Tinnitus

Tinnitus is sound heard without anything outside making it. Most people describe ringing, but hissing, buzzing, a high tone or a rhythmic whoosh are all common, and the form it takes is part of what points to the cause.

It is almost always a symptom rather than a disease of its own. The usual mechanism is a change somewhere in the hearing pathway — wax against the drum, fluid in the middle ear, noise damage or age-related loss in the inner ear — after which the brain's own volume control turns up and the gain itself becomes audible. That is why tinnitus so often arrives alongside a hearing loss the person had not noticed.

A small minority of cases behave differently. Sound in one ear only, or a noise that keeps time with the pulse, is investigated rather than managed, because those two patterns are the ones with a specific cause behind them.

The ear is examined first, because wax, a perforation or fluid behind the drum are visible causes that can be dealt with directly.

An audiogram follows in nearly every case. It is the single most useful test here: it finds the hearing loss that underlies most tinnitus, shows whether the fault is in the conducting chain or the inner ear, and gives the baseline every later comparison is made against. Tympanometry checks middle-ear pressure, and pitch and loudness matching records what the sound is like for this person.

Imaging is not routine. It is ordered for sound confined to one ear, for a noise synchronised with the pulse, and where the audiogram is much worse on one side, since those are the findings that raise a cause an examination cannot see.

Treatment follows the cause where there is one to treat — removing wax, clearing a middle-ear effusion, treating an infection.

Where the hearing pathway itself is the cause, the work is to make the sound matter less rather than to switch it off. Correcting a hearing loss does most of that: a hearing aid raises the level of ordinary sound, so the internal gain is turned down and the tinnitus recedes with it. Sound therapy fills quiet rooms and at night, when tinnitus is loudest because there is nothing else to hear. Where it has become distressing, structured counselling is what changes how much attention it takes, and it is the part with the strongest evidence behind it.

Medication is not a treatment for tinnitus itself. It is used for what travels with it — poor sleep, anxiety — which is a different claim from making the noise go.

This is managed rather than cured, and the measure of success is how much of the day it takes up rather than whether it is still there.

A treatable cause removed can settle the sound within days or weeks. Where a hearing aid or sound therapy is the answer, the change is gradual: most people notice a difference over six to twelve weeks, as the noise stops being the thing they listen for. Counselling programmes run over a few months.

It fluctuates, and a bad week after a loud evening, a cold or a stretch of poor sleep is not a relapse. Hearing is rechecked at intervals, because a tinnitus that changes character or an ear that loses more hearing is a reason to look again.