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Man holding head and neck. Tinnitus on left side of head

Updated 13th October 2025

Tinnitus, it's mechanisms, causes and treatment

Tinnitus is typically the perception of any sound in the head or ear(s) without an external source. Tinnitus is often subjective (heard only by the individual). Most people have tinnitus. There is a type of tinnitus that can be heard by others but this is not very common. Nearly 10 in 100 adults experience some form of tinnitus. with a higher prevalence in the elderly and those with hearing loss. Tinnitus can have multiple presentations. It isn't always the classic ringing. It can be a hiss, screech, drone, whine, buzz and sometimes music.

Tinnitus is a symptom of a disorder of the auditory system. Tinnitus is not a disease itself. It is often worsened by one's thoughts and emotions towards it. Tinnitus sufferers have an intolerance for loud sounds that most people would find tolerable - Hyperacusis.

Mechanism of Tinnitus

Pathophysiology mechanism of tinnitus

Tinnitus is often triggered by damage to the cochlea. Limited output from the cochlea to the auditory system leads to sensory deprivation affecting the central nervous system.

Bottom up processing

Key trigger of the initial development of tinnitus. Noise damage or ageing leads to reduced sensory input. Reduced input leads to hyperactivity in central auditory processes.

Top to bottom processing

Refers to how the brain responds to abnormal neuronal activities. Attention (fight or flight) and emotional evaluation modulate our perception of tinnitus.

Effective top-down processing will divert attention away from phantom sounds and reduce emotional distress. CBT (cognitive behavioural therapy) and mindfulness aim to modulate top-down processes. Tinnitus is a disorder consisting of bottom-up and top-down processes.

Summary

Bottom-up regulation causes the initial development, top top-down regulation plays a crucial role in how strongly the noise is perceived and how it affects the life of the sufferer.

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Hearing loss in the elderly is a big contributor to tinnitus. Elderly man holding head

Causes of Tinnitus

Tinnitus can happen for a number of reasons, some of which include:

Hearing loss:

This is one of the most common reasons for tinnitus. One hypothesis is that with cochlear sensorineural hearing loss, over time the brain compensates for the reduced input from the cochlear by making it's own version of the missing sound. With management of hearing loss, over 65% of hearing aid users have reported relief from their tinnitus when using their hearing aids, as the brain receives input that it was missing. (ref: tinnitus.org.uk) See Post: Hearing aids and tinnitus

Acoustic Trauma - Loud Noise Exposure:

Also, one common reason for tinnitus. Very high levels of noise damage the outer hair cells in the cochlea. Frequently seen with musicians, army officers and construction trade workers, due to exposure to loud sounds. With exposure it is not only the duration of exposure that needs to be considered but the level of exposure.

Loud drills with hearing protection to protect ears from tinnitus and noise damage]

VU Power meter turned up too loud can damage hearing and cause tinnitus

Use of loud weaponry by army officer increases risk of noise damage and hearing loss

Head & Neck injury:

The complete physiology behind the cause for this is not fully understood but acoustic shock, physical stress from an injury are related factors. The close proximity of the head and neck to the systems along the auditory pathway can provide a causal link for tinnitus. As an injury could affect the auditory pathway, thereby leading to tinnitus.

Some medications:

e.g. anti-depressants, antibiotics, chemotherapy. If tinnitus starts, or worsens after starting medication. You should inform your doctor of this change.

Some medical conditions:

e.g. acoustic neuroma, cardiovascular conditions, Meniere's disease. These would typically require further assessment including different health professionals like an audiologist and doctor.

Ear Wax buildup:

The buildup of wax in the ear can reduce or stop the passage of sound through the ear canal. Sometimes, removal of the earwax can bring tinnitus relief to the individual. Sometimes removal may result in no change, which, if intrusive, may require further investigation by the audiologist and doctor.

Eustachian tube dysfunction/Middle ear congestion:

Middle ear buildup of fluid following colds, upper respiratory tract infections can dampen one's hearing. This is usually temporary, and once the pressure equalising tube (eustachian tube) is working well, then the hearing can return to previous levels, and tinnitus might be reduced or stop entirely. If one tends to have repeated episodes of eustachian tube dysfunction, it would be recommended that one see an ENT doctor.

