102,125 In a study that included 113 military personnel exposed to loud noise, B12 deficiency was detected in 47% of those with tinnitus plus noise-induced hearing loss, 27% of those with noise-induced hearing loss only, and 19% of those with normal hearing, suggesting B12 deficiency may be associated with risk of developing tinnitus.126

In a randomized controlled trial, 40 patients with tinnitus (17 of whom also had vitamin B12 deficiency with levels below 250 pg/mL) were treated with weekly intramuscular injections providing 2,500 mcg vitamin B12 or saline (placebo) for six weeks. Vitamin B12 injections were found to improve tinnitus in those with B12 deficiency.127 Another clinical trial in 50 patients with tinnitus, half of whom also had hearing loss, found treatment with intramuscular injections providing 100 mg vitamin B1, 100 mg vitamin B6, and 1,000 mcg vitamin B12 twice weekly led to tinnitus improvement mainly in those without hearing loss.128 However, another small uncontrolled trial found that B12 replacement therapy did not improve tinnitus regardless of baseline B12 status.129

Korean Red Ginseng

Korean red ginseng (Panax ginseng, also known as Chinese or Asian ginseng) has been used in traditional herbal medicine throughout Asia to treat a broad range of health conditions including fatigue, stress, and age-related ailments. Extracts from ginseng have demonstrated immune-modulating, anti-inflammatory, oxidative stress-reducing, antimicrobial, and anticancer properties, as well as the ability to improve metabolism and counter the debilitating effects of stress.130 In an open controlled clinical trial, 61 subjects with chronic tinnitus received either 1,500 mg or 3,000 mg of Korean red ginseng daily, or 160 mg of ginkgo extract (as a control), for four weeks. Scores on the Tinnitus Handicap Inventory improved only in the group receiving 3,000 mg of Korean red ginseng, but measures of tinnitus loudness and intensity and health-related quality of life did not improve significantly in any group.131

Pycnogenol

Pycnogenol is a compound extracted from French maritime pine bark and known to have free radical scavenging and anti-inflammatory effects. One randomized controlled trial compared the effects of Pycnogenol to no treatment in 92 individuals with mild-to-moderate, sudden-onset, one-sided tinnitus of unknown origin lasting at least two weeks. After four weeks, those treated with Pycnogenol, at dosages of either 150 mg or 100 mg daily, had increased cochlear blood flow in the affected ear and reduced tinnitus severity, and the effects were more pronounced in those receiving the higher dosage.132 Another controlled trial that included 120 subjects with tinnitus and low cochlear blood flow related to Ménière disease found 150 mg of Pycnogenol per day for six months improved cochlear blood flow and reduced subjective measures of tinnitus compared with no treatment; in addition, 87.3% of subjects taking Pycnogenol were free of Ménière disease symptoms after six months.133

Magnesium

Magnesium is an electrolyte nutrient important for many aspects of healthy cellular function. In nerves, magnesium protects against damage due to excessive excitation134; in blood vessels, magnesium reduces blood vessel calcification and promotes healthy blood flow by relaxing smooth muscles in blood vessel walls.135,136 An observational study that included 76 tinnitus sufferers and 86 healthy controls found blood magnesium levels were lower in those with tinnitus.137 In a preliminary uncontrolled trial, 26 participants with tinnitus were found to have reduced tinnitus severity after treatment with 532 mg of magnesium per day for three months.138

Vitamin D

Vitamin D plays an important role in regulating calcium metabolism and immune function, and adequate levels are important for cardiovascular, metabolic, and neurological health. In fact, low vitamin D levels have been linked to the onset and progression of neurological disorders such as migraine headache, diabetic neuropathy, multiple sclerosis, Alzheimer disease, and Parkinson disease.139 An observational study that included 201 individuals with tinnitus and 99 with no tinnitus found vitamin D deficiency (<20 ng/mL) was more than twice as common in tinnitus sufferers: 50.7% of those with tinnitus versus 22.2% of those without tinnitus had vitamin D deficiency. In addition, increased tinnitus severity and loudness were correlated with severely decreased (≤15 ng/mL) blood vitamin D levels.140 A meta-analysis published in 2023 analyzing three observational studies identified that serum vitamin D levels were 22% lower in patients with tinnitus compared to those without, suggesting lower vitamin D levels may be a contributing factor to tinnitus.141

