Tinnitus
Tinnitus is hearing a sound that is not present in your surroundings. People describe it as ringing, rushing, whistling, hissing or buzzing, sometimes in one ear, more often in both or somewhere in the head.
It is not a disease but a symptom. It can be caused by something quite simple, such as a blockage with earwax, or it can be a sign of hearing damage. In some people, the cause cannot be clearly identified even after a careful examination, which does not mean the examination was pointless: ruling out dangerous causes is an important part of the answer.
How people experience it
Tinnitus is most noticeable in silence, so most people feel it most strongly in the evening, when falling asleep and at night. During the day, it is covered by the noise around them.
How much it troubles you does not depend on how loud the sound is. Someone with a very quiet noise may suffer more than someone with a loud one, because they focus on it, cannot sleep because of it and fear it means a more serious illness. Poor sleep and tension make the noise stronger, and a stronger noise makes sleep even worse.
The type of sound also matters. A noise that pulses in time with the heartbeat is a special form and needs to be assessed differently from steady ringing.
What may lie behind it
The most common companion of tinnitus is hearing loss caused by exposure to noise or by ageing. The noise often appears at exactly the frequencies where hearing is weakened, and can therefore be the first warning sign.
Other causes include a blockage of the ear canal with earwax, middle ear infections and fluid behind the eardrum, otosclerosis, Ménière's disease and head injuries. Tension in the jaw muscles and problems with the jaw joint or the neck can also contribute.
Tinnitus can be a side effect of medicines, including high doses of salicylates, certain antibiotics, diuretics and cancer medicines. If the noise appeared after starting a new medicine, say so, but do not stop the medicine on your own.
A pulsing noise that follows the heartbeat can come from blood vessels near the ear. This form should be examined even when it does not particularly bother you.
When not to wait
Sudden loss of hearing in one ear, with or without noise, is an emergency. Treatment is most successful if it starts within the first few days, so seek help immediately and do not wait to see whether it passes on its own.
Call 112 if tinnitus is accompanied by severe dizziness with vomiting and being unable to stand, double vision, weakness or numbness on one side of the body, difficulty speaking or a sudden severe headache. These can be signs of something happening in the brain.
You also need a prompt examination for tinnitus after a head injury, tinnitus with severe ear pain and fever, fluid leaking from the ear, and when the noise is in one ear only and persists.
Tinnitus that lasts for a longer time and disturbs your sleep or concentration is not an emergency, but it is a good reason to book an examination. You do not have to learn to put up with it without an assessment.
What the assessment involves
The examination begins with a description of the noise: when it appeared, whether it is constant or comes and goes, in which ear, what makes it worse and how it affects your sleep. This is followed by an examination of the ear canal and eardrum, which will also reveal a blockage with earwax that can be removed straight away.
The basic tests are a hearing test and an assessment of the middle ear. The result shows whether your hearing is weakened, at which frequencies, and whether the problem comes from the outer, middle or inner ear.
Depending on the specialist's judgement, further balance tests or referral for imaging follow, especially with one-sided and pulsing tinnitus. If you have had a hearing test before, bring the result; comparing two tests tells more than a single one.
What helps
When a treatable cause is found, that is what is treated. Removing earwax, treating an infection or changing a medicine can make the noise go away completely.
For tinnitus with hearing loss, hearing aids are the most effective. When the brain receives the missing sounds again, the noise usually loses its significance and fades into the background.
When there is no treatable cause, the aim is to reduce how much it troubles you, not necessarily how loud the noise is. What helps is enriching the sound environment, that is, quiet music or white noise instead of complete silence, good sleep, reducing stress, and counselling or cognitive behavioural approaches, which have the best support among the measures studied.
With tinnitus, protecting your hearing matters in both directions. Avoid noise and use earplugs in noisy environments, but do not seek complete silence, because the noise stands out in it.