Tinnitus treatment and diagnosis

Do you have tinnitus and are wondering how to make it go away—or at least get better? Relief is possible, but you may need to work with a physician, a hearing care professional, and a behavioral therapist to find the right treatment combination for you. Because so many health conditions can trigger tinnitus, diagnosing every case is unique.

In addition to the following treatments, there are alternative relief strategies that may help.

However, it's important to know there is no cure for tinnitus. Many people use habituation to help them reduce the daily annoyance of tinnitus.

Diagnosing tinnitus

The first step in treating tinnitus is uncovering what may be causing it. One of the challenges in tinnitus evaluation and treatment is that everyone experiences it differently. Measuring a subjective experience is very difficult. A hearing care professional will start by asking lots of questions about your symptoms such as:

• How long has this been going on?
• Is it intermittent or constant?
• Is it worse at certain points of the day?
• Is it a pulsating sensation?
• In which ear do you hear the tinnitus? Both?
• How loud is the noise?
• Is the pitch high or low?
• It the issue extremely bothersome or just a little irritating?
• Are there certain conditions that make it worse such as exposure to noise or certain foods or beverages?
• Does the sound change?
• What does it sound like? Clicking, rushing, humming, rhythmic? 

The practitioner will also ask you to report your medical history. After a thorough discussion of your symptoms and health history, the examination will begin with a visual inspection of your ears and standard hearing tests. Why?  Tinnitus often co-occurs with hearing loss.

Tinnitus-specific tests

If medical causes of tinnitus have been ruled out, then you likely have what's known as neurophysiologic (sensorineural) tinnitus. This can occur on its own, or may be due to hearing loss or loud noise exposure.

A health care professional's next step is to determine the best treatment. An audiologist or similar professional may use a series of tests to tailor your treatment to your specific needs. Examples include:

• A pitch match test to help your hearing care professional determine the approximate frequency of sound that you are hearing. For this exam, you will be asked to identify the pitch of your tinnitus as best as possible by comparing it to other sounds.
• A loudness match test to quantify the level of the sound you are hearing, which could range from a whisper to a shout. It is more common for people to experience soft sounds than loud. 
• A visual analog scale to determine perceived loudness. Tinnitus is often perceived much louder than the decibel level that matches. On a scale from zero to 10, you'll be asked to scale the loudness. About 70 percent of patients will report a loudness value of six or higher.

Hearing aids for tinnitus

If you have hearing loss as well as tinnitus—which is quite common—hearing aids can reduce your awareness of tinnitus while you are wearing them. That's because they amplify the sounds you want to hear, helping distract your brain from the unwanted sounds. 

Many modern hearing aids include tinnitus features to help mask unwanted sounds.

Today's hearing aids include tinnitus features to help mask unwanted sounds. These often come with smartphone apps to help you learn behavioral and relaxation techniques for managing tinnitus. 

Should you get a hearing aid for tinnitus?

It's worth a try, especially if you have hearing loss. It's very common for people with tinnitus to report a reduciton in borthersome symptoms when they get hearing aids for tinnitus.

Tinnitus sound therapies

Tinnitus sound therapy uses a process known as habituation to retrain the way the brain interprets tinnitus. Essentially, the brain learns to reclassify the unwanted sound as something neutral or unimportant. There are different methods and types of sounds that can help, and an audiologists trained in tinnitus therapy can explore several options.

Noise and notched-music devices

Another option is a tinnitus masking or noise suppression device. They're typically worn in the ear like a hearing aid and produce either a constant signal or tonal beats to compete with the ringing in your ears. Some devices have the capabilities to play 'notched music,' which is another form of tinnitus masking. Your hearing care professional mayl use the pitch matching and loudness matching tests mentioned above to set the signal at a level and pitch similar to the tinnitus you are perceiving. This may or may not be helpful: There is no current clinical standard for the best practicies for setting sound generators.