Acai

Acai berries are known for their rich flavonoid content and strong antioxidant and anti-inflammatory effects. In a randomized placebo-controlled trial that included 30 individuals with tinnitus and no-to-mild hearing loss, 100 mg acai extract daily for three months reduced self-reported tinnitus-related discomfort, but did not lower anxiety levels or improve markers of oxidative stress more than placebo.142

Taurine

Taurine is a non-essential amino acid that is mainly obtained in the diet but can also be made in the liver and kidney from the amino acids cysteine and methionine.143,144 Taurine has anti-inflammatory and oxidative stress-reducing effects, and has been shown to protect nerve tissue against oxidative and toxic injury, reduce glutamate-induced hyperactivation of nerves, and promote inhibitory nerve signaling.143-145 In an observational study, lower taurine levels were correlated with the presence of tinnitus.146 Preclinical research has shown taurine can reduce damage to hair cells and stimulate regeneration of the auditory nerve.147,148 In animal research, noise trauma was found to lower brain taurine levels,149 and taurine supplementation decreased noise-induced nerve activation.150

Other Antioxidants & Multi-nutrient Formulas

Oxidative damage to hair cells and other auditory tissues is thought to be an important contributing mechanism in tinnitus, and many therapies shown to be beneficial have antioxidant properties.151 Observational evidence suggests people with tinnitus have higher levels of markers of oxidative stress than those without tinnitus.152,153 In an animal study, the polyphenol resveratrol protected against toxin-induced tinnitus.154

Some clinical research also indicates a positive role for antioxidant supplements in tinnitus treatment. In one randomized placebo-controlled trial that enrolled 70 participants with tinnitus, 300 mg lipoic acid twice daily plus a multi-nutrient antioxidant tablet once daily for three months resulted in reduced tinnitus discomfort, loudness, and intensity.155 The multi-nutrient tablet provided:

  • grape seed extract (500 mg)
  • vitamin A (780 mcg RAE [2,600 IU])
  • vitamin D3 (10 mcg [400 IU])
  • vitamin E (dl-alpha tocopherol acetate) (100 α-tocopherol mg [150 IU])
  • folic acid (340 mcg DFE)
  • calcium (62 mg)
  • iron (14 mg)
  • magnesium (50 mg)
  • zinc (15 mg)
  • copper (1.2 mg)
  • vitamin C (150 mg)
  • vitamins B1, B2, B5, choline, inositol, and PABA (25 mg each)
  • vitamin B3 (25 mg NE)
  • vitamin B6 (10 mg)
  • vitamin B12 (10 mcg)
  • manganese (4 mg)
  • selenium (100 mcg)
  • chromium (200 mcg)
  • molybdenum (500 mcg)
  • iodine (150 mcg)

In an uncontrolled clinical trial that included 31 participants with one-sided tinnitus, 18 weeks of treatment with a multi-nutrient supplement, providing glycerophosphorylcholine (55 mg/day), glycerophosphorylethanolamine (45 mg/day), beta-carotene (6,000 mcg RAE/day), vitamin C (180 mg/day), and vitamin E (10 mg/day), led to reductions in tinnitus loudness and discomfort.156 On the other hand, another randomized controlled trial compared the effects of three different treatment approaches (120 mg ginkgo/day, 60 mg alpha-lipoic acid plus 600 mg vitamin C/day, and 100 mg papaverine hydrochloride [Pavacot, a vasodilating drug that increases brain blood flow] plus 400 mg vitamin E) to placebo in 58 tinnitus patients aged 60 years and older. After six months, there were no significant changes in tinnitus severity in any of the treatment groups.157 In a prospective interventional study that enrolled 61 patients given a commercial combination containing 5-hydroxytryptophan, Ginkgo biloba, magnesium, melatonin, vitamin B5 and B6, and zinc twice daily, tinnitus loudness was significantly decreased after three months of treatment.158

