View source for Tinnitus

{{Short description|False perception of sound}}
{{For|the Norwegian radio show|Tinitus (radio show){{!}}''Tinitus'' (radio show)}}
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{{Infobox medical condition (new)
| name            = Tinnitus
| image           =
| image_size      =
| caption         =
| field           = [[Otorhinolaryngology]], [[audiology]], [[neurology]]
| pronounce       = {{IPAc-en|ˈ|t|ɪ|n|ɪ|t|ə|s}} or {{IPAc-en|t|ɪ|ˈ|n|ai|t|ə|s}}
| symptoms        = Hearing sound when no external sound is present<ref name=Lev2015/>
| complications   = Poor concentration, anxiety, depression<ref name=NIH2014/>
| onset           = Gradual<ref name="Baguley McFerran Hall 2013">{{cite journal |last1=Baguley |first1=David |last2=McFerran |first2=Don |last3=Hall |first3=Deborah |title=Tinnitus |journal=The Lancet |date=November 2013 |volume=382 |issue=9904 |pages=1600–1607 |doi=10.1016/S0140-6736(13)60142-7 |pmid=23827090 |url=http://eprints.nottingham.ac.uk/id/eprint/3228 |url-access=subscription }}</ref>
| duration        =
| causes          = [[Noise-induced hearing loss]], [[ear infection]]s, [[cardiovascular disease|disease of the heart or blood vessels]], [[Ménière's disease]], [[brain tumor]]s, [[vestibular schwannoma|inner ear tumors]], [[stress (psychological)|emotional stress]], [[traumatic brain injury]], excessive [[earwax]]<ref name=NIH2014/><ref name=Han2009/>
| risks           =
| diagnosis       = Based on symptoms, [[audiogram]], [[neurological exam]]<ref name=Lev2015/><ref name="Baguley McFerran Hall 2013"/>
| differential    =
| prevention      =
| treatment       = [[Counseling]], [[Tinnitus masker|sound generators]], [[hearing aids]]<ref name=NIH2014/><ref name=Lang2013/>
| medication      =
| prognosis       =
| frequency       = ~12.5%<ref name=Lang2013/>
| deaths          =
}}
<!-- Definition and symptoms -->

'''Tinnitus''' is a condition when a person hears a ringing sound or a different variety of sounds when no corresponding external sound is present and that other people cannot hear.<ref name=Lev2015>{{cite book |doi=10.1016/B978-0-444-62630-1.00023-8 |chapter=Tinnitus |title=The Human Auditory System – Fundamental Organization and Clinical Disorders |series=Handbook of Clinical Neurology |year=2015 |last1=Levine |first1=Robert A. |last2=Oron |first2=Yahav |volume=129 |pages=409–431 |pmid=25726282 |isbn=978-0-444-62630-1 }}</ref> The word ''tinnitus'' comes from the [[Latin language|Latin]] ''[[wikt:en:tinnitus#Latin|tinnire]]'', "to ring".<ref name="Baguley McFerran Hall 2013" />
{{Wikiversity|Global Audiology}}Tinnitus is usually associated with [[hearing loss]] and decreased comprehension of speech in noisy environments.<ref name="NIH2014">{{cite web |title=Tinnitus |url=https://www.nidcd.nih.gov/health/tinnitus |access-date=20 September 2019 |date=6 March 2017 |url-status=live|archive-url=https://web.archive.org/web/20190403204320/https://www.nidcd.nih.gov/health/tinnitus |archive-date=3 April 2019|website=NIH – [[National Institute on Deafness and Other Communication Disorders]] (NIDCD) }}</ref> It is common, affecting about 10–15% of people. Most tolerate it well, and it is a significant (severe) problem in only 1–2% of people.<ref name="Lang2013">{{cite journal |last=Langguth |first=B |author2=Kreuzer, PM |author3=Kleinjung, T |author4= De Ridder, D |title=Tinnitus: causes and clinical management |journal=The Lancet Neurology |date=September 2013 |volume=12 |issue=9 |pages=920–930 |pmid=23948178 |doi=10.1016/S1474-4422(13)70160-1|s2cid=13402806 }}</ref><ref name=":1">{{Cite journal |last1=Jarach |first1=Carlotta M. |last2=Lugo |first2=Alessandra |last3=Scala |first3=Marco |last4=van den Brandt |first4=Piet A. |last5=Cederroth |first5=Christopher R. |last6=Odone |first6=Anna |last7=Garavello |first7=Werner |last8=Schlee |first8=Winfried |last9=Langguth |first9=Berthold |last10=Gallus |first10=Silvano |date=2022-09-01 |title=Global Prevalence and Incidence of Tinnitus: A Systematic Review and Meta-analysis |journal=JAMA Neurology |volume=79 |issue=9 |pages=888–900 |doi=10.1001/jamaneurol.2022.2189 |pmid=35939312 |issn=2168-6149|pmc=9361184 }}</ref> 

<!--Cause -->
Rather than a disease, tinnitus is a symptom that may result from a variety of underlying causes and may be generated at any level of the auditory system as well as outside that system. The most common causes are hearing damage, [[noise-induced hearing loss]], or age-related hearing loss, known as [[presbycusis]].<ref name=NIH2014/> Other causes include [[ear infection]]s, [[cardiovascular disease|disease of the heart or blood vessels]], [[Ménière's disease]], [[brain tumor]]s, acoustic neuromas (tumors on the auditory nerves of the ear), migraines, [[temporomandibular joint disorders]], exposure to certain medications, a previous [[head injury]], and [[earwax]].  In some people, it interferes with concentration, and can be associated with anxiety and [[Depression (mood)|depression]].<ref name="ResearchReview">{{cite journal|title=Depression in Patients with Tinnitus: A Systematic Review|first=James W. |last=Salazar|journal=Otolaryngol Head Neck Surg|year=2019 |volume=161|issue=1|pages=28–35|doi= 10.1177/0194599819835178|pmid=30909841 |pmc=7721477 }}</ref><ref name="Research1">{{cite journal|title=Relationships Between Tinnitus And The Prevalence Of Anxiety And Depression|first=Jay M.|last=Bhatt|journal=Laryngoscope|year=2016 |volume=127|issue=2|pages=466–469|doi= 10.1002/lary.26107|pmid=27301552 |pmc=5812676 }}</ref> It can suddenly emerge or increase during a period of [[Stress (psychological)|emotional stress]].<ref name=Han2009>{{cite journal |journal=Journal of Clinical Neurology |date=March 2009 |volume=5 |issue=1 |pages=11–19 |pmc=2686891 |pmid=19513328 |title=Tinnitus: characteristics, causes, mechanisms, and treatments |vauthors=Han BI, Lee HW, Kim TY, Lim JS, Shin KS |quote=About 75% of new cases are related to emotional stress as the trigger factor rather than to precipitants involving cochlear lesions. |doi=10.3988/jcn.2009.5.1.11}}</ref><ref name="Baguley McFerran Hall 2013"/><ref name=NIH2014/><ref>{{cite journal |last1=Esmaili |first1=Aaron A |last2=Renton |first2=John |title=A review of tinnitus |journal=Australian Journal of General Practice |date=1 April 2018 |volume=47 |issue=4 |pages=205–208 |doi=10.31128/AJGP-12-17-4420 |pmid=29621860 |doi-access=free }}</ref><ref name="Mazurek et al. (2022)">{{cite journal|vauthors=Mazurek B, Haupt H, Olze H, Szczepeck A|year=2022|title=Stress and tinnitus—from bedside to bench and back|journal= Frontiers in Systems Neuroscience|volume=6|issue=47|page=47 |doi=10.3389/fnsys.2012.00047|pmid=22701404 |pmc=3371598 |doi-access=free }}</ref> It may have a frequent occurrence in those with depression.<ref name="Baguley McFerran Hall 2013"/>

<!-- Diagnosis -->
The diagnosis of tinnitus is usually based on a patient's description of the symptoms they are experiencing.<ref name="Baguley McFerran Hall 2013"/> Such a diagnosis is commonly supported by an [[audiogram]], and an otolaryngological and [[neurological examination]].<ref name=Lev2015/><ref name="Baguley McFerran Hall 2013"/> How much tinnitus interferes with a person's life may be quantified with questionnaires.<ref name="Baguley McFerran Hall 2013"/> If certain problems are found, [[medical imaging]], such as [[magnetic resonance imaging]] (MRI), may be performed. Other tests are suitable when tinnitus occurs with the same rhythm as the heartbeat.<ref name="Baguley McFerran Hall 2013"/> Rarely, the sound may be heard by someone other than the patient by using a [[stethoscope]], in which case it is known as "objective tinnitus".<ref name="Baguley McFerran Hall 2013"/> Occasionally, [[Otoacoustic emission#Spontaneous|spontaneous otoacoustic emissions]], sounds produced normally by the [[inner ear]], may result in tinnitus.<ref name=Hen2005/>

<!--Management, epidemiology and prognosis -->
Measures to prevent tinnitus include avoiding chronic or extended exposure to loud noise, and limiting exposure to drugs and substances harmful to the ear ([[ototoxicity|ototoxic]]).<ref name=NIH2014/><ref name="pmid33080070">{{cite journal |vauthors=Rizk HG, Lee JA, Liu YF, Endriukaitis L, Isaac JL, Bullington WM |title=Drug-Induced Ototoxicity: A Comprehensive Review and Reference Guide |journal=Pharmacotherapy |volume=40 |issue=12 |pages=1265–1275 |date=December 2020 |pmid=33080070 |doi=10.1002/phar.2478 |s2cid=224828345 |url=}}</ref> If there is an underlying cause, treating that cause may lead to improvements.<ref name="Baguley McFerran Hall 2013"/> Otherwise, typically, tinnitus management involves psychoeducation or counseling, such as [[talk therapy]].<ref name=Lang2013/> [[Tinnitus masker|Sound generators]] or [[hearing aids]] may help.<ref name=NIH2014/> No medication directly targets tinnitus.

{{TOC limit}}

== Signs and symptoms ==
[[File:Tinnitus Simulation.mp3|thumb|Simulation of a tinnitus]]
Tinnitus is often described as ringing, but it may also sound like clicking, buzzing, hissing, or roaring.<ref name=Han2009/> It may be soft or loud, low- or high-[[Pitch (music)|pitched]], and may seem to come from either one or both ears, or from other parts of the head. It may be intermittent or continuous. In some individuals, its intensity may be changed by shoulder, neck, head, tongue, jaw, or eye movements.<ref>{{cite journal |last1=Simmons |first1=R |last2=Dambra |first2=C |last3=Lobarinas |first3=E |last4=Stocking |first4=C |last5=Salvi |first5=R |title=Head, Neck, and Eye Movements That Modulate Tinnitus |pmid=19183705 |journal=Seminars in Hearing |pmc=2633109 |doi=10.1055/s-0028-1095895 |volume=29 |issue=4 |year=2008 |pages=361–370}}</ref>

=== Course ===
Due to variations in study designs, data on the course of tinnitus shows few consistent results. Generally, prevalence increases with age in adults, and the ratings of annoyance increase with persistence at follow up.<ref>{{Cite book |author1=Baguley D |author2=Andersson g |author3=McFerran D |author4=McKenna L |title=Tinnitus: A Multidisciplinary Approach |edition=  2nd |publisher=Blackwell Publishing Ltd. |pages=16–17 |year=2013| isbn=978-1-118-48870-6 }}</ref><ref name="pmid20124901">{{cite journal | vauthors = Gopinath B, McMahon CM, Rochtchina E, Karpa MJ, Mitchell P | title = Incidence, persistence, and progression of tinnitus symptoms in older adults: the Blue Mountains Hearing Study | journal = Ear and Hearing | volume = 31 | issue = 3 | pages = 407–412 | year = 2010 | pmid = 20124901 | doi = 10.1097/AUD.0b013e3181cdb2a2 | s2cid = 23601127 }}</ref><ref name="pmid20670725">{{cite journal | vauthors = Shargorodsky J, Curhan GC, Farwell WR | title = Prevalence and characteristics of tinnitus among US adults | journal = The American Journal of Medicine | volume = 123 | issue = 8 | pages = 711–718 | year = 2010 | pmid = 20670725 | doi = 10.1016/j.amjmed.2010.02.015 }}</ref>

