Tinnitus is a frustrating condition that produces a constant sound in one or both ears that may resemble a ringing, buzzing, hissing or whistling sensation. Most people are susceptible when exposed to a very loud noise such as hammering or amplified rock music, but at least one in ten people experience tinnitus regularly, of whom over a third have symptoms for most of the time. This affects your ability to concentrate, to hear or sleep, and has a dramatic impact on your quality of life. Not surprisingly, persistent tinnitus can lead to distress, anxiety and depression.
Tinnitus caused by noise
Although the underlying cause remains poorly understood, it may be related to abnormal blood flow to the inner ear in some cases, or to damage to the inner ear in others.
Normal sounds are heard because they create waves of pressure that pass into your outer ear canals and cause your eardrums to vibrate. This triggers a chain of movement through three tiny, hinged bones in your middle ears which amplifies the vibration and channels it to your inner ear.
The inner ears contain thousands of microscopic hair-like cells that convert sound vibrations into electrical impulses and relay them to the brain for analysis. If any of the mechanisms involved in sound perception become damaged (for example by exposure to excessive noise), they may send an abnormal stream of signals to the brain and result in tinnitus.
The loudness of sounds such as rock music is measured in decibels (dB). Whispering, for example measures 20 dB, typical office noise is around 60dB, heavy traffic is 80dB and a pneumatic drill equals 100 dB. An aeroplane passing within 100m gives a decibel reading of 120 dB – similar to that which may be recorded in front of loud speakers at a rock concert.
Sounds above 90 dB can cause pain, while very loud sounds, above 130 dB, can cause vibration damage to the inner ears and may lead to deafness or ringing in the ears.
Prevention is better than cure, so avoid loud music as much as possible – wearing ear plugs will provide some protection.
If you develop tinnitus after listening to loud music, treat it as a warning sign that you have been exposed to potentially damaging levels of noise. It is important to have your hearing checked to see if it is already affected.
Other causes of tinnitus
Tinnitus can be triggered by a build-up of wax, which is the most easily remedied cause. As a GP I once removed wax plugs the size of wine corks from a patient who gained immediate relief, although this is unusual.
Other causes of tinnitus include a viral infection of the inner ear (labyrinthitis) and Ménière’s disease – a condition in which fluid pressure in the inner ear increases.
Tinnitus can also be caused by taking certain drugs. Over 200 different medicines are known to damage the ears (ototoxicity) and can cause tinnitus or problems with balance. These ototoxic drugs include high dose aspirin, quinine, loop diuretics such as furosemide, certain antibiotics (eg gentamicin) and some cancer treatments such as cisplatin and carboplatin.
If you are taking any prescribed medications, read the patient information leaflet, or check with a pharmacist to see if your medicines are known to cause tinnitus as a side effect. If that is the case, your doctor can usually prescribe an alternative remedy.
Clinical guidelines for treating tinnitus in the US recommend that doctors should not routinely use drug treatments such as antidepressants, anticonvulsants, anxiety medications or drugs delivered via the ear to manage tinnitus. This is mostly because there are no convincing studies to show that they work, and they can lead to unwanted side effects. However, if you have a raised cholesterol level, treatment to lower this may help.
Tinnitus and statins
In one study, 98 people with tinnitus and hearing loss and a raised cholesterol level were treated with a statin (atorvastatin 40 mg once daily) and followed a low-fat diet for 8 months. In those whose cholesterol responded to treatment, there were significant improvements in tinnitus score in more than two out of three (70.5%) people, compared with only 4.2% of those whose cholesterol remained high. NB If taking a statin, you may benefit from also taking ubiquinol coenzyme Q10 and vitamin D3 as levels of both of these are lowered by statin therapy.
Hearing assessments for tinnitus
Having examined your ears, and ruled out ear wax as a cause of tinnitus, another key recommendation is that you have a proper audiology examination if one of the following applies:
- the tinnitus is only on one side
- it is pulsatile (pulses in time with your heart rate)
- it is associated with hearing loss or difficulties
- the tinnitus has persisted for at least 6 months.