7 How is Tinnitus Treated?

Tinnitus has many possible causes and manifestations, and no single treatment approach is effective in every case. Therapies targeting associated conditions can sometimes reduce tinnitus’ negative impacts.4

Non-invasive therapies that aim to mask or reduce perception of the bothersome sound may further reduce or relieve persistent tinnitus. In severe cases that do not respond to first-line approaches, external therapies that modulate nerve function and more invasive treatments such as medications, deep brain stimulation, and cochlear implants may be considered.4,75

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a form of psychotherapy that helps individuals incorporate conscious thought patterns and behaviors that reduce suffering and support health. CBT may be useful for improving sleep, depressive symptoms, emotional tension, and worry, which may reduce tinnitus, as well as increase effectiveness of other tinnitus therapies.159,160 In fact, of all tinnitus therapies, CBT has the strongest body of evidence showing benefits.161

A comprehensive review that included 28 studies with a combined total of 2,733 participants experiencing tinnitus for at least three months found CBT may reduce the negative effect of tinnitus on quality of life.162

Hearing Aids

Hearing aids can be beneficial in tinnitus patients with or without hearing loss. Hearing aids increase the volume of ambient noise, which may be helpful in masking tinnitus.75 In addition, improved hearing by hearing aids may help reverse or normalize maladaptive brain activity in tinnitus sufferers, as well as reduce stress and anxiety by improving communication.4 Numerous studies have found hearing aids have a positive effect on tinnitus perception in those with hearing loss.163 In addition, in a clinical trial that included 91 chronic tinnitus patients without hearing loss, approximately 90% reported reductions in tinnitus loudness and annoyance after wearing hearing aids for three months to one year.164

Sound Therapy

Sound therapy involves the use of a generated sound to provide a distraction and lower the intensity of tinnitus perception. It has also been proposed to help by lowering stress and reversing maladaptive changes in brain neuronal networks involved in perpetuating tinnitus. Hearing aids or other devices can be used as sound generators, some of which can be programmed to produce sounds in an individualized fashion based on the pitch of the tinnitus.4 Although a number of studies suggest sound therapy may be a useful part of tinnitus treatment, the evidence so far is not conclusive.4,75

Tinnitus Retraining Therapy

Tinnitus retraining therapy combinestinnitus-specific counseling to develop the ability to view tinnitus as a neutral stimulus with sound therapy to decrease tinnitus-induced neuronal activation.165 A meta-analysis of 13 randomized controlled trials with a total of 1,345 participants found standard medical treatment plus tinnitus retraining therapy led to higher response rates after one, three, and six months, and reduced tinnitus-related disability more than medical treatment alone.166 However, many of the included studies were rated as lower-quality evidence. And a randomized controlled trial that included 151 subjects with tinnitus found no differences in outcomes after 18 months of treatment with tinnitus retraining therapy, tinnitus-specific counseling alone, or basic tinnitus care that involved providing educational information and guidance.167

Tailor-Made Notched Music Training

Tailor-made notched music training involves the use of music customized to exclude tonal frequencies within one octave above and below an individual’s tinnitus pitch (ie, the “notch”). In theory, this results in stimulation of auditory circuits that are not involved in tinnitus and inhibition of the hyperactivated neurons causing tinnitus.75 A small controlled trial with 23 participants suffering from chronic tinnitus found tailor-made notched music training reduced activity in auditory brain regions and tinnitus loudness more effectively than placebo music training (with a varying notch in frequency range) or no treatment after six months and one year.168 Another study showed tailor-made notched music training promoted normalization of brain activity that had been altered by tinnitus.169 However, in a comparison trial in 30 subjects with bothersome tinnitus, notched music training, unnotched music, and low-pitch white noise worked equally well at improving tinnitus both immediately and after two weeks.170