=== Adverse psychological effects ===
Although it is an annoying condition to which most people adapt, persistent tinnitus may cause anxiety and depression in some people.<ref name="pmid12238249">{{cite journal | vauthors = Andersson G | title = Psychological aspects of tinnitus and the application of cognitive-behavioral therapy | journal = Clinical Psychology Review | volume = 22 | issue = 7 | pages = 977–990 | year = 2002 | pmid = 12238249 | doi = 10.1016/s0272-7358(01)00124-6}}</ref><ref name="pmid10407886">{{cite journal | vauthors = Reiss M, Reiss G | title = Some psychological aspects of tinnitus | journal = Perceptual and Motor Skills | volume = 88 | issue = 3 Pt 1 | pages = 790–792 | year = 1999 | pmid = 10407886 | doi = 10.2466/pms.1999.88.3.790 | s2cid = 41610361 }}</ref> Tinnitus annoyance is more strongly associated with the psychological condition of the person than the loudness or frequency range of the perceived sound.<ref>{{Cite journal |author=Baguley DM |title=Mechanisms of tinnitus |journal=British Medical Bulletin |volume=63 |pages=195–212 |year=2002 |pmid=12324394 |doi=10.1093/bmb/63.1.195|doi-access=free }}</ref><ref>{{cite journal |last1=Henry |first1=James A. |last2=Meikle |first2=Mary B. |title=Pulsed versus Continuous Tones for Evaluating the Loudness of Tinnitus |journal=Journal of the American Academy of Audiology |date=May 1999 |volume=10 |issue=5 |pages=261–272 |doi=10.1055/s-0042-1748497 |pmid=10331618 |s2cid=18675226 }}</ref> Psychological problems such as depression, anxiety, sleep disturbances, and concentration difficulties are common in those with strongly annoying tinnitus.<ref name="Henry JA, Dennis KC, Schechter MA 2005 1204–1235"/><ref>{{Cite book |vauthors=Davies A, Rafie EA |chapter=Epidemiology of Tinnitus |editor=Tyler, RS |title=Tinnitus Handbook |location=San Diego |publisher=Singular |pages=1–23 |year=2000 |oclc=42771695}}</ref> One study found that complications can also include cognitive decline and difficulty communicating,<ref>{{Cite news |last=Clinic |first=Cleveland |date=May 25, 2025 |title=Tinnitus |url=https://my.clevelandclinic.org/health/symptoms/14164-tinnitus}}</ref> and 45% of people with tinnitus in that study had an [[anxiety disorder]] at some time in their lives.<ref>{{cite journal |vauthors=Pattyn T, Van Den Eede F, Vanneste S, Cassiers L, Veltman DJ, Van De Heyning P, Sabbe BC |title=Tinnitus and anxiety disorders: A review |journal=Hearing Research |volume= 333 |pages= 255–265 |year=2015 |pmid=26342399 |doi=10.1016/j.heares.2015.08.014|hdl=10067/1273140151162165141 |s2cid=205103174 |url=https://repository.uantwerpen.be/docman/irua/b0770b/10705.pdf |hdl-access=free }}</ref> Severe cases may lead some to consider suicide;<ref>{{Cite web |last=Rider |first=J. D. |date=2025-02-02 |title=Tinnitus and Suicides - Hyperacusis Central |url=https://hyperacusiscentral.org/understanding-tinnitus-and-how-it-leads-to-suicides/ |access-date=2025-06-05 |website=hyperacusiscentral.org |language=en-GB}}</ref><ref>{{Cite news |last=Elfrink |first=Tim |date=2021-03-22 |title=Texas Roadhouse CEO dies by suicide while battling 'unbearable' post-covid-19 symptoms, family says |url=https://www.washingtonpost.com/nation/2021/03/22/texas-roadhouse-kent-taylor-suicide/ |access-date=2025-06-05 |newspaper=The Washington Post |language=en-US |issn=0190-8286}}</ref> while suicidal behavior is complex, tinnitus can be a risk factor.<ref>{{Cite journal |last1=Szibor |first1=Annett |last2=Mäkitie |first2=Antti |last3=Aarnisalo |first3=Antti A. |date=2019-05-06 |title=Tinnitus and suicide: An unresolved relation |journal=Audiology Research |volume=9 |issue=1 |page=222 |doi=10.4081/audiores.2019.222 |issn=2039-4330 |pmc=6580142 |pmid=31275536}}</ref> In a cross-sectional analysis, 15.75% of the 292 patients that attended a 2019 Tinnitus and Hyperacusis Clinic in the United Kingdom "expressed that they have been bothered by suicidal and self-harm ideations within the last 2 weeks."<ref>{{Cite journal |last1=Aazh |first1=Hashir |last2=Landgrebe |first2=Michael |last3=Danesh |first3=Ali A. |date=2019-09-13 |title=Parental Mental Illness in Childhood as a Risk Factor for Suicidal and Self-Harm Ideations in Adults Seeking Help for Tinnitus and/or Hyperacusis |url=https://pubs.asha.org/doi/abs/10.1044/2019_AJA-18-0059 |journal=American Journal of Audiology |volume=28 |issue=3 |pages=527–533 |doi=10.1044/2019_AJA-18-0059|pmid=31184510 |url-access=subscription }}</ref>

Psychological research has focused on the tinnitus distress reaction to account for differences in tinnitus severity.<ref name="Henry JA, Dennis KC, Schechter MA 2005 1204–1235">{{Cite journal |vauthors=Henry JA, Dennis KC, Schechter MA |title=General review of tinnitus: Prevalence, mechanisms, effects, and management |journal=Journal of Speech, Language, and Hearing Research |volume=48 |pages=1204–1235 |year=2005 |pmid=16411806 |doi=10.1044/1092-4388(2005/084) |issue=5}}</ref><ref>{{Cite book |vauthors=Henry JA, Wilson P |contribution=Psychological management of tinnitus |editor=R.S. Tyler |title=Tinnitus Handbook |location=San Diego |publisher=Singular |pages=263–279 |year=2000 |oclc=42771695}}</ref><ref>{{Cite journal |vauthors=Andersson G, Westin V |title=Understanding tinnitus distress: Introducing the concepts of moderators and mediators |journal=International Journal of Audiology |volume=47 |issue=Suppl. 2 |pages=S106–111 |year=2008 |pmid=19012118 |doi=10.1080/14992020802301670|s2cid=19389202 }}</ref><ref>{{Cite journal |vauthors=Weise C, Hesser H, Andersson G, Nyenhuis N, Zastrutzki S, Kröner-Herwig B, Jäger B |title=The role of catastrophizing in recent onset tinnitus: its nature and association with tinnitus distress and medical utilization |journal=International Journal of Audiology |volume=52 |pages=177–188 |year=2013 |pmid=23301660 |doi=10.3109/14992027.2012.752111 |issue=3|s2cid=24297897 }}</ref> The research indicates that among the cohort studied, conditioning at the initial perception of tinnitus linked it with negative emotions, such as fear and anxiety.<ref name="TRT">{{Cite book |last1=Jastreboff |first1=PJ |last2=Hazell |first2=JWP |title=Tinnitus Retraining Therapy: Implementing the neurophysiological model |year=2004 |publisher=Cambridge University Press |location=Cambridge |oclc=237191959 }}</ref>

== Types ==
Commonly tinnitus is classified into "subjective and objective tinnitus".<ref name="Baguley McFerran Hall 2013"/> Tinnitus is usually subjective, meaning that the sounds the person hears are not detectable by means currently available to physicians and hearing technicians.<ref name="Baguley McFerran Hall 2013"/> Subjective tinnitus has also been called "tinnitus aurium", "non-auditory", or "non-vibratory" tinnitus. 

In rare cases, tinnitus may be heard by someone else using a [[stethoscope]]. Even more rarely, in some cases it may be measured as a spontaneous [[otoacoustic emission]] (SOAE) in the ear canal. This is classified as "objective tinnitus",<ref name="Baguley McFerran Hall 2013"/> also called "pseudo-tinnitus" or "vibratory" tinnitus.

=== Subjective tinnitus ===
Subjective tinnitus is the most frequent type. It may have many causes, but most commonly it results from hearing loss. When it is caused by disorders of the [[inner ear]] or [[auditory nerve]], it can be called "otic" (from the Greek word for ear).<ref name=Levine>{{cite journal|last1=Robert Aaron Levine|title=Somatic (craniocervical) tinnitus and the dorsal cochlear nucleus hypothesis|journal=American Journal of Otolaryngology|date=1999|doi=10.1016/S0196-0709(99)90074-1|pmid=10609479|volume=20|issue=6|pages=351–362|citeseerx=10.1.1.22.2488}}</ref> These [[otology|otological]] or [[neurology|neurological]] disorders include those triggered by infections, drugs, or trauma.<ref name="WMClark">{{cite journal |author=Chan Y |title=Tinnitus: etiology, classification, characteristics, and treatment |journal=Discovery Medicine |volume=8 |issue=42 |year=2009 |pages=133–136 |url=http://www.discoverymedicine.com/Yvonne-Chan/2009/10/10/tinnitus-etiology-classification-characteristics-and-treatment/ |pmid=19833060}}</ref> A cause is traumatic noise exposure that damages the [[Cilium|sensory cilia]], or [[hair cells]], in the inner ear.<ref>{{cite journal | last1=Vijayakumar | first1=Karthikeyan A | last2=Cho | first2=Gwang-Won | last3=Maharajan | first3=Nagarajan | last4=Jang | first4=Chul Ho | title=A Review on Peripheral Tinnitus, Causes, and Treatments from the Perspective of Autophagy | journal=Experimental Neurobiology | volume=31 | issue=4 | date=2022-08-31 | issn=1226-2560 | pmid=36050223 | pmc=9471415 | doi=10.5607/en22002 | doi-access=free | pages=232–242}}</ref> Some evidence suggests that long-term exposure to noise pollution from heavy traffic may increase the risk of developing tinnitus.<ref>{{cite journal | first=Marianne |last=Lie Becker|display-authors=etal |title= Transportation Noise and Risk of Tinnitus: A Nationwide Cohort Study from Denmark|journal=Environmental Health Perspectives |date=2023 |volume=131 |issue=2 |page=27001 |article-number=027001 |doi=10.1289/EHP11248|pmid=36722980 |pmc=9891135 |bibcode=2023EnvHP.131b7001C }}</ref>

When there does not seem to be a connection with a disorder of the inner ear or auditory nerve, tinnitus may be called "non-otic". In 30% of cases, tinnitus is influenced by the [[somatosensory system]]; for instance, people can increase or decrease their tinnitus by moving their face, head, jaw, or neck.<ref>{{cite journal|last1=Barbara Rubinstein |display-authors=etal |title=Prevalence of Signs and Symptoms of Craniomandibular Disorders in Tinnitus Patients|journal=Journal of Craniomandibular Disorders|date=1990|volume=4|issue=3|pages=186–192|pmid=2098394}}</ref> This type is called somatic or craniocervical tinnitus, since it is only head or neck movements that have the effect.<ref name=Levine/>

Some tinnitus may be caused by [[neuroplastic]] changes in the central auditory pathway. In this theory, the disturbance of sensory input caused by hearing loss results in such changes,<ref name="TriAudiogramSlope" /> as a [[homeostatic]] response of neurons in the central auditory system, causing tinnitus.<ref name="hiddenHearingLoss">{{cite journal |last1=Schaette |first1=R |last2=McAlpine |first2=D |title=Tinnitus with a Normal Audiogram: Physiological Evidence for Hidden Hearing Loss and Computational Model |journal=The Journal of Neuroscience |date=21 September 2011 |volume=31 |issue=38 |pages=13452–13457 |doi=10.1523/JNEUROSCI.2156-11.2011 |pmid=21940438|pmc=6623281 }}</ref> 

When some frequencies of sound are lost to hearing loss, the auditory system compensates by amplifying those frequencies, eventually producing sound sensations at those frequencies constantly, even when there is no corresponding external sound.

