Since the beginning of the pandemic, I’ve stayed fit and (relatively) sane through daily walks around my neighborhood, listening to my favorite true crime podcasts and K-pop songs. One afternoon in the spring of 2020, however, I started to hear a ringing in my right ear. I had developed tinnitus: the perception of sounds in the absence of external sources.
I knew the culprit was the volume level on my earbuds—I often couldn’t hear the occasional car rounding the bends of my neighborhood’s mountain roads. (I had set volume limits on my previous iPhone but didn’t check to ensure those settings would transition to my new one. They hadn’t.) Worse than the noise, though, was the knowledge that I had carelessly done this to myself, especially since I had witnessed my mother’s own struggle with the condition in the past.
I was lucky. Three months after ditching headphones completely, the constant high-pitched tone with a touch of vibrato faded away one afternoon as quickly as it had arrived. However, two-thirds of the estimated 45 million Americans—14 percent of the population—who experience tinnitus at some point in their lives have it for at least one year. Some experience it for decades.
Tinnitus has a reputation of being a curse you just have to learn to live with. Not true, says Dr. Melissa Wikoff, founder and director of audiology at Peachtree Hearing in Atlanta and member of the American Tinnitus Association’s (ATA’s) Board of Directors.
“The biggest misconception is that there is nothing that can be done—that this is a life sentence, and that no one can help you,” she said. “There is no magic pill…but there are so many things we can do to help [you] cope.”
Tinnitus can’t be cured, but its causes and characteristics can be treated—and it can go away. Most importantly, the majority of cases can be prevented by practicing good listening hygiene. Here’s what to do if your ears start ringing one day, as well as how to prevent it happening to you and your loved ones in the first place.
What are the causes of tinnitus?
Let’s get one thing out of the way first: You can pronounce it either as TIN-uh-tus or as ti-NIGH-tus, according to the ATA. (For the record, I am Team TIN-uh-tus.) No matter how you say it, though, tinnitus is a symptom rather than a condition in itself. 80 percent of tinnitus cases are linked to hearing loss, but over 200 other conditions can play a role, including:
- Middle ear blockages (e.g., from wax or foreign objects)
- Head and/or neck trauma
- Sinus pressure (including during snorkeling, flying, or SCUBA diving)
- TMJ (aka lockjaw)
- Medications (including some NSAIDs, chemotherapy, and antibiotics)
- Autoimmune disorders (Lyme disease and fibromyalgia in particular)
- Blood vessel disorders (e.g., high blood pressure—usually related to the pulse)
- Metabolic disorders like thyroid conditions
- Psychiatric disorders (e.g., depression, anxiety)
- Vestibular or inner ear disorders (such as Ménière’s Disease)
- Some tumors
Every so often, Wikoff sees people with tinnitus who have a serious underlying condition. “The ears are the window to so many other things in your body,” she said. My mother’s tinnitus, in fact, was caused by a fast-growing benign brain tumor near her ear canal. Once she had it removed, her tinnitus went away.
For most people, though, hearing loss is the central factor. We tend to think of hearing loss as a senior problem, and it’s true that age-related hearing loss (also known as presbycusis) affects 30 percent of adults 65 and over and 40-50% of those 75 and over. However, age-related hearing loss often results from years of sustained exposure to noise, and our increased use of on- and in-ear headphones in the iAge puts all of us at risk for developing this damage sooner.
Think of hearing loss like sun damage or CTE: Repeated exposure to loud noise creates temporary damage, called temporary threshold shifts (TTS), that accumulates over time and eventually leads to permanent damage, or a permanent threshold shift (PTS). Each time you leave a loud concert, finish mowing your lawn, or press pause on your favorite workout playlist at the gym, and your ears feel like they’ve been stuffed with cotton, you’re essentially giving your ears mild concussions that, over time, can lead to irreversible hearing loss.
It sounds (pun intended?) counterintuitive that hearing loss causes you to hear things no one else does, as is the case with tinnitus. The reason is that our brains recognize when we’ve lost the ability to hear certain frequencies and create these sounds to compensate. Since we tend to lose our ability to hear higher frequencies first, most tinnitus sounds—you can hear some samples here—are high pitched. Moreover, it’s not just ringing: Tinnitus can also sound like whooshing, buzzing, clicking, or roaring.
While most causes of tinnitus are not life threatening, many of them, including hearing loss, are chronic conditions that worsen without treatment. So, if you have no idea why you have tinnitus, see your primary care physician. Your ears are trying to tell you something.
How to treat tinnitus
While no cure for tinnitus currently exists, there are many ways to mitigate its impact in your daily life, and there are even a couple of treatments that can stop the noise. Treatments fall into three main categories: devices or apps that provide sound therapy, mental health therapies and lifestyle changes, and multidisciplinary approaches that use both.
Sound therapy devices
Sometimes, the solution is as simple as getting a hearing aid. If the pitch(es) of your tinnitus matches the pitch(es) that you can’t hear anymore, a hearing aid tuned to those frequencies can silence or greatly reduce the noise. Wikoff says that 80-90 percent of her patients experience some level of relief with hearing aids.
External and/or in-ear masking devices—some of which can be attached to hearing aids—can also help by masking or drowning out the tinnitus with sounds like white noise.
Mental health therapies and lifestyle changes
Just like any annoying external noise, tinnitus can disrupt sleep and concentration. It can also increase anxiety and depression, according to a 2014 ATA survey of 1,100 people with tinnitus. Studies estimate that people with tinnitus suffer from depression at rates more than twice the national average.