Neuronal Modulation

Both non-invasive and invasive techniques for modulating nerve activity have been used as treatments for tinnitus. These include4,171:

  • Repetitive transcranial magnetic stimulation (rTMS), in which a wire coil that emits a pulsed magnetic field is placed over the scalp above a target brain region. The magnetic field that is generated can either excite or inhibit neuronal activity, depending on the frequency. The effects of rTMS can result in long-term changes in neural connections and patterns of neuronal activation.172

    rTMS has been used to treat depression, pain, addiction, and a range of other neurological disorders.172 Numerous clinical trials have investigated the use of rTMS in chronic tinnitus, and although results have been mixed, there appear to be positive effects.4,173 In a meta-analysis that included data from 12 randomized controlled trials with a total of 717 participants, those treated with rTMS had significantly lower Tinnitus Handicap Inventory scores than those who received sham therapy at both one month and six months after treatment.174 One reason for inconsistent results may be the lack of a standardized protocol, including dose of pulses and duration of treatment.4,172

    Adverse side effects from rTMS are rare, but can include dizziness and mild neurological, psychological, or cognitive changes that may be temporary or persistent. The most severe potential adverse effect is seizure.175 A meta-analysis of adverse side effect data from 15 controlled trials in tinnitus patients found rTMS was no more likely to cause negative side effects than sham treatment, and none of the studies reported seizure as an adverse effect.176

  • Electrical stimulation is another technique for modulating nerve activity and promoting positive neuroplastic changes.4 Various types of electrical stimulation, including stimulation of the head, ear, vagus nerve, and cerebral cortex, have been tested as potential therapies for chronic tinnitus.177 Transcranial electrical stimulation (tES) is the most widely used method and involves the application of a small direct or alternating current to the scalp via two electrodes.4 A meta-analysis of findings from 11 clinical trials (seven that used transcranial direct current stimulation [tDCS], three that used transcutaneous electrical nerve stimulation [TENS], and one that used electroacupuncture of the ear) found electrical stimulation in general reduced Tinnitus Handicap Inventory scores and measures of tinnitus loudness and distress.178 In another meta-analysis, pooled findings from 14 trials with a total of 1,030 participants indicated tDCS can decrease tinnitus loudness and distress.179 Thirteen clinical trials using TENS were included in another meta-analysis that found 40% of tinnitus sufferers treated with TENS experienced improvement.180

    Despite these promising findings, questions remain regarding the best type, dose, and location of electrical stimulation for maximizing tinnitus relief.4 In addition, safety concerns around electrical stimulation therapy, especially with long-term use, have not been adequately addressed. Hearing loss, worsening of tinnitus, and visual changes, as well as sensations of tingling, pinpricks, and pain have all been reported in patients undergoing electrical stimulation for tinnitus.181

  • Neurofeedback is an individualized treatment approach in which brain wave patterns are collected and fed back to the participant in real time through visual, auditory, or tactile signals.4,171 The participant is then instructed to alter the signals in a certain way, and is rewarded with positive feedback when they are successful.171 In this way, brain activity patterns associated with tinnitus relief are reinforced.182 Although some individuals with tinnitus appear to benefit from neurofeedback training, a significant proportion of people are unable to change their brain activity, limiting the usefulness of neurofeedback as a therapeutic approach to tinnitus.4,182
  • Invasive brain stimulation involves the use of electrodes implanted in the brain to alter signaling in neuronal networks that are abnormally activated in tinnitus.171 Although research into brain stimulation is in its early stages, case reports of successful treatment using stimulation to the brain cortex or deeper brain structures indicate the potential for this method to be helpful in patients with severe tinnitus that has not responded to other therapies.171,177 Deep brain stimulation has a number of possible adverse side effects related to the surgery and the electrical stimulation itself. These include post-surgical infections, pain, and surgical complications; abnormal nerve activation leading to tingling and numbness, muscle spasms, and visual changes; and potentially serious neurological, cognitive, and mood changes such as forgetfulness, loss of balance, seizures, and depression.183,184