==== Hearing loss ====
The most common cause of tinnitus is [[hearing loss]]. Hearing loss may have many different causes, but among those with tinnitus, the major cause is [[cochlea]]r injury.<ref name="TriAudiogramSlope">{{cite journal |last1=Schecklmann |first1=Martin |last2=Vielsmeier |first2=Veronika |last3=Steffens |first3=Thomas |last4=Landgrebe |first4=Michael |last5=Langguth |first5=Berthold |last6=Kleinjung |first6=Tobias |last7=Andersson |first7=Gerhard |title=Relationship between Audiometric Slope and Tinnitus Pitch in Tinnitus Patients: Insights into the Mechanisms of Tinnitus Generation |journal=PLOS ONE |date=18 April 2012 |volume=7 |issue=4 |article-number=e34878 |doi=10.1371/journal.pone.0034878 |pmid=22529949 |pmc=3329543|bibcode=2012PLoSO...734878S |doi-access=free }}</ref>

In many cases, no underlying cause is identified.<ref name=NIH2014/><ref name=Yew2014>{{cite journal |last1=Yew |first1=KS |title=Diagnostic approach to patients with tinnitus. |journal=American Family Physician |date=15 January 2014 |volume=89 |issue=2 |pages=106–113 |pmid=24444578}}</ref>

[[Ototoxicity|Ototoxic]] drugs also may cause subjective tinnitus, as they may cause hearing loss,<ref name="pmid33080070" /> or increase the damage done by exposure to loud noise.<ref name="pmid32334867">{{cite journal |vauthors=Theodoroff SM, Konrad-Martin D |title=Noise: Acoustic Trauma and Tinnitus, the US Military Experience |journal=Otolaryngologic Clinics of North America |volume=53 |issue=4 |pages=543–553 |date=August 2020 |pmid=32334867 |pmc=9015011 |doi=10.1016/j.otc.2020.03.004 |url=}}</ref> This damage may occur even at doses not considered ototoxic.<ref>{{cite book |doi=10.1002/9780470720677.ch9 |chapter=Ototoxic Drugs and Noise |title=Ciba Foundation Symposium 85 – Tinnitus |series=Novartis Foundation Symposia |year=2008 |last1=Don Brown |first1=R. |last2=Penny |first2=Joe E. |last3=Henley |first3=Charles M. |last4=Hodges |first4=Keri B. |last5=Kupetz |first5=Suzyjo A. |last6=Glenn |first6=David W. |last7=Jobe |first7=Phillip C. |volume=85 |pages=151–171 |pmid=7035098 |isbn=978-0-470-72067-7 }}</ref> More than 260 medications have been reported to cause tinnitus as a side effect.<ref>{{cite web |author=Stas Bekman |url=http://stason.org/TULARC/health/body/tinnitus-ringing-ears/6-What-are-some-ototoxic-drugs.html |title=6) What are some ototoxic drugs? |publisher=Stason.org |access-date=26 October 2012 |url-status=live |archive-url=https://web.archive.org/web/20121019184052/http://stason.org/TULARC/health/body/tinnitus-ringing-ears/6-What-are-some-ototoxic-drugs.html |archive-date=19 October 2012 }}</ref>

Tinnitus may also occur from the discontinuation of therapeutic doses of [[benzodiazepine]]s. It may sometimes be a protracted symptom of [[benzodiazepine withdrawal syndrome|benzodiazepine withdrawal]] and may persist for many months.<ref name="clinical_manual_of_emergency_psychiatry">{{Cite book |last1=Riba |first1=Michelle B |last2=Ravindranath |first2=Divy |title=Clinical manual of emergency psychiatry |url=https://books.google.com/books?id=l8veL1bDoF8C&pg=PA197 |year=2010 |publisher=American Psychiatric Publishing Inc |location=Washington, DC |isbn=978-1-58562-295-5 |page=197}}</ref><ref name="seizures">{{Cite book |last1=Delanty |first1=Norman |title=Seizures: medical causes and management |url=https://books.google.com/books?id=u2B3SdfE8-gC&pg=RA1-PA187 |year=2001 |publisher=Humana Press |location=Totowa, NJ |isbn=978-0-89603-827-1 |page=187 }}{{Dead link|date=August 2023 |bot=InternetArchiveBot |fix-attempted=yes }}</ref> Medications such as [[bupropion]] may also cause tinnitus.<ref name="pmid20628627">{{cite journal | vauthors = Fornaro M, Martino M | title = Tinnitus psychopharmacology: A comprehensive review of its pathomechanisms and management | journal = Neuropsychiatric Disease and Treatment | volume = 6 | pages = 209–218 | year = 2010 | pmid = 20628627 | pmc = 2898164 | doi = 10.2147/ndt.s10361 | doi-access = free }}</ref>

==== Associated factors ====
Factors associated with tinnitus include:<ref>{{Cite journal |vauthors=Crummer RW, Hassan GA |title=Diagnostic approach to tinnitus |journal=American Family Physician |volume=69 |issue=1 |pages=120–106 |year=2004 |pmid=14727828}}</ref>
* Ear problems and [[hearing loss]]:
** Conductive hearing loss
*** [[Acoustic shock]]
*** Loud noise or music<ref>{{Cite journal |vauthors=Passchier-Vermeer W, Passchier WF |title=Noise exposure and public health |journal=Environmental Health Perspectives |volume=108 |issue=Suppl 1 |pages=123–131 |year=2000 |pmid=10698728 |doi=10.1289/ehp.00108s1123 |pmc=1637786 |jstor=3454637|bibcode=2000EnvHP.108S.123P }}</ref>
*** [[Otitis media|Middle ear effusion]]
*** [[Otitis]]
*** [[Otosclerosis]]
*** [[Eustachian tube]] dysfunction
** [[Sensorineural hearing loss]]
*** Excessive or loud noise; e.g. acoustic trauma
*** [[Presbycusis]] (age-associated hearing loss)
*** [[Ménière's disease]]
*** [[Endolymphatic hydrops]]
*** [[Superior canal dehiscence]]
*** [[Acoustic neuroma]]
*** [[mercury poisoning|Mercury]] or [[lead poisoning]]
*** [[Ototoxic]] medications
* [[neurology|Neurologic]] disorders:
** [[Chiari malformation]]
** [[Multiple sclerosis]]
** [[Head injury]]
** [[Giant cell arteritis]]
* [[Temporomandibular joint dysfunction]]
* [[metabolism|Metabolic]] disorders:
** [[vitamin B12 deficiency|Vitamin B<sub>12</sub> deficiency]]<ref>{{cite book |editor-last1=Zempleni |editor-first1=Janos |editor2-last=Suttie |editor2-first=John W |editor3-last=Gregory|editor3-first=Jesse F |editor4-last=Stover |editor4-first=Patrick J |title=Handbook of vitamins |date=2014 |publisher=CRC Press |location=Hoboken |isbn=978-1-4665-1557-4 |page=477 |edition=  5th|url=https://books.google.com/books?id=IEHSBQAAQBAJ&pg=PA477 |url-status=live |archive-url=https://web.archive.org/web/20160817155016/https://books.google.it/books?id=IEHSBQAAQBAJ&pg=PA477 |archive-date=17 August 2016 }}</ref>
** [[Iron deficiency anemia]]
* [[psychiatry|Psychiatric]] disorders
** Depression
** [[Anxiety disorders]]
* Other factors:
** [[Vasculitis]]
** Some [[psychedelic drugs]] can produce temporary tinnitus-like symptoms as a side effect:
*** [[5-MeO-DET]]<ref name="Shulgin">{{cite book |last1=Shulgin |first1=Alexander |author-link1=Alexander Shulgin |last2=Shulgin |first2=Ann |author-link2=Ann Shulgin |title=TiHKAL: the continuation |url=http://www.erowid.org/library/books_online/tihkal/tihkal.shtml |access-date=27 October 2012 |year=1997 |publisher=Transform Press |location=Berkeley, CA |isbn=978-0-9630096-9-2 |oclc=38503252 |chapter=#36. 5-MEO-DET |chapter-url=http://www.erowid.org/library/books_online/tihkal/tihkal36.shtml |url-status=live |archive-url=https://web.archive.org/web/20121031144030/http://www.erowid.org/library/books_online/tihkal/tihkal.shtml |archive-date=31 October 2012 }}</ref>
*** [[DiPT|Diisopropyltryptamine (DiPT)]]<ref>{{cite web |url=https://www.erowid.org/experiences/exp.php?ID=26540 |title=Erowid Experience Vaults: DiPT – More Tripping & Revelations – 26540 |url-status=live |archive-url=https://web.archive.org/web/20141102115409/https://www.erowid.org/experiences/exp.php?ID=26540 |archive-date=2 November 2014 }}</ref>
** [[Benzodiazepine withdrawal]]<ref name="clinical_manual_of_emergency_psychiatry"/><ref name="seizures"/>
** [[Intracranial pressure|Intracranial hyper or hypotension]] caused by, for example, [[encephalitis]] or a [[cerebrospinal fluid]] leak

=== Objective tinnitus ===
A specific type of tinnitus, ''objective tinnitus'', is characterized by hearing the sounds of one's own muscle contractions or pulse, typically a result of sounds that have been created by the movement of jaw muscles or sounds related to blood flow in the neck or face.<ref name="entnet-hearing">{{cite web |date=18 August 2021 |title=MEM, Tinnitus and Ear Drum Spasms |url=https://tinnitusandyou.com/mem-tinnitus-and-ear-drum-spasms/ |url-status=live |archive-url=https://web.archive.org/web/20210820064413/https://tinnitusandyou.com/mem-tinnitus-and-ear-drum-spasms/ |archive-date=20 August 2021 |access-date=24 May 2022 |website=Tinnitus And You}}</ref> This type of tinnitus is sometimes caused by an involuntary twitching of a muscle or a group of muscles ([[myoclonus]]) or by a vascular condition. In some cases, tinnitus is generated by muscle spasms around the middle ear.<ref name="entnet-hearing"/>

[[Otoacoustic emission#Spontaneous OAEs|Spontaneous otoacoustic emissions (SOAEs)]]—faint high-frequency tones that are produced in the inner ear and may be measured in the ear canal with a sensitive microphone—may also cause tinnitus.<ref name=Hen2005/> About 8% of those with SOAEs and tinnitus have SOAE-linked tinnitus,{{Request quotation | date = October 2018}} while the percentage of all cases of tinnitus caused by SOAEs is estimated at 4%.<ref name=Hen2005>{{cite journal |last1=Henry |first1=James A. |last2=Dennis |first2=Kyle C. |last3=Schechter |first3=Martin A. |title=General Review of Tinnitus: Prevalence, Mechanisms, Effects, and Management |journal=Journal of Speech, Language, and Hearing Research |date=October 2005 |volume=48 |issue=5 |pages=1204–1235 |doi=10.1044/1092-4388(2005/084) |pmid=16411806 }}</ref>

=== Pediatric tinnitus ===
Children may be subject to pulsatile or continuous tinnitus, involving anomalies and variants of the vascular parts<ref>{{cite journal |last1=Kerr |first1=Rhorie |last2=Kang |first2=Elise |last3=Hopkins |first3=Brandon |last4=Anne |first4=Samantha |title=Pediatric tinnitus: Incidence of imaging anomalies and the impact of hearing loss |journal=International Journal of Pediatric Otorhinolaryngology |date=December 2017 |volume=103 |pages=147–149 |doi=10.1016/j.ijporl.2017.10.027 |pmid=29224758 }}</ref> affecting the middle/inner ear structures. CT scans may be used to check the integrity of the structures, and MR scans may evaluate nerves and potential masses or malformations. Early diagnosis may prevent long-term impairments to development.<ref>{{cite journal |last1=Salman |first1=Rida |last2=Chong |first2=Insun |last3=Amans |first3=Matthew |last4=Hui |first4=Ferdinand |last5=Desai |first5=Nilesh |last6=Huisman |first6=Thierry A. G. M. |last7=Tran |first7=Brandon |title=Pediatric tinnitus: The role of neuroimaging |journal=Journal of Neuroimaging |date=May 2022 |volume=32 |issue=3 |pages=400–411 |doi=10.1111/jon.12986 |pmid=35307901 |s2cid=247584230 }}</ref>

=== Pulsatile tinnitus ===
Some people experience a sound that beats in time with their pulse, known as ''pulsatile tinnitus'' or ''vascular tinnitus''.<ref name="Pulsatile tinnitus August 2017">{{cite web |last1=McFerran |first1=Don |last2=Magdalena |first2=Sereda |title=Pulsatile tinnitus |url=https://www.actiononhearingloss.org.uk/-/media/ahl/documents/publications/factsheets-and-leaflets/factsheets/tinnitus/factsheet-pulsatile-tinnitus.pdf |website=Action on Hearing Loss |publisher=Royal National Institute for Deaf People (RNID) |access-date=22 July 2018 |archive-date=22 July 2018 |archive-url=https://web.archive.org/web/20180722095632/https://www.actiononhearingloss.org.uk/-/media/ahl/documents/publications/factsheets-and-leaflets/factsheets/tinnitus/factsheet-pulsatile-tinnitus.pdf }}</ref> Pulsatile tinnitus is usually objective in nature, resulting from altered blood flow or increased blood turbulence near the ear, such as from [[atherosclerosis]] or venous hum,<ref>{{Cite journal |author=Chandler JR |title=Diagnosis and cure of venous hum tinnitus |journal=The Laryngoscope |volume=93 |issue=7 |pages=892–895 |year=1983 |pmid=6865626 |doi=10.1288/00005537-198307000-00009|s2cid=33725476 }}</ref> but it may also arise as a subjective phenomenon from an increased awareness of blood flow in the ear.<ref name="Pulsatile tinnitus August 2017"/>