“We call it the vicious cycle,” Wikoff says. “All of a sudden, you hear tinnitus, and then it causes some anxiety, depression, [and] fatigue…and then the tinnitus is worse, because if we’re not getting enough sleep, we’re unable to fight it off the same day.”
Some studies hypothesize that the link between depression and tinnitus is not just psychological but physiological, due to a connection between the auditory nerve and the limbic system, which affects our emotions, memory, and sleep. Any lifestyle changes that reduce stress can, therefore, potentially lessen the impact of tinnitus.
While many patients find relief using only devices or mental health therapies, Wikoff finds that a multidisciplinary approach is necessary for the most stubborn tinnitus cases.
One such approach, Tinnitus Retraining Therapy (TRT), uses many of the same devices and mental health techniques as traditional standards of care. However, because it operates on the limbic system theory of tinnitus mentioned above, it focuses on neutralizing our attitudes toward the sound rather than masking or learning to accept it.
When TRT is successful, people perceive their tinnitus as no different from any other background noise (wind, birds, traffic, indoor and outdoor chatter) that we filter out as we go about our daily lives. Studies suggest that TRT works as well or slightly better than traditional care methods. There are also some experimental treatments being tested, including non-invasive neuromodulators and electromagnetic stimulation of the brain and the vagus nerve.
Which treatment people ultimately choose, Wikoff says, depends upon their budget, schedule, the severity of their tinnitus, and other factors. While many people anecdotally report improvement after seeking some form of treatment—especially mental health therapy—there is comparatively little clinical research on tinnitus, considering its prevalence. Organizations like the American Tinnitus Association are working on changing that.
How to avoid getting tinnitus in the first place
Of course, the most effective treatment remains prevention. This axiom applies not only to people who have never had tinnitus but also temporary tinnitus sufferers like me, who can prevent further hearing damage.
Because so many tinnitus cases are related to noise exposure, it’s important to establish healthy hearing habits by using products designed to protect your hearing—and using them correctly, so that as little sound as possible leaks out.
Parents should teach children healthy listening habits early. Just as you limit screen time, limit headphone time whenever possible. One metric is the 60-60 rule: 60 minutes per day at 60 percent of a device’s maximum volume. When you can’t limit headphone use (such as for virtual classes), Wikoff suggests purchasing volume-limited headphones. For her own kindergarten-aged daughter, she uses Puro Sound, a company that produces studio-grade quality, volume-limited headphones for kids and adults. (They even make specialized gaming headphones.)
While most smartphones allow you to set volume limitations, the earbuds that come along with these devices leak sound like sieves. As a result, we turn up the volume, thereby driving up the decibel level blaring into our ear canals. So, it’s important to have headphones or earbuds that fit tightly over, on, or into your ears. If you don’t want to toss your expensive earbuds, consider buying customized sleeves, which retail for $100-200. Molded to slip over your standard earbud, they seal in the sound.
If your job requires headphones for hours on end, or if you’re an audiophile who has the budget and desire for the best possible sound, in-ear monitors are the way to go. The costs can range from about $250 to $1,200, depending on whether you get a general or customized fit. If you work in music or theater, broadcasting, or other industries where good hearing is a prerequisite, this investment can potentially protect your livelihood.
For industries like construction or motorsports, those drugstore foam earplugs offer great protection—if you insert them correctly. The CDC has a great how-to website that shows each of the crucial steps.
Get your hearing tested as an adult to establish a baseline
Children often get hearing tests in elementary school, although the frequency and quality of the tests vary among states. Once we enter middle school, however, we’re usually on our own.
Even though the U.S. Preventive Services Task Force concluded earlier this year that there is insufficient evidence to establish hearing screening guidelines for Americans over age 50, Wikoff points out that we regularly test other body parts related to our senses. “Just like you clean your teeth twice a year [and] you check your eyes once a year,” she said, “you should be checking your hearing.”
Some primary care physicians test hearing during physicals, but many don’t. A couple of low-cost and free online tests can give you a general sense of how your hearing is doing: the $8 National Hearing Test (free for AARP members) and a free app called hearScreenUSA.
Most insurance plans will cover a visit to the audiologist with a doctor’s referral, and it’s a good idea to go at least once after you turn 18 in order to establish a baseline. Studies show that many older adults underestimate their level of hearing loss, and Wikoff stresses that the sooner it’s treated, the less it progresses.
She recommends adults over 40 get their hearing tested once every 1-2 years; other physicians recommend every 3-5. It’s a good idea to get tested if you begin to notice any of the following signs of hearing loss:
- Difficulty understanding people during conversation and asking them to repeat themselves
- Increasing the volume level on your electronic devices more than before
- Trouble hearing consonants
- Hearing muffled speech
Don’t stop the music—just be a conscientious consumer
We’re all exposed to more noise than ever, thanks to personal devices. The pandemic has exacerbated the problem, since many of us have been wearing headphones for hours each day in order to work or attend classes from home alongside partners, roommates, and children.
I’ve been able to avoid headphones thus far because I live in a relatively quiet house and walk where few neighbors can hear my podcasts and music playing. Eventually, though, I’ll be in situations where social etiquette and general courtesy require headphones.
Since I already have AirPods, I’ll likely look into getting customized sleeves. I also want to get my hearing checked to establish how much hearing loss I have. What I won’t do is stop listening to the music and podcasts I love.
“I don’t want anyone to not listen to the music, especially after the year and a half we’ve been through,” Wikoff says. “Music is what connects us and lets us escape, [so] we want to find ways to enjoy those things while protecting ourselves.”