Tinnitus typically begins as an audiological (hearing) condition, and so it is generally appropriate to consult medical providers with clinical specialties in hearing health. There are two general types of hearing health providers to consider:

Audiologists (Au.D.) — Audiologists are healthcare specialists, trained in the diagnosis and treatment of hearing loss and other hearing-related disorders. Audiologists can perform an array of hearing tests, interpret test results, fit and adjust hearing aids, and advise on the selection and use of hearing assistance tools. In general, audiologists are the best, first option for the vast majority of tinnitus cases.

Otolaryngologists (E.N.T.) — Otolaryngologists are medical physicians specializing in the integrated systems of the ear, nose, and throat (which is where the acronym E.N.T. comes from). They are trained surgeons, who can manage and treat physical issues within the ear. Generally, otolaryngologists are best suited to treat less common forms of tinnitus, caused by treatable medical maladies in the ear.
An audiologist (Au.D) or otolaryngologist (E.N.T.) may be able to provide a more precise diagnosis for your symptoms and identify the specific causes for your tinnitus, which informs the best treatment option for your condition. An Au.D. or E.N.T. with training and knowledge of tinnitus should be able to discuss an array of tinnitus management options, and help identify the best strategy for your specific medical situation.

Common causes of tinnitus

In many people, tinnitus is caused by one of these conditions:

• Age-related hearing loss. For many people, hearing worsens with age, usually starting around age 60. Hearing loss can cause tinnitus. The medical term for this type of hearing loss is presbycusis.
• Exposure to loud noise. Loud noises, such as those from heavy equipment, chain saws and firearms, are common sources of noise-related hearing loss. Portable music devices, such as MP3 players or iPods, also can cause noise-related hearing loss if played loudly for long periods. Tinnitus caused by short-term exposure, such as attending a loud concert, usually goes away; long-term exposure to loud sound can cause permanent damage.
• Earwax blockage. Earwax protects your ear canal by trapping dirt and slowing the growth of bacteria. When too much earwax accumulates, it becomes too hard to wash away naturally, causing hearing loss or irritation of the eardrum, which can lead to tinnitus.
• Ear bone changes. Stiffening of the bones in your middle ear (otosclerosis) may affect your hearing and cause tinnitus. This condition, caused by abnormal bone growth, tends to run in families.
While commonly referred to as “ringing in the ears,” tinnitus can actually manifest in a variety of different perceived sounds, both tonal and pulsing.

In almost all cases, tinnitus is a subjective noise, meaning that only the person who has tinnitus can hear it. People describe hearing different sounds: ringing, hissing, static, crickets, screeching, whooshing, roaring, pulsing, ocean waves, buzzing, dial tones, even music.

In general, there are three ways to describe a patient’s personal perception of the tinnitus sound:

Tonal Tinnitus: The perception of near-continuous sound (or overlapping sounds) with well-defined frequencies. The perceived volume of the tinnitus often fluctuates. Tonal tinnitus is generally associated with subjective tinnitus.

Pulsatile Tinnitus: The perception of pulsing sounds, often in-beat with the patient’s heartbeat. Pulsatile tinnitus is often associated with objective and somatic tinnitus.

Musical Tinnitus: The perception of music or singing, sometimes the same tune on a constant loop. Also known as Musical Ear Syndrome, Musical Tinnitus is very rare.
There is some scientific evidence that a patient’s tonal perception of tinnitus is influenced by the etiology (the underlying cause) of their tinnitus. However, current science has not identified a definitive correlation.


Consider seeing a behavioral health therapist

Tinnitus symptoms often generate feelings of despair and anxiety in many patients. Current estimates suggest that 48-78% of patients with severe tinnitus also experience depression, anxiety, or some other behavioral disorder. A trained behavioral health therapist may be able to help alleviate some of the negative emotional baggage associated with your tinnitus. There are several behavioral and educational treatment programs specifically for tinnitus management; general psychological therapy may also be beneficial.

• Find ways to increase relaxation. Patients often report that their tinnitus is less burdensome when they are relaxed. Find the activities and behaviors that best help you relax: exercise, yoga, meditation, soothing music, anything that helps you be calm and content.
• Get a good night’s sleep. Sleeping isn’t easy when you have tinnitus, but getting a restful night’s sleep can improve your overall health and may minimize the perceived intensity of tinnitus during waking hours. Many patients use sound machines, radio static, or a fan to mask their tinnitus and help them fall and stay asleep. You may also want to consider how your use of caffeine, alcohol, cigarettes, and other drugs impact your ability to sleep.