The differential diagnosis for pulsatile tinnitus is wide and includes vascular etiologies, tumors, disorders of the [[middle ear]] or [[inner ear]], and other intracranial pathologies.<ref>{{Cite journal |last1=Pegge |first1=Sjoert A. H. |last2=Steens |first2=Stefan C. A. |last3=Kunst |first3=Henricus P. M. |last4=Meijer |first4=Frederick J. A. |date=2017 |title=Pulsatile Tinnitus: Differential Diagnosis and Radiological Work-Up |journal=Current Radiology Reports |volume=5 |issue=1 |page=5 |doi=10.1007/s40134-017-0199-7 |issn=2167-4825 |pmc=5263210 |pmid=28203490}}</ref> Vascular causes of pulsatile tinnitus include venous causes (e.g., high riding or dehiscent [[jugular bulb]], [[sigmoid sinus]] diverticulum), arterial causes (e.g., cervical [[atherosclerosis]], potentially life-threatening conditions such as [[carotid artery]] [[aneurysm]]<ref>{{Cite journal |vauthors=Moonis G, Hwang CJ, Ahmed T, Weigele JB, Hurst RW |title=Otologic manifestations of petrous carotid aneurysms |journal=American Journal of Neuroradiology |volume=26 |issue=6 |pages=1324–1327 |year=2005 |pmid=15956490 |pmc=8149044 }}</ref> or [[carotid artery dissection]]), or dural [[arteriovenous fistula]] or [[arteriovenous malformation]]s.<ref name="Carotid Artery Dissection">{{cite journal |last1=Selim |first1=Magdy |last2=Caplan |first2=Louis R. |title=Carotid artery dissection |journal=Current Treatment Options in Cardiovascular Medicine |date=June 2004 |volume=6 |issue=3 |pages=249–253 |doi=10.1007/s11936-996-0020-z |pmid=15096317 |s2cid=7503852 }}</ref> 

Pulsatile tinnitus may also indicate [[vasculitis]], or more specifically, [[giant cell arteritis]]. Pulsatile tinnitus may also be caused by tumors such as [[paraganglioma]]s (e.g., [[glomus tympanicum]], [[glomus jugulare]]), or [[hemangioma]]s (e.g., [[facial nerve]] or [[Cavernous hemangioma|cavernous]]). [[Middle ear]] causes of pulsatile tinnitus include [[Patulous Eustachian tube|patulous eustachian tube]], [[otosclerosis]], or [[middle ear myoclonus]] (e.g., [[Stapedius muscle|stapedial]] or [[Tensor tympani muscle|tensor tympani]] myoclonus). The most common [[inner ear]] cause of pulsatile tinnitus is [[Superior canal dehiscence syndrome|superior semicircular canal dehiscence]].<ref>{{Cite journal |last1=Ward |first1=Bryan K. |last2=Carey |first2=John P. |last3=Minor |first3=Lloyd B. |date=2017-04-28 |title=Superior Canal Dehiscence Syndrome: Lessons from the First 20 Years |journal=Frontiers in Neurology |volume=8 |article-number=177 |doi=10.3389/fneur.2017.00177 |issn=1664-2295 |pmc=5408023 |pmid=28503164 |doi-access=free }}</ref> Pulsatile tinnitus may also indicate [[idiopathic intracranial hypertension]].<ref>{{cite journal |last1=Sismanis |first1=Aristides |last2=Butts |first2=Frank M. |last3=Hughes |first3=Gordon B. |title=Objective Tinnitus in Benign Intracranial Hypertension: An Update |journal=The Laryngoscope |date=January 1990 |volume=100 |issue=1 |pages=33–36 |doi=10.1288/00005537-199001000-00008 |pmid=2293699 |s2cid=20886638 }}</ref> Pulsatile tinnitus may be a symptom of intracranial vascular abnormalities and should be evaluated for ''irregular noises of blood flow'' ([[bruit]]s).<ref>{{cite encyclopedia | vauthors = Diamond BJ, Mosley JE | title = Arteriovenous Malformation (AVM) | year = 2011 | encyclopedia = Encyclopedia of Clinical Neuropsychology | veditors = Kreutzer JS, DeLuca J, Caplan B | publisher = Springer | isbn = 978-0-387-79947-6 | doi = 10.1007/978-0-387-79948-3 | pages = 249–252  | doi-access = free }}</ref>

== Pathophysiology ==
Tinnitus may be caused by increased neural activity in the auditory brainstem, where the brain processes sounds, causing some auditory nerve cells to become overexcited. The basis of this theory is that many with tinnitus also have [[hearing loss]].<ref name="Nicolas-Puel">{{cite journal |pmid=14763234 |last1=Nicolas-Puel |first1=C |last2=Faulconbridge |first2=RL |last3=Guitton |first3=M |last4=Puel |first4=JL |last5=Mondain |first5=M |last6=Uziel |first6=A |title=Characteristics of tinnitus and etiology of associated hearing loss: a study of 123 patients |journal=The International Tinnitus Journal |volume=8 |issue=1 |year=2002 |pages=37–44}}</ref>

Tinnitus may cause stress by triggering a [[fight-or-flight response]] in brain chemistry, as the brain may perceive it as dangerous and important, and in 2021 was documented as reported by study subjects as increasing during otherwise stressful situations.<ref>{{cite web | url=https://www.tinnitus.org.uk/taming-tinnitus | title=Taming tinnitus }}</ref><ref>{{cite web | url=https://jhbi.org/why-does-my-tinnitus-get-worse-when-im-stressed/ | title=Why Does My Tinnitus Get Worse when I'm Stressed? | date=17 May 2021 }}</ref><ref>{{cite book |doi=10.1002/9780470720677.ch11 |chapter=Personality of the Tinnitus Patient |title=Ciba Foundation Symposium 85 – Tinnitus |series=Novartis Foundation Symposia |year=2008 |last1=House |first1=Patricia R. |volume=85 |pages=193–203 |pmid=7035099 |isbn=978-0-470-72067-7 }}</ref> 

Three reviews in 2016 emphasized the large range and possible combinations of pathologies involved in tinnitus, which result in a great variety of symptoms and specifically adapted therapies.<ref name="pmid26977153">{{cite journal | vauthors = Møller AR | title = Sensorineural Tinnitus: Its Pathology and Probable Therapies | journal = International Journal of Otolaryngology | volume = 2016 | pages = 1–13 | year = 2016 | pmid = 26977153 | pmc = 4761664 | doi = 10.1155/2016/2830157 | doi-access = free }}</ref><ref name="pmid27871729">{{cite journal | vauthors = Sedley W, Friston KJ, Gander PE, Kumar S, Griffiths TD | title = An Integrative Tinnitus Model Based on Sensory Precision | journal = Trends in Neurosciences | volume = 39 | issue = 12 | pages = 799–812 | year = 2016 | pmid = 27871729 | pmc = 5152595 | doi = 10.1016/j.tins.2016.10.004 }}</ref><ref name="pmid26868680">{{cite journal | vauthors = Shore SE, Roberts LE, Langguth B | title = Maladaptive plasticity in tinnitus – triggers, mechanisms and treatment | journal = Nature Reviews Neurology | volume = 12 | issue = 3 | pages = 150–160 | year = 2016 | pmid = 26868680 | pmc = 4895692 | doi = 10.1038/nrneurol.2016.12 }}</ref><ref>{{cite journal |last1=Park |first1=Jung Mee |last2=Kim |first2=Woo Jin |last3=Han |first3=Jae Sang |last4=Park |first4=So Young |last5=Park |first5=Shi Nae |title=Management of palatal myoclonic tinnitus based on clinical characteristics: a large case series study |journal=Acta Oto-Laryngologica |date=2 July 2020 |volume=140 |issue=7 |pages=553–557 |doi=10.1080/00016489.2020.1749724 |pmid=32406274 |s2cid=218635840 }}</ref>

== Diagnosis==
The diagnostic approach is based on a history of the condition and an examination of the head, neck, and neurological system.<ref name=Yew2014/> Typically an audiogram is conducted, and occasionally [[medical imaging]] or [[electronystagmography]].<ref name=Yew2014/> Treatable conditions may include middle ear infection, acoustic neuroma,
concussion, and [[otosclerosis]].<ref>{{cite journal |last1=Crummer |display-authors=etal |first1=RW |title=Diagnostic Approach to Tinnitus |journal=American Family Physician |date=2004 |volume=69 |issue=1 |pages=120–126|pmid=14727828 }}</ref>

Evaluation of tinnitus may include a hearing test (audiogram), measurement of acoustic parameters of the tinnitus such as pitch and loudness, and psychological assessment of comorbid conditions such as depression, anxiety, and stress that might be associated with severity of the tinnitus.{{citation needed|date=December 2020}}

One definition of tinnitus, in contrast to normal ear noise experience, is that tinnitus lasts five minutes at least twice a week.<ref>{{cite journal |last=Davis |first=A |year=1989 |title=The prevalence of hearing impairment and reported hearing disability among adults in Great Britain |journal=International Journal of Epidemiology |volume=18 |issue= 4 |pages=911–917 |doi=10.1093/ije/18.4.911|pmid=2621028 }}</ref> However, people with tinnitus often experience the noise more frequently than this. Tinnitus may be present constantly or intermittently. Some people with constant tinnitus might not be aware of it all the time, but only, for example, during the night or in situations when there is less environmental noise to mask it. Chronic tinnitus may be defined as tinnitus with a duration of six months or more.<ref>{{cite journal | last=Henry | first=James A. | title="Measurement" of Tinnitus | journal=Otology & Neurotology | volume=37 | issue=8 | date=2016 | issn=1531-7129 | doi=10.1097/MAO.0000000000001070 | pages=e276–e285| pmid=27518136 }}</ref>

=== Audiology ===
Since most people with tinnitus also have hearing loss, a [[pure tone audiometry|pure tone hearing test]] resulting in an audiogram may help diagnose a cause. An audiogram may also facilitate fitting of a hearing aid in those cases where hearing loss is significant. The pitch of tinnitus is often in the range of the hearing loss.

=== Psychoacoustics ===
Acoustic qualification of tinnitus includes measurement of several acoustic parameters such as frequency in cases of monotone tinnitus or {{Clarify | text = frequency range and bandwidth in cases of narrow band noise tinnitus| date = December 2024 | reason = What is bandwidth, in addition to frequency range?}}, loudness in dB above hearing threshold at the indicated frequency, {{Clarify | text = mixing-point| date = December 2024}}, and minimum masking level.<ref>{{cite journal |last1=Henry |first1=JA |last2=Meikle |first2=MB |title=Psychoacoustic measures of tinnitus. |journal=Journal of the American Academy of Audiology |date=March 2000 |volume=11 |issue=3 |pages=138–155 |doi=10.1055/s-0042-1748040 |pmid=10755810 |s2cid=34933069 }}</ref> In most cases, tinnitus pitch or frequency range is between 5&nbsp;kHz and 10&nbsp;kHz,<ref name="pmid26583098">{{cite journal | vauthors = Vielsmeier V, Lehner A, Strutz J, Steffens T, Kreuzer PM, Schecklmann M, Landgrebe M, Langguth B, Kleinjung T | title = The Relevance of the High Frequency Audiometry in Tinnitus Patients with Normal Hearing in Conventional Pure-Tone Audiometry | journal = BioMed Research International | volume = 2015 | pages = 1–5 | year = 2015 | pmid = 26583098 | pmc = 4637018 | doi = 10.1155/2015/302515 | doi-access = free }}</ref> and loudness between 5 and 15&nbsp;[[decibel|dB]] above the hearing threshold.<ref name="pmid24349414">{{cite journal | vauthors = Basile CÉ, Fournier P, Hutchins S, Hébert S | title = Psychoacoustic assessment to improve tinnitus diagnosis | journal = PLOS ONE | volume = 8 | issue = 12 | article-number = e82995 | year = 2013 | pmid = 24349414 | pmc = 3861445 | doi = 10.1371/journal.pone.0082995 | bibcode = 2013PLoSO...882995B | doi-access = free }}</ref> 

