Tinnitus: treatment, causes, symptoms and how long it lasts

NHS inform says there is currently no treatment for tinnitus that works for everyone. If it is caused by an underlying condition, treating that condition may help. If a cause cannot be found, treatment focuses on helping you manage the condition on a daily basis.

The NHS says that if the cause is unknown or cannot be treated, your GP or specialist may refer you for a type of talking therapy. You will usually be offered digital CBT first, which is delivered through an online programme or app. If you have hearing loss, hearing aids may be recommended.

NICE guideline NG155 recommends a stepped approach for adults whose tinnitus still affects their emotional and social wellbeing and daily activities despite initial support. If someone does not benefit from the first intervention or declines it, they are offered the next step: digital tinnitus-related CBT provided by psychologists, then group-based psychological interventions including mindfulness-based cognitive therapy, acceptance and commitment therapy or CBT, then individual tinnitus-related CBT.

NICE also says not to offer betahistine to treat tinnitus. It recommends considering the Tinnitus Functional Index to assess impact in adults, and that people are given information including what can make tinnitus worse (such as stress or exposure to loud noise) and safe listening practices.

The NHS says tinnitus can sound like ringing, buzzing, whooshing, humming, hissing, throbbing, or music or singing. You may hear it in one or both ears, or in your head, and it may come and go or be present all the time.

NHS inform adds that it is not just ringing, that you might also notice hearing loss or be more sensitive to everyday sounds, and that it can be noises that beat in time with your pulse. For some people it can affect concentration and cause difficulty sleeping and depression.

NICE CKS describes subjective tinnitus, which only the affected person hears, and objective tinnitus, which the examiner can hear too and which is less common. NHS inform says most people have tinnitus for a short time after loud noise such as a music concert.

It is not always clear what causes tinnitus. The NHS says it is often linked to some form of hearing loss, Ménière's disease, conditions such as diabetes, thyroid disorders or multiple sclerosis, anxiety or depression, and taking certain medicines. It names some chemotherapy medicines, antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin as possible causes.

NHS inform adds inner ear damage caused by repeated exposure to loud noise, earwax build-up, middle ear infection and otosclerosis, an inherited condition where abnormal bone growth in the middle ear causes hearing loss. NICE CKS advises reviewing medicines and, if appropriate, stopping a drug that may be causing tinnitus. Do not stop a prescribed medicine yourself without speaking to the prescriber or a pharmacist first.

It varies. NHS inform says tinnitus will sometimes get better over time, either by disappearing or by the body getting used to it. NICE CKS says people should be reassured that it is common and may resolve by itself.

For others it persists, which is why management focuses on reducing its impact. The NHS suggests seeing a GP if you have tinnitus regularly or constantly, if it is getting worse, or if it is bothering you, for example affecting your sleep or concentration or making you anxious or depressed.

The NHS and NHS inform list things to try to help cope with tinnitus.

• Try to relax: deep breathing or yoga may help.

• Improve your sleep, for example with a bedtime routine or by cutting down on caffeine.

• Avoid things that can make tinnitus worse, such as stress or loud background noises.

• Join a support group: talking to other people with tinnitus may help you cope.

• Do not aim for total silence: soft music or sounds may distract you from the tinnitus.

• Do not focus on it, as this can make it worse. Hobbies and activities may take your mind off it.

The NHS says to ask for an urgent GP appointment if you have tinnitus that beats in time with your pulse. NICE guideline NG155 says to offer imaging to people with pulsatile tinnitus to look for a cause, and NICE CKS says sudden-onset pulsatile tinnitus needs immediate referral in line with local pathways, while persistent pulsatile tinnitus should be considered for referral.

The NHS says to go to A&E or call 999 if you have tinnitus after a head injury, or with sudden hearing loss, weakness in the muscles of your face, or a spinning sensation (vertigo). It advises not to drive yourself: ask someone to drive you or call 999.

NICE CKS describes a very urgent referral, to be seen within 24 hours, for tinnitus with hearing loss that developed suddenly over 3 days or less in the past 30 days. Immediate referral is advised for tinnitus with a high risk of suicide, sudden significant neurological symptoms, acute uncontrolled vestibular symptoms or suspected stroke.

The NHS says a GP will look in your ears to see if tinnitus is caused by something they can treat, like an ear infection or earwax. They may also check for hearing loss, and you may be referred to a specialist.

NICE CKS says all people with tinnitus should be offered an audiological assessment. NICE NG155 advises MRI of the internal auditory meati for people with non-pulsatile tinnitus who have associated neurological, ear or head and neck signs, and considering it for unilateral or asymmetrical tinnitus without other signs.

NHS inform says tinnitus can affect people of all ages, including children, and that it is more common in people aged over 65. NICE guideline NG155 includes children and young people, and suggests age- or ability-appropriate measures, such as a visual analogue scale, to assess how tinnitus affects them.

On the NHS the route is usually through the GP, then audiology or an ear, nose and throat clinic, with psychology-based services for distress. Digital CBT may be available through an app or online programme.

Private audiologists and ENT specialists can also assess hearing and offer therapies, and the NHS notes tinnitus retraining therapy is widely available privately. What is included differs between providers, so ask what the assessment covers and whether the approach is consistent with NICE guidance.