Allergies:

Increased inflammation of the mucosal passages due to an immune response to an allergy can lead to tinnitus. Some patients may present with repeated sinusitis, eustachian tube dysfunction which in turn can affect the auditory system leading to tinnitus.

Ear infections:

Especially infections which discharge liquid can eventually leave behind debris in the ear. Use of ear drops for the treatment of the infection could also build up within the ear canal. Removing the obstructing build-up in the ear canal can sometimes help tinnitus symptoms.

Hormonal changes Menopause/Perimenopause:

The decline of the stimulation of oestrogen receptors all over the body (due to fluctuating/lowering levels of the hormone oestrogen), including the cochlea (inner ear), can result in tinnitus. Recent research is highlighting tinnitus as a common symptom experienced by women experiencing hormonal changes. Reduced sleep, stress and anxiety are also related precursors to tinnitus in this group.

If you have tinnitus, then the first step we would advise is that you have an audiological assessment. This is because up to 80% of people with hearing losses have tinnitus. So the absence or presence of a hearing loss amongst other medical conditions will need to be determined initially.

You can book here with Sonant Hearing for a Tinnitus Assessment.

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Some Methods of Relieving Tinnitus.

Whilst these examples are not exhaustive. Some may prove helpful for reducing the burden of tinntus. For Professional Guidance and more options. Contact Us.

1. Sound Therapy.

This can come from amplification with carefully selected and programmed hearing aids. As other sounds not previously heard acutely due to one's hearing loss now become distinct and easily heard. These newly audible sounds can draw focus away from the tinnitus and in turn relieve it's impact. When taking hearing aids off at night, it's usually advisable to have some level of noise in the background to get ones attention. Otherwise one can go seeking the tinnitus automatically after the aids are removed.

With no hearing loss requiring amplication (NICE guidelines currently recommend against amplification in the presence of normal hearing thresholds.) Other maskers can be used such as apps (some can be recommended by the audiologist), white noise maskers and low level music in the background. With maskers it's recommended not to try and turn the volume up so loud that the "tinnitus is not heard" as this worsens it's presence.

Hearing aid can mask tinnitus in the presence of a hearing loss

2. Speaking to someone and peer support

As inate social beings, some may find that talking to someone about tinnitus is often helpful at reducing concerns and in turn relieving tinnitus. One may no longer feel alone and may be exposed to other anecdotal means of managing tinnitus. It is advisable to choose reputable social groups, as not all practices shared online can be said to be safe.

3. Cognitive Behavioural Therapy.

This is currently the only evidence based and peer-reviewed means of managing tinnitus. It involves the use of in-depth discussions, relaxation techniques and methods of changing ones' automatic negative thoughts around their tinnitus. It's main goal is to change one's emotional thoughts and reactions to tinnitus. This in turn aids habituation where the tinnitus has a reduced impact on ones's thoughts over time. Click here for our blog post on Internet Based CBT iCBT

4. Relaxation.

This can help reduce the impact of tinnitus. Everyone has a different preference for relaxing. From taking a nice long soak in the bath, to listening to music, gentle exercises to meditation. Relaxation reduces stress and encourages a calmer self. Less stress often results in reduced impact of tinnitus. Meditation is a common method requiring one to sit still quietly for about 10-15 minutes in a comfortable restful position whilst breathing in and out in a measured, focused way. One needs to remain present of themselves and their surroundings whilst doing this. Some apps can help one pace their inhalations and exhalations as well as a simple timer on the clock/watch or phone.

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Reference:

Mazurek B, Steinmetzger K, Boecking B, Hesse G, Brueggemann P. Tinnitus – aktuelle Entwicklungen : Überblick und Zusammenfassung des Wissensstands 2024 [Tinnitus-current developments : Overview and summary of current state of knowledge in 2024]. HNO. 2025 Sep 8. German. doi: 10.1007/s00106-025-01668-3. Epub ahead of print. PMID: 40920197.