Another relevant parameter of tinnitus is residual inhibition: the temporary suppression or disappearance of tinnitus following a period of masking. The degree of residual inhibition may indicate how effective tinnitus maskers would be as treatment.<ref name="pmid17956813">{{cite book |doi=10.1016/S0079-6123(07)66047-6 |chapter=Residual inhibition |title=Tinnitus: Pathophysiology and Treatment |series=Progress in Brain Research |year=2007 |last1=Roberts |first1=Larry E. |volume=166 |pages=487–495 |pmid=17956813 |isbn=978-0-444-53167-4 }}</ref><ref name="pmid18712566">{{cite journal | vauthors = Roberts LE, Moffat G, Baumann M, Ward LM, Bosnyak DJ | title = Residual inhibition functions overlap tinnitus spectra and the region of auditory threshold shift | journal = Journal of the Association for Research in Otolaryngology | volume = 9 | issue = 4 | pages = 417–435 | year = 2008 | pmid = 18712566 | pmc = 2580805 | doi = 10.1007/s10162-008-0136-9 }}</ref>

=== Hyperacusis ===
An assessment of [[hyperacusis]], a frequent accompaniment of tinnitus,<ref name="pmid24012803">{{cite journal | vauthors = Knipper M, Van Dijk P, Nunes I, Rüttiger L, Zimmermann U | title = Advances in the neurobiology of hearing disorders: recent developments regarding the basis of tinnitus and hyperacusis | journal = Progress in Neurobiology | volume = 111 | pages = 17–33 | year = 2013 | pmid = 24012803 | doi = 10.1016/j.pneurobio.2013.08.002 | doi-access = free }}</ref> may also be made.<ref name="pmid25104073">{{cite journal |last1=Tyler |first1=Richard S. |last2=Pienkowski |first2=Martin |last3=Roncancio |first3=Eveling Rojas |last4=Jun |first4=Hyung Jin |last5=Brozoski |first5=Tom |last6=Dauman |first6=Nicolas |last7=Coelho |first7=Claudia Barros |last8=Andersson |first8=Gerhard |last9=Keiner |first9=Andrew J. |last10=Cacace |first10=Anthony T. |last11=Martin |first11=Nora |last12=Moore |first12=Brian C. J. |title=A Review of Hyperacusis and Future Directions: Part I. Definitions and Manifestations |journal=American Journal of Audiology |date=December 2014 |volume=23 |issue=4 |pages=402–419 |doi=10.1044/2014_AJA-14-0010 |pmid=25104073 }}</ref> Anari et al. (199) found that 86% of patients with hyperacusis also present with tinnitus.<ref>{{Cite journal |last1=Anari |first1=M. |last2=Axelsson |first2=A. |last3=Eliasson |first3=A. |last4=Magnusson |first4=L. |date=1999 |title=Hypersensitivity to sound--questionnaire data, audiometry and classification |journal=Scandinavian Audiology |volume=28 |issue=4 |pages=219–230 |doi=10.1080/010503999424653 |issn=0105-0397 |pmid=10572967}}</ref>

Hyperacusis is related to negative reactions to sound and may take many forms. One parameter that may be measured is Loudness Discomfort Level (LDL) in dB, which is the subjective level of acute discomfort at specified frequencies over the frequency range of hearing. This defines a dynamic range between the hearing threshold at that frequency and the loudness discomfort level. A compressed dynamic range over a particular frequency range may be associated with hyperacusis. The normal hearing comfort threshold is generally defined as 0–20 decibels (dB). Normal loudness discomfort levels are 85–90+ dB, with some authorities citing 100&nbsp;dB. A dynamic range of 55&nbsp;dB or lower is indicative of hyperacusis.<ref name="pmid15807048">{{cite journal |last1=Sherlock |first1=LaGuinn P. |last2=Formby |first2=Craig |title=Estimates of Loudness, Loudness Discomfort, and the Auditory Dynamic Range: Normative Estimates, Comparison of Procedures, and Test-Retest Reliability |journal=Journal of the American Academy of Audiology |date=February 2005 |volume=16 |issue=2 |pages=85–100 |doi=10.3766/jaaa.16.2.4 |pmid=15807048 }}</ref><ref name="pmid25478787">{{cite journal |last1=Pienkowski |first1=Martin |last2=Tyler |first2=Richard S. |last3=Roncancio |first3=Eveling Rojas |last4=Jun |first4=Hyung Jin |last5=Brozoski |first5=Tom |last6=Dauman |first6=Nicolas |last7=Coelho |first7=Claudia Barros |last8=Andersson |first8=Gerhard |last9=Keiner |first9=Andrew J. |last10=Cacace |first10=Anthony T. |last11=Martin |first11=Nora |last12=Moore |first12=Brian C. J. |title=A Review of Hyperacusis and Future Directions: Part II. Measurement, Mechanisms, and Treatment |journal=American Journal of Audiology |date=December 2014 |volume=23 |issue=4 |pages=420–436 |doi=10.1044/2014_AJA-13-0037 |pmid=25478787 }}</ref>

=== Severity ===
Tinnitus is often rated on a scale from "slight" to "severe" according to the effects it has, such as interference with sleep, quiet activities, and normal daily activities.<ref name="pmid11678946">{{cite journal |last1=McCombe |first1=A. |last2=Baguley |first2=D. |last3=Coles |first3=R. |last4=McKenna |first4=L. |last5=McKinney |first5=C. |last6=Windle-Taylor |first6=P. |title=Guidelines for the grading of tinnitus severity: the results of a working group commissioned by the British Association of Otolaryngologists, Head and Neck Surgeons, 1999 |journal=Clinical Otolaryngology and Allied Sciences |date=October 2001 |volume=26 |issue=5 |pages=388–393 |doi=10.1046/j.1365-2273.2001.00490.x |pmid=11678946 }}</ref> Severe tinnitus has been associated with rarer variants.<ref name=":1" />

Assessment of psychological processes related to tinnitus involves measurement of tinnitus severity and distress, as measured subjectively by validated self-report tinnitus questionnaires.<ref name="Henry JA, Dennis KC, Schechter MA 2005 1204–1235"/> Such questionnaires measure the degree of psychological distress and handicap associated with tinnitus, including effects on hearing, lifestyle, health, and emotional functioning.<ref name="pmid17956816">{{cite book |doi=10.1016/S0079-6123(07)66050-6 |chapter=Consensus for tinnitus patient assessment and treatment outcome measurement: Tinnitus Research Initiative meeting, Regensburg, July 2006 |title=Tinnitus: Pathophysiology and Treatment |series=Progress in Brain Research |year=2007 |last1=Langguth |first1=B. |last2=Goodey |first2=R. |last3=Azevedo |first3=A. |last4=Bjorne |first4=A. |last5=Cacace |first5=A. |last6=Crocetti |first6=A. |last7=Del Bo |first7=L. |last8=De Ridder |first8=D. |last9=Diges |first9=I. |last10=Elbert |first10=T. |last11=Flor |first11=H. |last12=Herraiz |first12=C. |last13=Ganz Sanchez |first13=T. |last14=Eichhammer |first14=P. |last15=Figueiredo |first15=R. |last16=Hajak |first16=G. |last17=Kleinjung |first17=T. |last18=Landgrebe |first18=M. |last19=Londero |first19=A. |last20=Lainez |first20=M.J.A. |last21=Mazzoli |first21=M. |last22=Meikle |first22=M.B. |last23=Melcher |first23=J. |last24=Rauschecker |first24=J.P. |last25=Sand |first25=P.G. |last26=Struve |first26=M. |last27=Van De Heyning |first27=P. |last28=Van Dijk |first28=P. |last29=Vergara |first29=R. |volume=166 |pages=525–536 |pmid=17956816 |pmc=4283806 |isbn=978-0-444-53167-4 }}</ref><ref name="pmid17956815">{{cite book |doi=10.1016/S0079-6123(07)66049-X |chapter=Assessment of tinnitus: Measurement of treatment outcomes |title=Tinnitus: Pathophysiology and Treatment |series=Progress in Brain Research |year=2007 |last1=Meikle |first1=M.B. |last2=Stewart |first2=B.J. |last3=Griest |first3=S.E. |last4=Martin |first4=W.H. |last5=Henry |first5=J.A. |last6=Abrams |first6=H.B. |last7=McArdle |first7=R. |last8=Newman |first8=C.W. |last9=Sandridge |first9=S.A. |volume=166 |pages=511–521 |pmid=17956815 |isbn=978-0-444-53167-4 }}</ref><ref name="pmid22156949">{{cite journal |last1=Meikle |first1=Mary B. |last2=Henry |first2=James A. |last3=Griest |first3=Susan E. |last4=Stewart |first4=Barbara J. |last5=Abrams |first5=Harvey B. |last6=McArdle |first6=Rachel |last7=Myers |first7=Paula J. |last8=Newman |first8=Craig W. |last9=Sandridge |first9=Sharon |last10=Turk |first10=Dennis C. |last11=Folmer |first11=Robert L. |last12=Frederick |first12=Eric J. |last13=House |first13=John W. |last14=Jacobson |first14=Gary P. |last15=Kinney |first15=Sam E. |last16=Martin |first16=William H. |last17=Nagler |first17=Stephen M. |last18=Reich |first18=Gloria E. |last19=Searchfield |first19=Grant |last20=Sweetow |first20=Robert |last21=Vernon |first21=Jack A. |title=The Tinnitus Functional Index: Development of a New Clinical Measure for Chronic, Intrusive Tinnitus |journal=Ear & Hearing |date=March 2012 |volume=33 |issue=2 |pages=153–176 |doi=10.1097/AUD.0b013e31822f67c0 |pmid=22156949 |s2cid=587811 }}</ref> A broader assessment of general functioning, such as levels of anxiety, depression, stress, life stressors, and sleep difficulties, is also important in the assessment of tinnitus due to higher risk of negative well-being across these areas, which may be affected by or exacerbate the tinnitus symptoms.<ref>{{Cite book |last1=Henry |first1=J. L. |last2=Wilson |first2=PH |title= The Psychological Management of Chronic Tinnitus: A Cognitive Behavioural Approach |publisher=Allyn and Bacon |year=2000}}</ref> 

Current assessment measures aim to identify levels of distress and interference, coping responses, and perceptions of tinnitus to inform treatment and monitor progress. However, wide variability, inconsistencies, and lack of consensus regarding assessment methodology are evidenced in the literature, limiting comparison of treatment effectiveness.<ref>{{Cite journal |vauthors=Landgrebe M, Azevedo A, Baguley D, Bauer C, Cacace A, Coelho C, etal |title=Methodological aspects of clinical trials in tinnitus: A proposal for international standard |journal=Journal of Psychosomatic Research |volume=73 |pages=112–121 |year=2012 |pmid=22789414 |doi=10.1016/j.jpsychores.2012.05.002 |issue=2 |pmc=3897200}}</ref> Questionnaires developed to guide diagnosis or classify severity of tinnitus may be treatment-sensitive outcome measures.<ref name=":0">{{cite journal |last1=Martinez-Devesa |first1=Pablo |last2=Perera |first2=Rafael |last3=Theodoulou |first3=Megan |last4=Waddell |first4=Angus |title=Cognitive behavioural therapy for tinnitus |journal=Cochrane Database of Systematic Reviews |date=8 September 2010 |issue=9 |article-number=CD005233 |doi=10.1002/14651858.CD005233.pub3 |pmid=20824844 |pmc=12529915 | url =  https://www.hopefortinnitus.com/storage/app/media/forms/cochrane-review-of-cbt.pdf | archive-url = https://archive.today/20241211090451/https://www.hopefortinnitus.com/storage/app/media/forms/cochrane-review-of-cbt.pdf | archive-date = 2024-12-11 | url-status = live}}</ref>{{Request quotation|date=December 2024|reason = Not obvious what statements are used to support this sentence.}}  

=== Pulsatile tinnitus ===
If examination reveals a bruit (sound due to turbulent blood flow), imaging studies such as [[transcranial doppler]] (TCD) or [[magnetic resonance angiography]] (MRA) should be performed.<ref name="pmid28203490">{{cite journal | vauthors = Pegge S, Steens S, Kunst H, Meijer F | title = Pulsatile Tinnitus: Differential Diagnosis and Radiological Work-Up | journal = Current Radiology Reports | volume = 5 | issue = 1 | article-number = 5 | year = 2017 | pmid = 28203490 | pmc = 5263210 | doi = 10.1007/s40134-017-0199-7 }}</ref><ref name="pmid23885280">{{cite journal | vauthors = Hofmann E, Behr R, Neumann-Haefelin T, Schwager K | title = Pulsatile tinnitus: imaging and differential diagnosis | journal = Deutsches Ärzteblatt International | volume = 110 | issue = 26 | pages = 451–458 | year = 2013 | pmid = 23885280 | pmc = 3719451 | doi = 10.3238/arztebl.2013.0451 }}</ref><ref name="pmid22552697">{{cite journal |last1=Sismanis |first1=Aristides |title=Pulsatile tinnitus: contemporary assessment and management |journal=Current Opinion in Otolaryngology & Head and Neck Surgery |date=October 2011 |volume=19 |issue=5 |pages=348–357 |doi=10.1097/MOO.0b013e3283493fd8 |pmid=22552697 |s2cid=22964919 }}</ref>