Guidelines also recommend that your doctor refers you for a hearing aid evaluation if you have persistent, bothersome tinnitus that is associated with hearing loss.
Tinnitus sound therapy
Another guideline recommendation is to trial a device which delivers sound therapy, as this can provide respite from persistent and bothersome tinnitus. Known as masking sound therapy, this remedy can be delivered by a worn hearing-aid-like device or a non-wearable appliance. A tinnitus masker that plays a random mixture of sounds at differing frequencies (white noise) which can be customised to help block out the noise you are hearing inside your head.
Masking sound therapy is often effective, but surveys suggest people with tinnitus are often not aware of it.
The results from nine studies evaluating the effectiveness of tinnitus retraining therapy and cognitive behavioural therapy concluded that both were equally effective treatments for tinnitus.
Tinnitus retraining therapy
Cognitive behavioural therapy (CBT) was originally developed as a psychological treatment for pain, depression and anxiety, but can also apply to other neurological problems such as tinnitus. Sometimes known as tinnitus retraining therapy, it helps to change how you react to tinnitus. Tinnitus retraining therapy doesn’t eliminate the sounds you hear, but reduces any negative responses such as feelings that tinnitus is unpredictable or that you have lost control. CBT adjusts these ‘learned’ responses to ones that are more positive and realistic. Many studies confirm that CBT is effective in reducing annoyance, anxiety and distress by helping you become more used to the sounds you are experiencing. CBT also uses relaxation techniques and may incorporate sound masking therapy. Your doctor can refer you to an experienced CBT practitioner.
Dietary advice for tinnitus
In a nutritional study involving 2,176 people in the US, around one in five (21.1%) reported tinnitus within the past year and more than one in ten (11.7%) reported persistent tinnitus, defined as tinnitus experienced at least once a month or more. After taking other lifestyle factors into account, they found that people with the healthiest diets were 33% less likely to experience persistent tinnitus than those with unhealthy diets.
Dietary changes usually suggested for treating tinnitus include reducing intakes of salt (to reduce any fluid retention), and cutting back on your intakes of refined sugar and carbohydrates, meats and saturated fats. At the same time, you should increase your intakes of fruit and vegetables as these approaches have helped some people with tinnitus. Losing any excess weight can also help.
A UK study involving 171,722 people, found that dietary factors most associated with persistent tinnitus, defined as present at least a lot of the time, were high intakes of bread, low intakes of dairy (especially dairy avoidance which increased the risk by 27%). Dietary factors which most reduced the risk of persistent tinnitus were good intakes of fish 9% reduction), avoiding eggs (13% reduction in risk) and caffeinated coffee consumption (1% risk reduction per cup per day).
Supplements for tinnitus
First off, it’s important to say that clinical guidelines do not recommend using dietary supplements for treating tinnitus. Having said that, many people have told me they find the following supplements helpful, although there are no guarantees that you will find the same.
Garlic for tinnitus
Garlic is a traditional remedy for tinnitus, with one or two raw cloves being eaten every day after meals. There is a good rationale for its use in tinnitus, as garlic is a powerful antioxidant, anti-inflammatory and improves blood flow to the peripheries, including the brain. All of these characteristics are likely to benefit the inner ear in people with tinnitus. However, no clinical trials to date have investigated the effects of garlic for treating tinnitus, so its benefits remain anecdotal. If you want to try it, it’s better to take a standardised powdered garlic tablet rather than raw garlic, so you get a consistent dose. Enteric coating will reduce odour. I also recommend black garlic, as it is more antioxidant and less smelly.
Gingko biloba for tinnitus
There is conflicting evidence regarding the efficacy of Ginkgo biloba supplements for treating tinnitus. By improving blood flow to the inner ear, Ginkgo extracts can improve vertigo and tinnitus where symptoms are linked with abnormal circulation.
