Ringing in the Ears (Tinnitus) at Home

What tinnitus is

Tinnitus is the perception of sound without any external source. It may be constant or intermittent, in one ear, both ears or "in the head", and may sound like ringing, hissing, buzzing, roaring, clicking or humming. It is not a disease itself but a symptom, and the brain's response to it, including attention and emotion, shapes how bothersome it is. Many people have mild tinnitus and are not troubled, while others suffer greatly. Guidance such as the NICE guideline NG155 recommends a careful assessment and support rather than expecting a quick fix.

Common contributors in older adults

• Age-related hearing loss: the most common link. When the ear sends less signal, the brain turns up its own activity, and may produce phantom sound.
• Noise damage: from work, loud music, firecrackers, machinery or gunfire.
• Ear wax blocking the canal; see ear wax and hearing: safe care.
• Ear infections or fluid behind the eardrum.
• Medicines: some can cause or worsen tinnitus, including high doses of aspirin and similar painkillers, some antibiotics, certain water tablets, some cancer drugs and others. Do not stop any medicine yourself. Tell the doctor, who can review.
• Blood pressure and circulation problems, and diabetes.
• Jaw (temporomandibular) problems and neck tension.
• Anxiety, stress and poor sleep, which worsen tinnitus.
• Caffeine, alcohol and smoking may affect some people.
• Head or neck injury.
• Less common causes: Ménière's disease, nerve growth such as an acoustic neuroma, blood vessel abnormalities and others, assessed by an ENT doctor.

Warning signs: see a doctor promptly

Most tinnitus is benign, but see a doctor, ideally an ENT specialist, soon if there is:

• Tinnitus in one ear only, or much worse in one ear, particularly with hearing loss in that ear.
• Sudden hearing loss with or without tinnitus. This is an emergency needing assessment within a day or so; see signs of hearing loss in parents and how to raise it gently.
• A pulsing or whooshing sound in time with the heartbeat (pulsatile tinnitus), which may reflect a blood vessel problem or other cause needing investigation.
• Dizziness or vertigo, unsteadiness or fainting; see vertigo, BPPV and balance problems.
• Ear pain, discharge, bleeding or swelling.
• Facial weakness, numbness, headaches, vision changes, difficulty speaking or swallowing, or weakness of limbs. Call 112 if sudden, as this may indicate stroke.
• Tinnitus after a head injury.
• Distressing tinnitus with low mood, hopelessness, severe anxiety or thoughts of self-harm. Seek help; call 112 if there is immediate danger.
• Tinnitus that began after starting a new medicine. Call the doctor; do not stop the medicine without advice.

What the assessment involves

The doctor will ask about the sound, when it started, one or both ears, hearing, dizziness, medicines, noise exposure and mood; examine the ears (to check for wax or infection); and usually arrange a hearing test; see a hearing test: what to expect. Further tests, such as scans or blood tests, are for particular patterns, such as one-sided or pulsatile tinnitus. The doctor may also check blood pressure, blood sugar and cholesterol, and ask about sleep, anxiety and depression.

What helps: a stepwise approach

There is no proven medicine or supplement that removes tinnitus for everyone. But much can be done to make it less intrusive.

### 1. Treat what can be treated

• Wax and infection managed by a doctor.
• Hearing loss: hearing aids are often the most effective single step, since they bring back external sound, which helps the brain to ignore the internal noise. See hearing aids: types, costs and how to choose.
• Review medicines with the doctor.
• Blood pressure, sugar and other conditions well managed.
• Jaw and neck problems assessed.
• Anxiety, depression and insomnia treated; see anxiety in older adults, depression in older adults and insomnia in older adults.

### 2. Sound enrichment: avoid silence

Tinnitus is loudest in quiet. Gentle background sound makes it less noticeable.

• Use low-level sound such as a fan, soft music, a radio, nature sounds, a water fountain or a sound machine, especially at bedtime. The sound should be quieter than the tinnitus or at a level where the two blend, not loud.
• Pillow speakers or a speaker at the bedside help at night, with a timer.
• Hearing aids with sound generator options, if the audiologist offers.
• TV and radio at a moderate level, not blasting; see TV headphones and streamers for hearing loss.
• Avoid complete silence in the home during the day.
• Avoid very loud sound, which can damage the ears further.

### 3. Counselling, relaxation and cognitive approaches

Evidence supports psychological therapies, such as cognitive behavioural therapy (CBT) and tinnitus retraining or mindfulness-based approaches, which reduce distress even when the sound remains. A psychologist or audiologist trained in tinnitus support can help. At home:

• Understand it: knowing that tinnitus is common and rarely dangerous reduces fear.
• Practise relaxation: slow breathing, progressive muscle relaxation, gentle yoga, meditation and prayer; see breathing techniques for relieving stress and anxiety and ways of performing meditation at home.
• Shift attention: keep busy with enjoyable activity, company, hobbies, walks and music.
• Do not fight it or check it constantly; focusing on the sound makes it louder.
• Keep a diary of what makes it better or worse, such as caffeine, stress, noise or sleep.

### 4. Sleep

• Keep a regular sleep routine; go to bed and rise at the same time.
• Use soft sound in the bedroom.
• Avoid screens, large meals, caffeine and alcohol late in the day.
• Create a calm bedtime routine, with a warm bath, quiet reading or prayer.
• Do not lie in bed worrying; get up, do something gentle and return when sleepy.
• Discuss persistent insomnia with the doctor. Avoid sleeping tablets unless prescribed; they have risks in older adults. See insomnia in older adults.

### 5. Lifestyle and protection

• Protect the ears from loud noise: earplugs or earmuffs for noisy work or events, and keep volume low on headphones.
• Limit caffeine, alcohol and tobacco if they seem to worsen it.
• Exercise regularly, within safe limits.
• Manage stress and avoid isolation; see hearing loss and isolation in later life.
• Eat well and take medicines as prescribed.

What not to do

• Do not poke the ear with buds, pins or ear candles; see ear wax and hearing: safe care.
• Do not use oils, home drops or herbal preparations in the ear without a doctor's advice, especially if there may be a perforated eardrum.
• Do not buy products that promise to remove tinnitus, supplements or devices that make big promises. No supplement has been proven to remove tinnitus, and some cost a lot or cause harm. Ask the doctor before trying any.
• Do not stop prescribed medicines because of tinnitus without advice.
• Do not ignore warning signs.
• Do not dismiss the distress. Tinnitus can be exhausting.

Supporting a parent with tinnitus

• Listen and acknowledge: "I believe you; it must be tiring."
• Help arrange tests and appointments.
• Provide background sound and a calm environment.
• Encourage hearing aids and consistent use.
• Talk gently, and avoid shouting; see talking with someone who is hard of hearing.
• Encourage activity and company.
• Watch for low mood and sleep problems.
• Look after yourself as a carer.

When to ask a professional

See an ENT doctor or audiologist for tinnitus that is one-sided, pulsatile, sudden, bothersome, associated with hearing loss, dizziness or other symptoms, or that started after a new medicine. Ask about a hearing test, hearing aids, sound therapy and counselling. Seek urgent care for sudden hearing loss. Ask a psychologist or counsellor for help with distress. Call 112 for stroke signs, severe dizziness with weakness or any immediate danger.