=== Differential diagnosis ===
Other potential sources of the sounds normally associated with tinnitus should be ruled out. For instance, two recognized external sources of high-pitched sounds might be electromagnetic fields common in modern wiring and various sound signal transmissions. A common and often misdiagnosed condition that mimics tinnitus is radio frequency (RF) hearing, in which subjects hear objectively audible high-pitched transmission frequencies that sound similar to tinnitus.<ref>{{cite journal |last=Elder |first=JA |author2=Chou, CK |title=Auditory response to pulsed radiofrequency energy |journal=Bioelectromagnetics |year=2003 |volume=6 |pages=S162–173 |pmid=14628312 |doi=10.1002/bem.10163|s2cid=9813447 |doi-access=free }}</ref><ref name="pmid17495664">{{cite journal | vauthors = Lin JC, Wang Z | title = Hearing of microwave pulses by humans and animals: effects, mechanism, and thresholds | journal = Health Physics | volume = 92 | issue = 6 | pages = 621–628 | year = 2007 | pmid = 17495664 | doi = 10.1097/01.HP.0000250644.84530.e2 | bibcode = 2007HeaPh..92..621L | s2cid = 37236570 }}</ref>

== Prevention ==
[[File:HSR 1996 II 3.3c.svg|thumb|Safety sign from UK Government Regulations requiring ear protection]]
[[Acoustic trauma|Prolonged exposure]] to loud [[Sound pressure#Examples of sound pressure and sound pressure levels|sound or noise levels]] can lead to tinnitus.<ref name=CPG2014>{{cite journal | vauthors = Tunkel DE, Bauer CA, Sun GH |display-authors=etal | title = Clinical practice guideline: tinnitus | journal =   Otolaryngology–Head and Neck Surgery | volume = 151 | issue = 2 Suppl | pages = S1–40 | year = 2014 | pmid = 25273878 | doi = 10.1177/0194599814545325 |s2cid=206468767 }}</ref> Custom made [[ear plug]]s or other measures may help with prevention. Employers may use hearing loss prevention programs to help educate and prevent dangerous levels of exposure to noise. Government organizations set regulations to ensure employees, if following the protocol, should have minimal risk to permanent damage to their hearing.<ref>{{Cite web|url=https://www.cdc.gov/niosh/programs/hlp/default.html|title= NIOSH Program Portfolio : Hearing Loss Prevention: Program Description|date=5 February 2019|website=www.cdc.gov – CDC|language=en-us|access-date=26 March 2019}}</ref>

Certain groups are advised to wear ear plugs to avoid the risk of tinnitus, such as that caused by overexposure to loud noises such as wind noise for motorcycle riders.<ref>{{Cite web|url=https://www.carolenash.com/news/bike-news/detail/bikers-warned-wear-earplugs-avoid-lifetime-tinnitus|title= Bike news|date= |website=www.carolenash.com|language=en-us|access-date=28 June 2021}}</ref> This includes military personnel,<ref name="pmid32334867"/> musicians,<ref>{{cite journal |last1=Burns-O'Connell |first1=Georgina |last2=Stockdale |first2=David |last3=Cassidy |first3=Oscar |last4=Knowles |first4=Victoria |last5=Hoare |first5=Derek J. |title=Surrounded by Sound: The Impact of Tinnitus on Musicians |journal=International Journal of Environmental Research and Public Health |date=27 August 2021 |volume=18 |issue=17 |page=9036 |doi=10.3390/ijerph18179036 |pmid=34501628 |pmc=8431046 |doi-access=free }}</ref> DJs,<ref>{{cite web |last=Boles |first=Benjamin |title=DJs Shouldn't Have to Live With Constant Ringing in Their Ears |website=VICE |date=9 August 2016 |url=https://www.vice.com/en/article/hearing-loss-tinnitus-laidback-luke-roger-sanchez-feature/ |access-date=22 July 2024}}</ref> agricultural workers,<ref>{{cite journal |last1=Couth |first1=Samuel |last2=Mazlan |first2=Naadia |last3=Moore |first3=David R. |last4=Munro |first4=Kevin J. |last5=Dawes |first5=Piers |title=Hearing Difficulties and Tinnitus in Construction, Agricultural, Music, and Finance Industries: Contributions of Demographic, Health, and Lifestyle Factors |journal=Trends in Hearing |date=January 2019 |volume=23 |article-number=2331216519885571 |doi=10.1177/2331216519885571 |pmid=31747526 |pmc=6868580 }}</ref> and construction workers<ref>{{cite web | url=https://www.cdc.gov/niosh/topics/ohl/construction.html | title=Construction Statistics – Occupational Hearing Loss Surveillance &#124; NIOSH &#124; CDC | date=12 November 2021 }}</ref> as people in those occupations are at a greater risk compared to the general population.

Several medicines have [[ototoxic]] effects, which can have a cumulative effect that increases the damage resulting from loud noise.<ref name="pmid32334867"/> If ototoxic medications must be administered, close attention by the physician to prescription details, such as dose and dosage interval, may reduce the amount of damage.<ref name="pmid33080070"/><ref name="pmid21796866">{{cite journal |last1=Cianfrone |first1=G |last2=Pentangelo |first2=D |last3=Cianfrone |first3=F |last4=Mazzei |first4=F |last5=Turchetta |first5=R |last6=Orlando |first6=MP |last7=Altissimi |first7=G |title=Pharmacological drugs inducing ototoxicity, vestibular symptoms and tinnitus: a reasoned and updated guide. |journal=European Review for Medical and Pharmacological Sciences |date=June 2011 |volume=15 |issue=6 |pages=601–636 |pmid=21796866 }}</ref><ref>{{cite journal |last=Palomar García |first=V |author2=Abdulghani Martínez, F |author3=Bodet Agustí, E |author4=Andreu Mencía, L |author5=Palomar Asenjo, V |title=Drug-induced otoxicity: current status |journal=Acta Oto-Laryngologica |date=July 2001 |volume=121 |issue=5 |pages=569–572 |pmid=11583387 |doi=10.1080/00016480121545|s2cid=218879738 }}</ref><ref name="pmid8934581">{{cite journal | vauthors = Seligmann H, Podoshin L, Ben-David J, Fradis M, Goldsher M | title = Drug-induced tinnitus and other hearing disorders | journal = Drug Safety | volume = 14 | issue = 3 | pages = 198–212 | year = 1996 | pmid = 8934581 | doi = 10.2165/00002018-199614030-00006| s2cid = 23522352 }}</ref>

== Management ==
If a specific underlying cause is determined, treating it may lead to improvements.<ref name="Baguley McFerran Hall 2013"/> Otherwise, the primary treatment for tinnitus is [[talk therapy]],<ref name=Lang2013/> [[sound therapy]], or [[hearing aid]]s. There are no effective drugs that treat tinnitus.<ref name="Baguley McFerran Hall 2013"/><ref>{{Cite web |date=20 March 2015 |title=Drug Therapies |url=https://www.ata.org/managing-your-tinnitus/treatment-options/drug-therapies |access-date=3 March 2022 |website=[[American Tinnitus Association]] |language=en |quote=There are presently no FDA-approved drugs specifically for tinnitus, and no medications that have been shown to reverse the neural hyperactivity at the root of tinnitus. Drugs cannot cure tinnitus, but they may provide relief from some severe tinnitus symptoms.}}</ref><ref>{{cite journal |last1=Kleinjung |first1=Tobias |last2=Langguth |first2=Berthold |title=Avenue for Future Tinnitus Treatments |journal=Otolaryngologic Clinics of North America |date=August 2020 |volume=53 |issue=4 |pages=667–683 |doi=10.1016/j.otc.2020.03.013 |pmid=32381341 |doi-access=free }}</ref>

=== Psychological ===
The best-supported treatment for adapting to high stress that might be associated with tinnitus is [[cognitive behavioral therapy]] (CBT).<ref name=Lang2013/><ref name=":0" /><ref name=Hoarre2011/> It decreases the stress those with tinnitus feel.<ref>{{Cite journal |vauthors=Hesser H, Weise C, Zetterquist Westin V, Andersson G |title=A systematic review and meta-analysis of randomized controlled trials of cognitive–behavioral therapy for tinnitus distress |journal=Clinical Psychology Review |volume=31 |pages=545–553 |year=2011 |doi= 10.1016/j.cpr.2010.12.006 |pmid=21237544 |issue=4}}</ref> This appears to be independent of any effect on depression or anxiety.<ref name=Hoarre2011>{{Cite journal |vauthors=Hoare D, Kowalkowski V, Knag S, Hall D |title=Systematic review and meta-analyses of randomized controlled trials examining tinnitus management |journal=The Laryngoscope |volume=121 |issue=7 |pages=1555–1564 |year=2011 |doi= 10.1002/lary.21825 |pmid=21671234 |pmc=3477633}}</ref> [[Acceptance and commitment therapy]] (ACT) also shows promise in the treatment of tinnitus.<ref>{{cite journal |last1=Ost |first1=LG |title=The efficacy of Acceptance and Commitment Therapy: an updated systematic review and meta-analysis |journal=Behaviour Research and Therapy |date=October 2014 |volume=61 |pages=105–121 |pmid=25193001 |doi=10.1016/j.brat.2014.07.018}}</ref> [[Relaxation technique]]s may also help.<ref name="Baguley McFerran Hall 2013"/> A clinical protocol called Progressive Tinnitus Management has been developed by the [[United States Department of Veterans Affairs]].<ref>{{Cite web |vauthors=Henry J, Zaugg T, Myers P, Kendall C |title=Chapter 9 – Level 5 Individualized Support |work=Progressive Tinnitus Management: Clinical Handbook for Audiologists |publisher=US Department of Veterans Affairs, National Center for Rehabilitative Auditory Research |url=http://www.ncrar.research.va.gov/Education/Documents/TinnitusDocuments/Index.asp |year=2012 |access-date=20 December 2013 |url-status=live |archive-url=https://web.archive.org/web/20131220223240/http://www.ncrar.research.va.gov/Education/Documents/TinnitusDocuments/Index.asp |archive-date=20 December 2013 }}</ref>

=== Sound-based interventions ===
The application of [[sound therapy]] by either [[hearing aids]] or [[tinnitus masker]]s may help the brain ignore the specific tinnitus frequency. Although these methods are poorly supported by evidence, there are no negative effects.<ref name="Baguley McFerran Hall 2013"/><ref name="pmid24622861">{{cite journal | vauthors = Hoare DJ, Searchfield GD, El Refaie A, Henry JA | title = Sound therapy for tinnitus management: practicable options | journal = Journal of the American Academy of Audiology | volume = 25 | issue = 1 | pages = 62–75 | year = 2014 | pmid = 24622861 | doi = 10.3766/jaaa.25.1.5}}</ref><ref>{{cite journal |last1=Sereda |first1=Magdalena |last2=Xia |first2=Jun |last3=El Refaie |first3=Amr |last4=Hall |first4=Deborah A |last5=Hoare |first5=Derek J |title=Sound therapy (using amplification devices and/or sound generators) for tinnitus |journal=Cochrane Database of Systematic Reviews |date=27 December 2018 |volume=2018 |issue=12 |article-number=CD013094 |doi=10.1002/14651858.CD013094.pub2 |pmid=30589445 |pmc=6517157 }}</ref> There are several approaches for tinnitus sound therapy. The first is sound modification to compensate for the individual's [[hearing loss]]. The second is tailored music therapy, notched at the tinnitus frequency, which may affect [[lateral inhibition]] of the notched neural region, suppressing tinnitus.<ref>{{cite journal |last1=Shore |first1=Susan E. |last2=Roberts |first2=Larry E. |last3=Langguth |first3=Berthold |title=Maladaptive plasticity in tinnitus – triggers, mechanisms and treatment |journal=Nature Reviews Neurology |date=March 2016 |volume=12 |issue=3 |pages=150–160 |doi=10.1038/nrneurol.2016.12 |pmid=26868680 |pmc=4895692 }}</ref><ref name="Hesse Doc04">{{cite journal |last1=Hesse |first1=Gerhard |title=Evidence and evidence gaps in tinnitus therapy |journal=GMS Current Topics in Otorhinolaryngology – Head and Neck Surgery; 15:Doc04 |date=15 December 2016 |volume=15 |pages=Doc04 |doi=10.3205/cto000131 |pmid=28025604 |pmc=5169077 }}</ref> 