An analysis of six trials carried out in 2004 found that 21.6% of those taking Ginkgo biloba for tinnitus experienced benefit, but the response in the placebo group was also good at 18.4%, so the overall conclusion was that Ginkgo biloba did not benefit patients with tinnitus – however only 66 patients were involved which is not really conclusive. Another medical review concluded that ‘Ginkgo biloba may somewhat improve tinnitus’.
The latest study, from June 2018, compared 120mg Ginkgo biloba extract (EGb 761) against the most widely prescribed tinnitus drug (pentoxifylline) in 197 people referred to hospital for bothersome chronic tinnitus. After 12 weeks treatment, significant improvements were seen in all tinnitus scores for loudness, annoyance the anxiety with no differences between those taking ginkgo and those taking the drug. This suggests they are both equally effective. Side effects were much less in those taking Ginkgo compared with pentoxifylline however.
My usual advice is to try a pharmaceutical grade Ginkgo biloba extract for at least 3 months to see if this helps you as an individual.
Vitamin B12 for tinnitus
Vitamin B12 is often recommended following findings that some people with tinnitus have low vitamin B12 levels. Among 113 army personnel with noise-induced hearing loss, for example, 47% of those with tinnitus had a vitamin B12 deficiency and as vitamin B12 is involved in nerve conduction, it’s possible that low levels may cause dysfunction of the auditory nerve and pathways. In this study, some improvement in tinnitus was reported in some of those given vitamin B12 replacement therapy.
In another study involving people with tinnitus, 63 had low B12 vitamin levels, and 37 had normal B12 vitamin levels. No significant change was observed in tinnitus severity after vitamin B12 therapy, however – only 8 reported some relief. Audiometric tests conducted after vitamin B12 replacement treatment revealed a significant improvement in hearing levels at the 250 Hz frequency, but no change was seen at other frequencies.
The latest study, from 2016, involved 40 people with tinnitus who received either intramuscular vitamin B12 injections (2500 mcg) once a week for 6 weeks, or saline placebo injections. At the beginning of the study, 42.5% were classed as vitamin B12 deficient. Those who were vitamin B12 deficient showed significant improvement in tinnitus severity after vitamin B12 therapy, compared with placebo.
If you think you could be vitamin B12 deficient, your doctor may be willing to test you for this. Alternatively, you could try vitamin B12 supplements (oral spray nor lozenges in case you do not absorb it well from the gut.
Magnesium for tinnitus
Magnesium is involved in nerve conduction and the flow of electrolytes in and out of cells.
A study involving 76 people with severe, bilateral tinnitus (accepted as severe and catastrophic according to tinnitus severity index) were found to have significantly lower magnesium levels than those of 86 similar people without tinnitus.
Magnesium supplements have been found to improve sudden hearing loss, and may also improve the severity of tinnitus, but unfortunately, few studies have investigated this.
In one small, open-label trial 19 people with tinnitus took magnesium (532 mg per day) for 3 months and reported significant improvements. Those with the worst tinnitus symptoms reported the greatest improvements.
Given that average magnesium intakes are around 229mg per day, compared with the EU recommended daily amount of 375 mg, deficiency of this important mineral is widespread. As magnesium has so many important functions in the body it’s certainly worth trying a supplement to see if they help.
Talk to your doctor
A US survey of over 2 million people with tinnitus found that doctors were most likely to talk to them about medications (45%, even though these are not recommended), and not to discuss recommended approaches such as hearing aids (9.2%), masking sound devices (4.9%), tinnitus retraining therapy (3%) or CBT (0.2%).
If you have tinnitus and haven’t seen your doctor for a while it’s worth requesting a re-evaluation of your symptoms.
Persistent tinnitus should usually be assessed by an ENT specialist.
Acupressure for tinnitus
Acupressure: massage the area one finger’s width in front of the ear at the top of your cheekbone.