Medications

There are currently no medications approved by the U.S. Food and Drug Administration (FDA) for treating tinnitus.75 However, tinnitus can sometimes improve with medical treatments targeting associated conditions, such as high blood pressure, sleep disorders, or depression. A number of drugs have been reported to be helpful when used as off-label therapy in tinnitus patients.81 It is important to note that, paradoxically, some of the drugs used to treat tinnitus can also cause tinnitus, and none are currently recommended as primary therapies for tinnitus.75,81

Misoprostol. Limited evidence from a few preliminary trials suggests misoprostol (Cytotec) may be effective in some cases of tinnitus. However, more evidence is needed. Importantly, misoprostol can cause pregnancy termination or complications so must not be used unintentionally by women who are pregnant or may become pregnant.185-188

Antidepressants. Some evidence suggests antidepressant therapy may reduce tinnitus-related stress, anxiety, and depression.81 Small placebo-controlled trials have indicated amitriptyline (Elavil),189 nortriptyline (Pamelor),190 and sertraline191 may reduce tinnitus. Nevertheless, the evidence for antidepressants in tinnitus treatment is inconclusive.192

Anti-anxiety drugs. Alleviating tinnitus-related anxiety may help reduce the perception of tinnitus. A family of anti-anxiety drugs called benzodiazepines have been studied for their possible benefits in tinnitus sufferers. These drugs may work by interrupting signaling between auditory circuits and other brain regions. Findings from several clinical trials have suggested benzodiazepines such clonazepam (Klonopin) and oxazepam (Serax) may reduce tinnitus, although results are mixed.193,194

Anticonvulsants. A common neurological and psychological basis for tinnitus and pain disorders has been proposed. This has led to research evaluating whether chronic pain disorder treatments may be useful in tinnitus.160 Gabapentin (Neurontin) is an anticonvulsant sometimes used as an off-label therapy for chronic pain. Despite some promising findings, particularly in those with noise-induced tinnitus, gabapentin’s usefulness in tinnitus has not been clearly demonstrated.81,195

NMDA antagonists. Acamprosate (Campral), a drug that inhibits the action of glutamate on receptors known as N-methyl-D-aspartate (NMDA) receptors, is used to treat alcohol abuse disorder. NMDA receptors are thought to play a role in neuronal hyperexcitation, a likely mechanism of tinnitus.81 Acamprosate has been found to reduce tinnitus in three small randomized controlled trials.196-198 Neramexane, an investigational NMDA blocker, was found in a randomized placebo-controlled trial to reduce scores on the Tinnitus Handicap Inventory questionnaire, but not tinnitus loudness.199 More research is needed to establish whether or not these medications have the potential to help tinnitus sufferers.

Intratympanic steroid injections. Some evidence suggests steroids injected through the tympanic membrane (ear drum) may help tinnitus patients by reducing inflammation and enhancing blood flow. However, a meta-analysis of four randomized controlled trials was not able to show this treatment was more effective than placebo.200 Intratympanic steroid injections appear to be more likely to be beneficial in acute than chronic tinnitus.201

Cochlear Implants

Cochlear implants are devices that are surgically placed in the cochlea where they stimulate the auditory nerve, allowing some people with deafness to perceive sounds. They have been studied for their possible role in treatment of tinnitus accompanied by moderate-to-severe hearing loss, but findings have been mixed. The induction or worsening of tinnitus by cochlear implants has also been reported.4,202 A study that monitored 142 tinnitus patients who were treated for severe hearing loss with cochlear implants found 66% experienced suppression of tinnitus—with 37% experiencing complete resolution—one year after surgery.203 Another study that followed 25 subjects with one-sided tinnitus and hearing loss for one year found 22 of 25 participants (92%) experienced significant improvement in tinnitus beginning one to two months after implantation.204 Emerging evidence from a three-week trial in 22 chronic tinnitus patients without substantial hearing loss suggests a trans-tympanic device for stimulating the cochlea may help reduce tinnitus while preserving hearing, and represents a potential option for tinnitus sufferers without hearing loss.205