There is some tentative evidence supporting [[tinnitus retraining therapy]], which aims to reduce tinnitus-related neuronal activity.<ref name="Baguley McFerran Hall 2013"/><ref name="pmid20238353">{{cite journal | vauthors = Phillips JS, McFerran D | title = Tinnitus Retraining Therapy (TRT) for tinnitus | journal = Cochrane Database of Systematic Reviews | issue = 3 | article-number = CD007330 | year = 2010 | volume = 2010 | pmid = 20238353 | doi = 10.1002/14651858.CD007330.pub2 | pmc = 7209976 }}</ref><ref name="Hesse Doc04"/> An alternative tinnitus treatment uses mobile applications that include various methods including [[Tinnitus masking|masking]], sound therapy, and relaxation exercises.<ref>{{cite journal |last1=Casale |first1=Manuele |last2=Costantino |first2=Andrea |last3=Rinaldi |first3=Vittorio |last4=Forte |first4=Antonio |last5=Grimaldi |first5=Marta |last6=Sabatino |first6=Lorenzo |last7=Oliveto |first7=Giuseppe |last8=Aloise |first8=Fabio |last9=Pontari |first9=Domenico |last10=Salvinelli |first10=Fabrizio |title=Mobile applications in otolaryngology for patients: An update: Otolaryngology Apps for Patients |journal=Laryngoscope Investigative Otolaryngology |date=December 2018 |volume=3 |issue=6 |pages=434–438 |doi=10.1002/lio2.201 |pmid=30599026 |pmc=6302723 }}</ref><ref>{{cite journal |last1=Mosa |first1=Abu Saleh Mohammad |last2=Yoo |first2=Illhoi |last3=Sheets |first3=Lincoln |title=A Systematic Review of Healthcare Applications for Smartphones |journal=BMC Medical Informatics and Decision Making |date=December 2012 |volume=12 |issue=1 |page=67 |doi=10.1186/1472-6947-12-67 |pmid=22781312 |pmc=3534499 |doi-access=free }}</ref> Such applications can work as a separate device or as a [[hearing aid]] control system.<ref>{{cite journal |last1=Kalle |first1=Sven |last2=Schlee |first2=Winfried |last3=Pryss |first3=Rüdiger C. |last4=Probst |first4=Thomas |last5=Reichert |first5=Manfred |last6=Langguth |first6=Berthold |last7=Spiliopoulou |first7=Myra |title=Review of Smart Services for Tinnitus Self-Help, Diagnostics and Treatments |journal=Frontiers in Neuroscience |date=20 August 2018 |volume=12 |article-number=541 |doi=10.3389/fnins.2018.00541 |pmid=30177869 |pmc=6109754 |doi-access=free }}</ref>

[[Neuromonics]] is another sound-based intervention. Its protocol follows the principle of systematic desensitization and involves a structured rehabilitation program lasting 12 months. Neuromonics therapy employs customized sound signals delivered through a device worn by the patient, which aims to target the specific frequency range associated with their tinnitus perception.<ref>{{cite journal | last1=Hobson | first1=Jonathan | last2=Chisholm | first2=Edward | last3=El Refaie | first3=Amr | title=Sound therapy (masking) in the management of tinnitus in adults | journal=Cochrane Database of Systematic Reviews | date=2012-11-14 | volume=11 | issue=11 | article-number=CD006371 | pmid=23152235 | pmc=7390392 | doi=10.1002/14651858.CD006371.pub3 | doi-access=free }}</ref>

=== Physical therapy ===
Physical therapy for tinnitus focuses on relaxing jaw and neck muscles that may contribute to symptoms. Muscle tension, particularly in the jaw muscles such as the [[Masseter muscle|masseter]] and [[Medial pterygoid muscle|medial pterygoid]], may radiate to the ears, leading to '''somatic tinnitus'''. Specialized physical therapists use neuromuscular techniques to alleviate tension in these areas, which may reduce tinnitus intensity and the associated pain in connected areas, such as the jaw, teeth, and ears.<ref>{{cite journal | last1=Yu | first1=Hong-Zhe | last2=Gong | first2=Jia-Min | last3=Hong | first3=Guo-Wei | last4=Zhou | first4=Ruo-Qiao | last5=Fu | first5=Xin-Ping | last6=Fan | first6=Ting | last7=Zheng | first7=Yu-Qing | last8=Peng | first8=Ying-Qiu | last9=Li | first9=Jian | last10=Wang | first10=Yun-Feng | title=The Effect of Physical Therapy on Somatosensory Tinnitus | journal=Journal of Clinical Medicine | date=2024 | volume=13 | issue=12 | page=3496 | doi=10.3390/jcm13123496 | pmid=38930025 | pmc=11204550 | doi-access=free }}</ref>

=== Medications ===
{{See also|List of investigational tinnitus drugs}}

{{As of|2018}} there were no medications effective for idiopathic tinnitus.<ref name="Baguley McFerran Hall 2013"/><ref name=CPG2014/><ref name="Bauer2018">{{cite journal |last1=Bauer |first1=CA |title=Tinnitus |journal=New England Journal of Medicine |date=March 2018 |volume=378 |issue=13 |pages=1224–1231 |doi=10.1056/NEJMcp1506631 |pmid=29601255}}</ref> There is not enough evidence to determine whether [[antidepressant]]s<ref>{{cite journal |last=Baldo |first=P |author2=Doree, C |author3=Molin, P |author4=McFerran, D |author5= Cecco, S |title=Antidepressants for patients with tinnitus |journal=Cochrane Database of Systematic Reviews |date=12 September 2012 |volume=2012 |issue=9 |article-number=CD003853 |pmid=22972065 |doi=10.1002/14651858.CD003853.pub3|pmc=7156891 }}</ref> or [[acamprosate]] are useful to treat tinnitus.<ref>{{cite journal |last=Savage |first=J |author2=Cook, S |author3=Waddell, A |title=Tinnitus |journal=BMJ Clinical Evidence |date=12 November 2009 |volume=2009 |pmid=21726476 |pmc=2907768}}</ref> There are conflicting studies regarding the effectiveness of [[benzodiazepines]] for tinnitus.<ref name="Baguley McFerran Hall 2013"/><ref name="Bauer2018"/><ref name="Savage2014">{{cite journal |last1=Savage |first1=J |last2=Waddell |first2=A |title=Tinnitus |journal=BMJ Clinical Evidence |date=October 2014 |volume=2014 |page=0506 |pmid=25328113 |pmc=4202663 }}</ref><ref name="pmid34205776">{{cite journal |vauthors=Kim SH, Kim D, Lee JM, Lee SK, Kang HJ, Yeo SG |title=Review of Pharmacotherapy for Tinnitus |journal=Healthcare |volume=9 |issue=6 |date=June 2021 |page=779 |pmid=34205776 |pmc=8235102 |doi=10.3390/healthcare9060779|doi-access=free }}</ref> As of 2015, the usefulness of [[melatonin]] is unclear.<ref>{{cite journal |last1=Miroddi |first1=M |last2=Bruno |first2=R |last3=Galletti |first3=F |last4=Calapai |first4=F |last5=Navarra |first5=M |last6=Gangemi |first6=S |last7=Calapai |first7=G |title=Clinical pharmacology of melatonin in the treatment of tinnitus: a review. |journal=European Journal of Clinical Pharmacology |date=March 2015 |volume=71 |issue=3 |pages=263–270 |doi=10.1007/s00228-015-1805-3 |pmid=25597877|s2cid=16466238 }}</ref> It is unclear whether [[anticonvulsant]]s are useful for treating tinnitus.<ref name="Baguley McFerran Hall 2013"/><ref>{{cite journal |last1=Hoekstra |first1=Carlijn EL |last2=Rynja |first2=Sybren P |last3=van Zanten |first3=Gijsbert A |last4=Rovers |first4=Maroeska M |title=Anticonvulsants for tinnitus |journal=Cochrane Database of Systematic Reviews |date=6 July 2011 |volume=2011 |issue=7 |article-number=CD007960 |doi=10.1002/14651858.CD007960.pub2 |pmid=21735419 |pmc=6599822 }}</ref> Steroid injections into the middle ear also do not seem to be effective.<ref>{{cite journal |last1=Pichora-Fuller |first1=M. Kathleen |last2=Santaguida |first2=Pasqualina |last3=Hammill |first3=Amanda |last4=Oremus |first4=Mark |last5=Westerberg |first5=Brian |last6=Ali |first6=Usman |last7=Patterson |first7=Christopher |last8=Raina |first8=Parminder |title=Evaluation and Treatment of Tinnitus: Comparative Effectiveness |journal=Comparative Effectiveness Reviews |series=AHRQ Comparative Effectiveness Reviews |issue=122 |date=2013 |url=https://www.ncbi.nlm.nih.gov/books/NBK158963/ |pmid=24049842 }}</ref><ref>{{cite journal |last1=Lavigne |first1=P |last2=Lavigne |first2=F |last3=Saliba |first3=I |author-link3=Issam Saliba |date=23 June 2015 |title=Intratympanic corticosteroids injections: a systematic review of literature |journal=European Archives of Oto-Rhino-Laryngology |volume=273 |issue=9 |pages=2271–2278 |doi=10.1007/s00405-015-3689-3 |pmid=26100030 |s2cid=36037973}}</ref> There is no evidence to suggest that the use of [[betahistine]] to treat tinnitus is effective.<ref>{{Cite journal|last1=Hall|first1=Deborah A|last2=Wegner|first2=Inge|last3=Smit|first3=Adriana Leni|last4=McFerran|first4=Don|last5=Stegeman|first5=Inge|date=2018|editor-last=Cochrane ENT Group|title=Betahistine for tinnitus|journal=Cochrane Database of Systematic Reviews|language=en|volume=12|issue=8|article-number=CD013093|doi=10.1002/14651858.CD013093|pmid=30908589|pmc=6513648}}</ref>

[[Botulinum toxin]] injection has succeeded in some of the rare cases of objective tinnitus resulting from a palatal tremor.<ref name="pmid27273401">{{cite journal | vauthors = Slengerik-Hansen J, Ovesen T | title = Botulinum Toxin Treatment of Objective Tinnitus Because of Essential Palatal Tremor: A Systematic Review | journal = Otology & Neurotology | volume = 37 | issue = 7 | pages = 820–828 | year = 2016 | pmid = 27273401 | doi = 10.1097/MAO.0000000000001090 | s2cid = 23675169 }}</ref>

In 2009, use in a few countries of [[Caroverine]] to treat tinnitus was published.<ref name=Martindale36>{{cite book |editor1-last=Sweetman |editor1-first=Sean C. |title=Martindale |date=2009 |publisher=Pharmaceutical Press |isbn=978-0-85369-840-1 |page=2277 |edition= 36th}}</ref> Upon review, the evidence for its usefulness was very weak.<ref name=Langguth2009>{{cite journal |last1=Langguth |first1=B |last2=Salvi |first2=R |last3=Elgoyhen |first3=AB |title=Emerging pharmacotherapy of tinnitus. |journal=Expert Opinion on Emerging Drugs |date=December 2009 |volume=14 |issue=4 |pages=687–702 |doi=10.1517/14728210903206975 |pmid=19712015 |pmc=2832848}}</ref>

=== Neuromodulation ===
In 2020, information was reported about clinical trials indicating that bimodal neuromodulation may reduce the symptoms of tinnitus. It is a noninvasive technique that involves applying an electrical stimulus to the tongue while also administering sounds.<ref>{{cite journal |last1=Kwon |first1=Diana |title=New Tinnitus Treatment Alleviated Annoying Ringing in the Ears |journal=Scientific American |date=7 October 2020 |volume=2 |issue=6 |pages=None |url=https://www.scientificamerican.com/article/new-tinnitus-treatment-alleviates-annoying-ringing-in-the-ears1/ |publisher=Springer Nature America, Inc.|doi=10.1038/scientificamerican122020-2VzL6BO1nViUY4ozIqWxY8 |url-access=subscription }}</ref> Equipment associated with the treatments is available through physicians. Studies with it and similar devices continue in several research centers.{{citation needed|date=December 2020}}

