What causes Tinnitus?

Many causes - almost everything that can go wrong with our ears can produce tinnitus as a symptom! Perhaps as simple as wax against the eardrum, or as serious as a tumour on the hearing nerve. Otosclerosis (fixation of the tiny stirrup bone in the middle ear) may cause tinnitus; head/neck trauma; some common medications may cause tinnitus as a side effect or make your existing tinnitus worse. Take special care with medications for arthritis, rheumatic diseases, some antibiotics and anti-depressants. Also, aspirin taken in high doses may cause or exacerbate tinnitus – discuss your medication(s) with your doctor.

So can Manière’s disease.

A major cause of tinnitus is EXPOSURE TO EXCESSIVE NOISE, eg chain saws, machinery, and rock concerts. Noise hurts!

Do many people suffer from Tinnitus?

Yes, millions around the world! Probably 20%-30% of Australians have tinnitus at some time of their lives and approximately '50 million Americans have tinnitus in some form'. Severe tinnitus is recognised as a major affliction, however, most people have tinnitus to a milder degree. Given time, commitment and up-to-date professional help, tinnitus can reduce for many people.

Is Tinnitus understood?

Worldwide research continues but the actual mechanisms, or processes of tinnitus are not yet fully understood. We do know that tinnitus is real, not imagined, and that it is a symptom of a malfunction, usually somewhere in the hearing system (includes ear and brain). The inner ear or cochlear is involved for many people.

See diagram below.

Inside of your Ear

+ Ear Drum

When the sound waves hit the Ear Drum they make it vibrate. The ear drum is stretched across the entrance to the Middle Ear and provides an airtight seal.

+ Outer Ear

We have an ear on each side of our head. Noise is collected by the Outer Ear or pinna (the flaps which stick out from the sides of your head and come in all shapes and sizes!)

+ Eustachian Tube

The Eustachian Tube is a canal that connects the middle ear to the nasopharynx, which consists of the upper throat and the back of the nasal cavity. It controls the pressure within the middle ear, making it equal with the air pressure outside the body.

+ Ear Canal

The sound waves travel along the Ear Canal to the ear drum. Did you know that the ear canal is lined by 4000 wax glands which secrete ear wax or cerumen to trap dirt, dust or bugs and protect the ear drum?

+ 3 Tiny Bones

The Hammer, Anvil and Stirrup are the smallest bones in your body. Vibrations by the ear drum cause the 3 bones to vibrate in turn. As the last (the stirrup) vibrates, it causes vibrations in the fluid of the Cochlea.

+ Balance Canals

Your Balance Canals are three tiny, fluid-filled tubes in your Inner Ear that help you keep your balance. When your head moves around, the liquid inside the semicircular canals sloshes around and moves the tiny hairs that line each canal.

+ Hearing Nerve

The Hearing Nerve then carries these electric impulses to the brain.

+ The Cochlea

The Cochlea (snail shell) is about the size of a pea. The mechanical vibrations in the fluid of the cochlea bend the thousands of tiny delicate Hair Cells, which change the vibrations into electric nerve impulses.

What Can Make Tinnitus Worse?

Loud Noise

Exposure to sudden or long-term noise can damage your hearing with resultant loss of hearing and tinnitus. High-risk groups include industrial workers, farmers, transport workers - and don't forget that noisy lawn mower! Reduce the noise source or protect your ears with earplugs or earmuffs. Leisure noise can also be a hazard, eg rock concerts, boom boxes in cars and misuse of an ear gear - never play it loudly.

Stress and Fatigue

They make tinnitus worse! Keeping busy - trying to focus your energies OUTWARD AND AWAY from the tinnitus - is an excellent idea, but stress and fatigue only undermine you. Minimise them by rethinking your lifestyle. Relaxation therapy may help greatly if learnt and practised daily. Hypnotherapy from a qualified practitioner may help. Sports, hobbies, yoga, tai chi, reflexology or massage may also help.


Itis essential to tell your family doctor about your tinnitus; some common medications may cause tinnitus as a side effect or may make your existing tinnitus worse.

Try easing off caffeine (tea, coffee, colas), alcohol as they may temporarily worsen tinnitus for some people. Avoid quinine- as in tonic water, nicotine and mind altering drugs. Smoking narrows your blood vessels that supply vital oxygen to your ears and their sensory cells. PLEASE - quit smoking!

Does Tinnitus Mean That One Is Going Deaf?
Tinnitus is a symptom of a fault in the hearing system, so usually it is associated with a hearing loss. Sometimes tinnitus is present with normal hearing and for no discernible reason.


I have Tinnitus - What should I do?

Do see your doctor and have your hearing checked by an audiologist (hearing clinician). Some audiologists run specialist tinnitus clinics to help you manage your tinnitus and they fit hearing aids and/or therapeutic noise generators if needed. Some people may require a referral to an ENT specialist. There may be a TREATABLE medical cause.

Hearing Aids
Good quality and properly fitted hearing aids reduce and even eliminate most tinnitus associated with hearing loss. Hearing aids take away the strain of listening and distract from the tinnitus by bringing you more environmental sounds from the outside world.

Therapeutic Noise Generators
Devices that look like a hearing aid and recommended for people with no hearing loss. It produces a blend of external sounds that stimulate most fibres of the hearing nerve helping to deviate attention away from the tinnitus.

Tinnitus Retraining Therapy (TRT)
Aims to reduce and ultimately eliminate tinnitus perception. It combines auditory therapy - hearing aids and/or therapeutic noise generators - to provide the brain with maximum environmental sounds to reduce tinnitus perception. Directive counselling helps to change negative beliefs, distract from tinnitus and reduce stress.

Cognitive Behaviour Therapy (CBT)
Effective in alleviating distress and producing adaptation to tinnitus. CBT is threefold: changing the way a person perceives tinnitus; teaching ways to focus attention away from tinnitus and achieving control over stress.

Is there an Operation for Tinnitus?
For the vast majority of people there is no specific operation for tinnitus. However, following successful surgical treatment for some ear problems, an existing tinnitus may sometimes disappear for some people,
eg otosclerosis, Manières disease and middle ear infection.

Is there any Medication for Tinnitus?
Perhaps for some people. It depends on the cause of the tinnitus; consult your doctor or specialist. Vitamin B12 may be helpful. Herbal remedies, if taken under medical supervision, may be of some use.

Check with your Dentist
Perhaps 5% of tinnitus is caused by a Jaw Joint (TMJ*) problems which may be treatable. This type of tinnitus occurs because jaw muscles and a muscle in the middle ear are closely connected. When jaw muscles spasm the ear muscles react by pulling the eardrum too tight and this situation may result in tinnitus.

*Temporo-mandibular joint.

In Summary

Tinnitus is not simple. Everybody's tinnitus noise is individual to them, although there are several major types eg ringing, buzzing, whistling, roaring, humming etc. Its causes are many (though excessive noise and some medications are the major PREVENTABLE causes). The range of tinnitus is very wide from mild to severe. It is usual for tinnitus to fluctuate with stress or tiredness and this has no sinister significance.
If tinnitus is troubling you - TAKE ACTION.

Please note that no person should refrain from taking any medication or cause any person to alter, discontinue or refrain from taking any medication as a consequence of information obtained from this ATA (NSW) website. Any queries an individual may have about medication should be referred to a competent medical practitioner.

No part of this publication can be reproduced without the express written permission from the Australian Tinnitus Association (NSW) Ltd

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