Acupuncture

Acupuncture is sometimes used to treat tinnitus, and appears to work by improving cochlear blood flow and neuronal activation.99 Although there are multiple clinical trials suggesting acupuncture and electroacupuncture are beneficial therapies in tinnitus, systematic reviews of the literature have led to questions regarding the quality of the evidence, and definitive conclusions have not been made.206-208 No adverse effects from treating tinnitus with acupuncture have been reported.99

8 Dietary & Lifestyle Changes for Tinnitus

Eating a healthy diet and being physically active may help protect against tinnitus. In a study that used data from 2,176 participants in the ongoing National Health and Nutrition Examination Survey (NHANES), those with higher Healthy Eating Index scores were less likely to report persistent tinnitus.209 Specifically, diets high in protein and fiber and low in sugars and starches have been linked to lower odds of tinnitus.98 In a study of 1,730 participants aged 50 years and older, those with lower intakes of fiber from fruit and cereal grains were 65% and 54%, respectively, more likely to have tinnitus than those with higher intakes.210 A study that compared the diets of 185 tinnitus patients to those of 198 matched controls without tinnitus found diets that included a wide diversity of foods, and higher consumption of high-protein foods, coffee and butter were correlated with lower risk of tinnitus.211 Another study based on data from 3,826 NHANES participants found being physically active was also associated with lower likelihood of having tinnitus.212

On the other hand, few studies have examined whether lifestyle changes after the onset of tinnitus are helpful.22 In two randomized controlled trials, one with 46 and the other 63 subjects with obesity and tinnitus, a diet and exercise weight loss intervention was found to reduce tinnitus severity and improve quality of life, particularly in participants who lost 5% or more of their body weight.66,67 Although some observational data has linked daily coffee consumption with decreased incidence of tinnitus, other research suggests that, for modest coffee drinkers (those drinking about 5–10 ounces per day), reducing caffeine intake may reduce tinnitus severity.213,214

Dietary changes are often used as first-line therapies for Ménière disease, a condition that can cause tinnitus.215 A low-salt diet to relieve fluid retention is the most common recommendation, and while it may be helpful in some cases, there is minimal scientific evidence to support it.216,217 Alcohol and caffeine restriction are also frequently recommended, but are similarly lacking in supportive research.215,218 Other speculative interventions include dairy avoidance and a gluten-free diet.33,219

What are Effective Coping Strategies for Living with Tinnitus?

Because chronic tinnitus has no cure, finding effective coping strategies is essential for maintaining quality of life.220 Tinnitus sufferers who passively avoid or deny their condition, as well as those whose goal is to eliminate tinnitus, are likely to be frustrated and feel increased anxiety and distress.220-222 Instead, coping strategies that allow tinnitus to be acknowledged and accepted can lead to a greater ability to adapt to life with the condition.220

It has been suggested that finding a balance between limiting social participation (due to tinnitus discomfort) and spontaneously engaging in enjoyable activities is key to building tolerance.222 In addition, a sense of personal resiliency in the face of negative emotions has been correlated with lower tinnitus-related annoyance, suggesting strategies that build self-resiliency may be helpful to individuals learning to live with tinnitus.223

A wide range of self-help skills have been explored for living with tinnitus. For example, the U.S. Department of Veterans Affairs has developed a progressive treatment approach that employs techniques such as guided imagery, deep breathing, relaxation, and engagement in enjoyable pastimes, and can progress beyond self-help to include cognitive behavioral therapy, sound generators, and other more intensive therapies.224 Researchers have found, among 155 individuals who completed a tinnitus self-management skills training workshop and responded to a follow-up survey six to 10 years later, more than half were still using all of the skills they learned, and relaxation was the most commonly practiced. Approximately 69% of respondents reported they felt more able to control their response to tinnitus, and about half reported improved well-being.225 Another survey study with 460 participants with chronic tinnitus found 40.9% used one or more self-help strategies to reduce their tinnitus severity. In this study, sound therapy was the most commonly used treatment, and other coping practices included diverting attention, relaxation, meditation, yoga, and physical activity.226

9 Tinnitus: Frequently Asked Questions

What does tinnitus sound like?