The Lenire bimodal neuromodulation device marketed by Neuromod was approved as a treatment option for tinnitus in March 2023 by the United States [[Food and Drug Administration]] (FDA).<ref name="George 2023">{{cite web |last1=George |first1=Judy |title=First Bimodal Neuromodulation Device for Tinnitus Gets FDA Nod |website=MedPage Today |date=8 March 2023 |url=https://www.medpagetoday.com/surgery/otolaryngology/103453 |access-date=23 July 2024}}</ref><ref name="Everts 2023">{{cite web |last=Everts |first=Quinn |title=FDA Grants De Novo Approval to Non-Invasive Tinnitus Treatment Device |website=Drug Topics |date=14 March 2023 |url=https://www.drugtopics.com/view/fda-grants-de-novo-approval-to-non-invasive-tinnitus-treatment-device |access-date=23 July 2024}}</ref><ref name="Philpott 2024">{{cite web |last=Philpott |first=Jenna | title=Neuromod inks contract to treat US veterans with tinnitus device |website=Medical Device Network |date=18 June 2024 |url=https://www.medicaldevice-network.com/news/neuromod-inks-contract-to-treat-us-veterans-with-tinnitus-device/ |access-date=23 July 2024}}</ref> In June 2024, the United States Department of Veterans Affairs (VA) announced it would begin offering the treatment to veterans with tinnitus, making it the first bimodal neuromodulation device to be awarded a Federal Supply Schedule (FSS) contract from the U.S. Government.<ref name="Philpott 2024" />

Some evidence supports neuromodulation techniques such as [[transcranial magnetic stimulation]],<ref name="Baguley McFerran Hall 2013"/><ref>{{cite journal |last=Meng |first=Z |author2=Liu, S |author3=Zheng, Y |author4= Phillips, JS |title=Repetitive transcranial magnetic stimulation for tinnitus |journal=Cochrane Database of Systematic Reviews |date=5 October 2011 |issue=10 |article-number=CD007946 |pmid=21975776 |doi=10.1002/14651858.CD007946.pub2}}</ref> [[transcranial direct current stimulation]], and [[neurofeedback]].{{cn|date=February 2025}}

=== Nerve damage repair via neurotrophins ===   
Research into treatments that may encourage the auditory nerve to repair itself through the use of [[neurotrophins]] is under way.<ref>Viacheslav Vasilkov, Benjamin Caswell-Midwinter, Yan Zhao, Victor de Gruttola, David H. Jung, M. Charles Liberman, Stéphane F. Maison, ''[https://www.nature.com/articles/s41598-023-46741-5#ref-CR124 Evidence of cochlear neural degeneration in normal-hearing subjects with tinnitus]'', ''[[Nature.com|Nature]]'', November 30, 2023, Sci Rep 13, 19870 (2023), https://doi.org/10.1038/s41598-023-46741-5</ref> Stéphane Maison, an auditory physiologist at Massachusetts Eye and Ear Infirmary, noted in 2023, "Our work reconciles the idea that tinnitus may be triggered by a loss of auditory nerve, including in people with normal hearing... We won't be able to cure tinnitus until we fully understand the mechanisms underlying its genesis. This work is a first step toward our ultimate goal of silencing tinnitus". The study follows studies that established that treatment with neurotrophins demonstrated encouragement for repair of the nerve in other mammals and the findings should lead to investigation of the potential for a treatment for tinnitus in humans.<ref>Cockerill, Jess, ''[https://www.sciencealert.com/tinnitus-could-be-our-brains-way-of-coping-with-nerve-damage Tinnitus Could Be Our Brain's Way of Coping With Nerve Damage]'', Science Alert, December 5, 2023</ref>

=== Alternative medicines not effective ===
A 2013 report indicated that ''[[Ginkgo biloba]]'' does not appear to be effective as a treatment for tinnitus.<ref name="Bauer2018"/><ref>{{cite journal |last=Hilton |first=MP |author2=Zimmermann, EF |author3=Hunt, WT |title=Ginkgo biloba for tinnitus |journal=Cochrane Database of Systematic Reviews |date=28 March 2013 |volume=2013 |issue=3 |article-number=CD003852 |pmid=23543524 |doi=10.1002/14651858.CD003852.pub3|s2cid=205171459 |doi-access=free |pmc=11669941 }}</ref> The [[American Academy of Otolaryngology]] recommends against taking [[melatonin]] or [[zinc]] supplements to relieve symptoms of tinnitus, and reported in 2014 that evidence for the efficacy of many dietary supplements (such as lipoflavonoids, garlic, traditional Chinese/Korean herbal medicine, honeybee larvae, and various other vitamins and minerals, as well as homeopathic preparations) did not exist for tinnitus.<ref name=CPG2014/> A 2016 Cochrane Review also concluded that evidence was not sufficient to support taking zinc supplements to reduce symptoms associated with tinnitus.<ref>{{Cite journal |last1=Person |first1=Osmar C |last2=Puga |first2=Maria ES |last3=da Silva |first3=Edina MK |last4=Torloni |first4=Maria R |date=23 November 2016 |title=Zinc supplements for tinnitus |journal=Cochrane Database of Systematic Reviews |volume=2016 |issue=11 |article-number=CD009832 |doi=10.1002/14651858.cd009832.pub2 |pmid=27879981 |pmc=6464312 }}</ref>

== Prognosis ==
While there is no cure, over time most affected people adapt to living with tinnitus; for a minority, it remains a significant problem.<ref name=Lang2013/>

== Epidemiology ==
=== Adults ===
Tinnitus affects 10{{ndash}}15% of people.<ref name=Lang2013/> About a third of North Americans over age 55 experience it.<ref>{{cite journal |vauthors=Sanchez TG, Rocha CB |title=Diagnosis and management of somatosensory tinnitus: review article |journal=Clinics |volume=66 |issue=6 |pages=1089–1094 |year=2011 |pmid=21808880 |pmc=3129953 |doi= 10.1590/S1807-59322011000600028}}</ref> Tinnitus affects one third of adults at some time in their lives, whereas 10–15% are disturbed enough to seek medical evaluation.<ref>{{cite journal |author=Heller AJ |title=Classification and epidemiology of tinnitus |journal=Otolaryngologic Clinics of North America |volume=36 |issue=2 |year=2003 |pages=239–248 |pmid=12856294 |doi=10.1016/S0030-6665(02)00160-3}}</ref> In [[Europe]], 70 million people are estimated to have tinnitus.<ref name="KarolinskaInstitutet">{{cite web|url=https://ki.se/forskning/transkribering-av-89-varfor-far-man-tinnitus|language= Swedish|title=Transkribering av #89: Varför får man tinnitus?|publisher=[[Karolinska Institutet]]|archive-url=https://web.archive.org/web/20221201111037/https://ki.se/forskning/transkribering-av-89-varfor-far-man-tinnitus|archive-date=2022-12-01}}</ref><ref name="CORDIS">{{cite web|url=https://cordis.europa.eu/article/id/435788-almost-15-of-europe-s-adults-have-a-ringing-in-their-ears-say-researchers|language= English|title=Almost 15% of Europe's adults have a ringing in their ears, say researchers|publisher=[[Community Research and Development Information Service|European Commission: CORDIS]]|date=|archive-url=https://web.archive.org/web/20221201105120/https://cordis.europa.eu/article/id/435788-almost-15-of-europe-s-adults-have-a-ringing-in-their-ears-say-researchers|archive-date=2022-12-01}}</ref>

=== Children ===
Commonly thought of as typically affecting adults, tinnitus often is overlooked in children. Even though children do not express the condition or its effect on their lives, children with hearing loss have a high incidence of pediatric tinnitus.<ref name="Celik et al">{{cite journal |last1=Celik |first1=N |last2=Bajin |first2=MD |last3=Aksoy |first3=S |year=2009 |title=Tinnitus incidence and characteristics in children with hearing loss |journal=Journal of International Advanced Otology |volume=5 |issue=3 |pages=363–369 |oclc=695291085 |hdl=11655/17046 }}</ref><ref>{{cite journal |last1=Lee |first1=Doh Young |last2=Kim |first2=Young Ho |title=Risk factors of pediatric tinnitus: Systematic review and meta-analysis |journal=The Laryngoscope |date=June 2018 |volume=128 |issue=6 |pages=1462–1468 |doi=10.1002/lary.26924 |pmid=29094364 |s2cid=24633085 }}</ref> Children do not generally report tinnitus spontaneously and their complaints may not be taken seriously.<ref>{{cite journal | last1 = Mills | first1= RP | last2= Albert |first2=D | last3= Brain |first3= C |year = 1986 | title = Tinnitus in childhood | journal = Clinical Otolaryngology and Allied Sciences |volume = 11 | issue = 6 | pages = 431–434 | doi= 10.1111/j.1365-2273.1986.tb02033.x | pmid= 3815868 }}</ref> Among children who do complain of tinnitus, there is an increased likelihood of associated otological or neurological pathology such as migraine, juvenile Meniere's disease, or chronic suppurative otitis media.<ref>{{cite book |author=Ballantyne JC |editor1=Graham JM |editor2=Baguley D |year=2009 |title=Ballantyne's Deafness |edition= 7th |location=Chichester |publisher=Wiley-Blackwell |oclc=275152841 }}</ref> 

Its reported prevalence varies from 12 to 36% in children with normal hearing thresholds, and up to 66% in children with a hearing loss. Approximately 3–10% of children have been reported to be troubled by tinnitus.<ref name="pmid20371585">{{cite journal |last1=Shetye |first1=A. |last2=Kennedy |first2=V. |title=Tinnitus in children: an uncommon symptom? |journal=Archives of Disease in Childhood |date=1 August 2010 |volume=95 |issue=8 |pages=645–648 |doi=10.1136/adc.2009.168252 |pmid=20371585 |s2cid=34443303 }}</ref>

== See also ==
{{Portal|Medicine|Psychology|Nursing
}}
* [[List of investigational tinnitus drugs]]
* {{Annotated link|Auditory hallucination}}
* {{Annotated link|Health effects from noise}}
* [[Hearing protection device|Hearing protection]]
* [[Noise-induced hearing loss]]
* {{Annotated link|List of people with tinnitus}}
* {{Annotated link|List of unexplained sounds}}
* {{Annotated link|Phantom vibration syndrome}}
* {{Annotated link|Safe listening}}
* {{Annotated link|Zwicker tone}}

== References ==
{{Reflist}}

== Further reading ==
* {{cite book |last1=Baguley |first1=David |last2=Andersson |first2=Gerhard |author-link2=Gerhard Andersson |last3=McFerran |first3=Don |last4=McKenna |first4=Laurence |title=Tinnitus: A Multidisciplinary Approach |edition=  2nd |orig-date=2004 |date= 2013 |publisher=[[Wiley-Blackwell]] |location=Indianapolis, IN |isbn=978-1-4051-9989-6 |oclc=712915603 |lccn=2012032714}}
* {{cite book |editor1-last=Langguth |editor1-first=B |editor2-last=Hajak |editor2-first=G |editor3-last=Kleinjung |editor3-first=T |editor4-last=Cacace |editor4-first=A |editor5-last=Møller |editor5-first=AR |title=Tinnitus: pathophysiology and treatment |edition=  1st |series=Progress in brain research no. 166 |date= 2007 |publisher=[[Elsevier]] |location=Amsterdam; Boston |isbn=978-0-444-53167-4 |oclc=648331153 |lccn=2012471552}} [https://books.google.com/books?id=XydUtbVHtdEC Alt URL]
* {{cite book |editor1-last=Møller |editor1-first=Aage R |editor2-last=Langguth |editor2-first=Berthold |editor3-last=Ridder |editor3-first=Dirk |display-editors = 3 |editor4-last=Kleinjung |editor4-first=Tobias |title=Textbook of Tinnitus |year=2011 |publisher=[[Springer Publishing|Springer]] |location=New York |isbn=978-1-60761-144-8 |lccn=2010934377 |doi=10.1007/978-1-60761-145-5 |id={{OCLC |695388693 |771366370 |724696022}} }}

== External links ==
* [https://ata.org American Tinnitus Association]
* [https://tinnitus.org.uk Tinnitus.org UK]

{{Medical condition classification and resources | DiseasesDB=27662
 | ICD11 = {{ICD11|MC41}}
 | ICD10={{ICD10|H|93|1|h|90}}
 | ICD9={{ICD9|388.3}}
 | ICDO=
 | OMIM=
 | MedlinePlus=003043
 | eMedicineSubj=ent
 | eMedicineTopic=235
 | MeshID= D014012
}}
{{Diseases of the ear and mastoid process}}
{{Occupational safety and health}}
{{Autism spectrum}}
{{Authority control}}

[[Category:Audiology]]
[[Category:Diseases of the ear and mastoid process]]
[[Category:Occupational hazards]]
[[Category:Psychoacoustics]]
[[Category:Symptoms]]
[[Category:Wikipedia medicine articles ready to translate]]
[[Category:Wikipedia neurology articles ready to translate]]