Tinnitus
Ringing, buzzing or hissing with no outside source. Very common, rarely serious, and for most people it becomes less noticeable over time. Treatment aims to make it bother you less.
The tinnitus ladder
There’s no off switch yet, so the ladder is about turning down the bother, not the volume. Most people find a mix of steps works best.
- Step 1 · Self-careBackground sound and ear protectionLow background sound (a fan, music or a sound app) makes tinnitus less noticeable, especially at night. Earplugs around loud noise.
- Works
- No good trials show a benefit, but low risk and many people feel less bothered
- Cost
- Free, or about $20–40 for earplugs
- How long
- Every day, especially at bedtime
- Watch for
- Silence: it makes tinnitus seem louder
Silence is overrated. Bring a fan.
- Step 2 · PharmacyTreat a fixable causeEar wax drops or wax removal, treating an ear infection, or reviewing medicines that can worsen tinnitus.
- Works
- Not tested in trials; can help when there’s a cause to fix, but many people won’t have one
- Cost
- About $10–15 for wax drops; GP visit for wax removal
- How long
- Days to weeks
- Watch for
- Never use cotton buds or ear candles
Cotton buds: great for craft, terrible for ears.
- Step 3 · Allied healthHearing test and hearing aidsAn audiologist checks your hearing. If you have hearing loss, hearing aids help you hear and may make tinnitus less noticeable.
- Works
- Helps hearing; trials can’t show a tinnitus benefit (low-quality evidence), though many notice it less
- Cost
- Hearing aids about $2,000–8,000 a pair. Free or subsidised for pensioners and some others through the Hearing Services Program
- How long
- Weeks to get used to them; long term
- Watch for
- Sales pressure. Ask about trial periods and refunds
Straining to hear makes the brain listen harder to everything, including the ringing.
- Step 4 · Allied healthCBT for tinnitusA talking therapy, in person, in a group or online, that reduces distress and the impact on daily life.
- Works
- Tinnitus distress score about 10 points lower out of 100 than waiting list; doesn’t make the sound quieter
- Cost
- About $150–250 a session; Medicare rebates only if tinnitus comes with a mental health condition such as anxiety or depression, on a GP mental health treatment plan
- How long
- Usually 6–10 sessions
- Watch for
- Some programs promise more than they deliver: CBT is about coping, not cure
The best-studied help for tinnitus distress.
- Step 5 · SpecialistENT or audiology specialist reviewFor tinnitus in one ear, pulsing tinnitus, or hearing loss that needs a closer look. May include a scan.
- Works
- Not tested as a step in trials; finds the rare treatable cause, reassures when there isn’t one
- Cost
- About $150–300 a visit with a Medicare rebate when referred; scans vary
- How long
- One or a few visits
- Watch for
- Long waits for public clinics
Usually reassuring, occasionally important.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- BetahistineNo evidence it helps tinnitus. A vertigo medicine moonlighting badly.
- Ginkgo bilobaReviews find no meaningful benefit. Trees: great for shade, not for ringing.
- ZincNo benefit in trials, unless you’re genuinely deficient.
- Melatonin and ‘tinnitus formula’ vitaminsWeak or no evidence. The only thing ringing is the till.
- Ear candlingNo benefit, and it can burn the ear or block it with wax. Fire near your face: what could go wrong?
- Expensive ‘cure’ devices and programsNone has been shown to cure tinnitus. Some newer devices show promise, but get an audiologist’s view before paying thousands.
What you can do
- Keep headphone volume down: if others can hear it, it’s too loud.
- Look after stress and sleep, as both affect how loud tinnitus seems.
See your GP if
- Tinnitus is in one ear only, or you can hear your heartbeat (pulsing) in your ear
- You notice hearing loss
- It affects your sleep, mood or concentration
See a doctor the same day for sudden hearing loss in one ear, with or without tinnitus: treatment works best if started within days. Call 000 for tinnitus with face weakness, slurred speech or severe dizziness. If you feel hopeless, call Lifeline on 13 11 14.
Support lines
If you or someone else is in danger right now, call your emergency number. To talk to someone, any time:
- Australia: Lifeline 13 11 14 (24/7, or text 0477 13 11 14), Suicide Call Back Service 1300 659 467, Beyond Blue 1300 22 4636, 13YARN 13 92 76 for Aboriginal and Torres Strait Islander people. Emergency: 000.
- Young people in Australia: Kids Helpline 1800 55 1800 (24/7, ages 5 to 25) or headspace (ages 12 to 25).
- New Zealand: call or text 1737. Emergency: 111.
- UK and Ireland: Samaritans 116 123. Emergency: 999 (or 112).
- US and Canada: call or text 988. Emergency: 911.
- Anywhere else: findahelpline.com lists free helplines in more than 100 countries.
Common questions
Is tinnitus serious?
It’s rarely a sign of anything serious, and for most people it becomes less noticeable over time. See your GP if it’s in one ear only or you can hear your heartbeat in your ear.
Can tinnitus be cured?
There’s no cure, so treatment aims to reduce how much it bothers you. CBT, hearing aids if you have hearing loss, and background sound can all help.
Do supplements help tinnitus?
No. Betahistine, ginkgo, zinc, melatonin and vitamins don’t help tinnitus.
When is tinnitus urgent?
See a doctor the same day for sudden hearing loss in one ear, as treatment works best if started within days. Call 000 for tinnitus with face weakness, slurred speech or severe dizziness.
What causes tinnitus?
Most often hearing loss from age or noise. Earwax, ear infections, jaw problems, some medicines, stress and anxiety can also cause it or make it louder. Often there’s no single cause.
Why is my tinnitus worse at night?
When it’s quiet, there’s less background sound to cover it, so the brain notices it more. A fan, soft music or a sound app at a low volume can help you fall asleep.
Can stress make tinnitus worse?
Yes. Stress, anxiety and poor sleep can make tinnitus louder and more bothersome, and tinnitus can increase stress in turn. Relaxation, CBT and treating anxiety can break that cycle.
Helpful resources
- Take on Tinnitus (Tinnitus UK)Free online course for new tinnitus: seven short modules with videos and exercises. From a UK charity.
- Hearing Australia: free online hearing checkA quick check of whether you need a full hearing test. Free, Australia.
Evidence and more information
- Healthdirect: Tinnitus
- NICE: Tinnitus assessment and management
- Cochrane: CBT for tinnitus
- Australian Government: Hearing Services Program
- Cochrane: Hearing aids and sound generators for tinnitus
maladywise.com/tinnitus/