Tinnitus is often described as “ringing” in the ears, but may also be perceived as buzzing, whistling, hissing, rushing, crackling, beeping, or simply an unpleasant sound.11

Who treats tinnitus?

A primary healthcare provider can help determine whether your tinnitus needs investigation and possibly treatment by an audiologist or other specialist, but many people with tinnitus manage their condition with self-help measures. A psychotherapist or counselor may also be part of a tinnitus healthcare team.12

How long does tinnitus last?

Depending on the cause, tinnitus may resolve quickly or persist for months or years. Chronic tinnitus (lasting three months or longer) usually does not go away, but many people become habituated to their tinnitus, such that is becomes less bothersome over time.20

Does tinnitus cause hearing loss?

Hearing loss is the most common cause of tinnitus, and the two conditions share certain risk factors and mechanisms. However, while tinnitus may cause trouble hearing by obscuring sound, tinnitus does not cause hearing loss.2

Is tinnitus curable?

Chronic tinnitus is considered incurable, but most people with chronic tinnitus improve a small amount over time.19

Is tinnitus dangerous?

Tinnitus is not dangerous. However, it can be a symptom of a dangerous or even life-threatening condition, such as stroke, aneurysm, hemorrhage, or other cardiovascular emergency. Warning signs that tinnitus might be due to a dangerous underlying cause include a pulsating sound, a sudden onset, affecting only one side, or occurring at the same time as other neurological changes.2

Why is tinnitus worse at night?

When tinnitus is worse at night, it may be due to surroundings being quieter and less able to mask the tinnitus sound. Other possible factors include changes in posture and muscle tension, or circadian changes in stress hormone levels.15

What does tinnitus do to your brain?

The brain adapts to tinnitus in various ways, depending on the individual. In some cases, nerve networks between the auditory system and other brain regions are altered by tinnitus, a process that can lead to increased anxiety, depression, and stress. Unfortunately, this is thought to reinforce tinnitus-related nerve signaling and make it harder to recover from tinnitus.75

Can you prevent tinnitus?

Protecting yourself from loud noise at work and in recreational activities, not smoking, and maintaining good heart and general health are ways to lower your risk of tinnitus.4

2023

  • Aug: Initial publication

2012

  • Aug: Comprehensive update & review

Disclaimer and Safety Information

This information (and any accompanying material) is not intended to replace the attention or advice of a physician or other qualified health care professional. Anyone who wishes to embark on any dietary, drug, exercise, or other lifestyle change intended to prevent or treat a specific disease or condition should first consult with and seek clearance from a physician or other qualified health care professional. Pregnant women in particular should seek the advice of a physician before using any protocol listed on this website. The protocols described on this website are for adults only, unless otherwise specified. Product labels may contain important safety information and the most recent product information provided by the product manufacturers should be carefully reviewed prior to use to verify the dose, administration, and contraindications. National, state, and local laws may vary regarding the use and application of many of the therapies discussed. The reader assumes the risk of any injuries. The authors and publishers, their affiliates and assigns are not liable for any injury and/or damage to persons arising from this protocol and expressly disclaim responsibility for any adverse effects resulting from the use of the information contained herein.

The protocols raise many issues that are subject to change as new data emerge. None of our suggested protocol regimens can guarantee health benefits. Life Extension has not performed independent verification of the data contained in the referenced materials, and expressly disclaims responsibility for any error in the literature.

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