You can also use a free-standing white noise generating machine or a special notched-noise machine. Tinnitus is perceived as louder or more bothersome when you're in a quiet space, so being able to bathe a room in background sound might be all you need to help you ignore the ringing in your ears.

However, notch therapy sounds have not been proven to be any more effective than other forms of sound therapy. Like other forms, they can help—but not always.

Tinnitus retraining therapy 

Tinnitus retraining therapy uses cognitive behavioral therapy in combination with a masking device to help you learn to ignore the background ringing noise in your ears. 

Medications for tinnitus

While antidepressant medications have been used to treat tinnitus, the evidence supporting antidepressants in the treatment of tinnitus is weak. It is currently not the clinical standard of treatment for tinnitus, and audiologists do not prescribe any medications.

Let your doctor or pharmacist know if you experience tinnitus after starting a new drug or changing a drug dose.

Some medications can cause tinnitus. The most common drugs linked are NSAID pain relievers, diuretics and the malaria drug quinine—all of which are known to trigger tinnitus or make tinnitus worse. But many others can cause tinnitus, too. If you experience tinnitus after starting any new medication, or changing a dosage, discuss it right away with your pharmacist or physician to determine if you should stop, reduce or change the medications you are currently taking. 

Tinnitus can be a symptom of another medical condition, such as high blood pressure or a head injury. In those cases, treating the underlying medical condition may remediate your tinnitus. Sometimes the treatment is simple: Your doctor may remove excess earwax that has built up and blocked the ear canal, causing hearing loss and a ringing noise.

Behavioral treatment options for tinnitus

Mental health care is an important part of tinnitus treatment. As the Journal of Family Practice states "some patients experience extreme anxiety or depression in response to tinnitus and should be referred to a mental health professional on the day they present with symptoms."

A therapist with experience treating tinnitus patients can use a combination of sound-based and tinnitus-focused cognitive-behavioral therapy to help you manage the emotional impact of tinnitus.

When is tinnitus a medical emergency?

Sudden deafness and tinnitus

If you or a loved one experiences sudden hearing loss along with tinnitus (usually in just one ear), it could be idiopathic sudden sensorineural hearing loss, known as sudden deafness. Prompt treatment can help increase your chance of a full recovery. Steroids are usually given when this disorder occurs. 

Pulsatile tinnitus

If you start to hear sounds that pulse at the same rate as your heartbeat, you may have what's known as pulsatile tinnitus. This can be harmless, but needs thorough investigation since it could be a serious blood vessel or vascular condition.

Suicidal thoughts and tinnitus

Lastly, if you are experiencing suicidal thoughts and have tinnitus, tell a loved one and seek emergency help right away. While alarming, suicidal thoughts are treatable. You can also reach out to the National Suicide and Life Crisis by dialing 988.

Additional treatment strategies and alternative medicine

There are many behavioral changes you can make that can either help relieve your tinnitus or help you learn to cope with it.  

Homeopathy, hypnosis, meditation and acupuncture are also thought to help. That's because any activity that aims to reduce overall stress levels may also help tinnitus-related stress levels.

Regain quality of life

Tinnitus can be extremely frustrating and can leave you feeling overwhelmed and unsure about your next steps. Remember that you are not alone—tinnitus, while not well-understood, is common. To get better, seek out a practitioner who has experience treating tinnitus, and be prepared to discuss your symptoms in detail so you can get relief and regain your quality of life. 

Find an audiologist that specializes in tinnitus treatment near you by visiting our directory of hearing care providers. Please note that not all hearing clinics treat tinnitus, so you may need to browse several clinic pages to find the right provider.

^{This article has been medically reviewed by Emma R. Alscher, AuD, CCC-A, a nationally certified and state-licensed audiologist at Mass Eye and Ear. She received her doctoral degree from the University of Pittsburgh, and her clinical interests include diagnostic audiologic evaluations, hearing aids, cochlear implants, assistive listening devices and tinnitus management. Dr. Alscher is certified in tinnitus management by the American Academy of Audiology and she is a leading member of the Tinnitus Management Program at Mass Eye and Ear.}