How you feel today is not how you will feel in the future.

Tinnitus is commonly described as a ringing in the ears, but it also can sound like roaring, clicking, hissing, or buzzing. It may be soft or loud, high pitched or low pitched. You might hear it in either one or both ears.

Roughly 10 percent of the adult population of the United States has experienced tinnitus lasting at least five minutes in the past year — nearly 25 million Americans.

Tinnitus is not a disease — it is a symptom that something has changed in the body. It’s often linked to changes in the auditory system: the ear, the auditory nerve, and the parts of the brain that process sound. Something as simple as earwax blocking the ear canal can cause tinnitus, but it can also result from many health conditions, including:

• Hearing loss
• Noise-induced hearing loss
• Ear and sinus infections
• Physical trauma
• Emotional trauma
• Diseases of the heart or blood vessels
• Ménière’s disease
• Brain tumors (often benign)
• Hormonal changes in women
• Thyroid abnormalities

More than 200 medications are known to cause tinnitus when started or stopped. People who work in noisy environments — factory or construction workers, road crews, musicians — can develop tinnitus over time as ongoing noise exposure damages the inner ear’s sensory hair cells.

Tinnitus is also one of the most common service-related disabilities among veterans returning from Iraq and Afghanistan.

Pulsatile tinnitus is a rarer type that sounds like a rhythmic pulsing in time with your heartbeat. It’s most often caused by problems with blood flow in the head or neck and should be medically evaluated.

Although we hear tinnitus in our ears, its real source is in the networks of brain cells (neural circuits) that make sense of the sounds the ears hear. A useful way to think about tinnitus: it often begins in the ear, but it continues in the brain.

Scientists think tinnitus may be similar to chronic pain syndrome, where pain persists after a wound has healed. It may also be the result of neural circuits trying to adapt to the loss of inner-ear hair cells by turning up sensitivity to sound — which would explain why some people with tinnitus are oversensitive to loud noise.

The neural circuits involved in hearing also communicate with regions like the limbic system, which regulates mood and emotion. That’s why tinnitus can have an outsized effect on how you feel.

The first step is to see an audiologist who specializes in tinnitus. We’ll check whether something is blocking the ear canal, then ask about your current health, medical conditions, and medications to find out if an underlying condition is involved.

If medication treatment is needed, we’ll refer you back to your primary care physician or to an ENT, as appropriate.

Unfortunately, many patients first bring up tinnitus to a primary care provider and are told “there’s nothing that can be done — learn to live with it.” That advice creates hopelessness and worsens the mental health impact. We don’t practice that way.

Some people find their tinnitus doesn’t go away or worsens. In severe cases it may interfere with hearing, concentration, or sleep. Your audiologist will work with you to find ways to reduce the severity of the noise — and just as importantly, its impact on your life.

Yes — there are many ways to provide relief. While there is no single “cure” that helps everyone, management and habituation are achievable with the right tools. Common evidence-based options include:

• Lenire™ — FDA-approved bimodal neuromodulation device used at home with clinical guidance
• Hearing aids — reduce tinnitus awareness in patients who also have hearing loss
• Counseling & CBT — including programs led by Dr. Tarvin and Dr. Cioli
• Mindfulness & meditation — powerful, often-overlooked habituation skills
• Wearable sound generators — small in-ear devices using soft, pleasant sound
• Tabletop sound generators — for relaxation and sleep
• Acoustic neural stimulation — broadband acoustic signal embedded in music
• Cochlear implants — in patients with severe-to-profound hearing loss
• Anti-depressants and anti-anxiety medications — prescribed by your physician when appropriate

We do not recommend complete masking of tinnitus — it doesn’t help with habituation. Our goal is long-term relief, not just a louder cover.

Noise-induced hearing loss — damage to the inner ear’s sensory hair cells — is one of the most common causes of tinnitus. Anything you can do to limit loud-noise exposure (move away from the sound, turn down the volume, wear earplugs or earmuffs) helps prevent tinnitus or keep it from worsening.

Active areas of research include:

• Electrical or magnetic stimulation of brain areas involved in hearing — similar in concept to deep-brain stimulators used for Parkinson’s
• Repetitive transcranial magnetic stimulation (rTMS) — a non-invasive technique already used in epilepsy
• Hyperactivity and deep brain stimulation — targeting the spread of hyperactivity in neural networks after intense noise exposure
• Resetting the tonotopic map — restoring the auditory cortex’s frequency organization after noise damage

Source: National Institute on Deafness and Other Communication Disorders (NIDCD).