Boz Banner


The word 'tinnitus' comes from the Latin word for 'ringing' and is the perception of sound in the absence of any corresponding external sound.


Tinnitus is not a disease or an illness but a symptom generated by the person's own auditory pathway usually caused by a disease or condition of the ears but this is not always the case. 

Causes can include;

  1. Noise induced hearing loss by sustained loud noise (factory) or sudden noise (gunshot)
  2. Age related hearing loss
  3. Outer/middle ear issues; excessive ear wax, Eustachian tube dysfunction, foreign bodies
  4. Sinus Pressure/Barotrauma; diving, flying, sinus infection, concussive explosion
  5. Ménière's Disease
  6. Ototoxic drug side effects, some antibiotics, diuretics, quinine based or non-steroidal anti-inflammatory drugs
  7. Mental health disorders; stress, anxiety or depression
  8. Metabolic disorders; hypothyroidism, hyperthyroidism, anaemia or hormonal changes
  9. Autoimmune disorders; Lyme’s disease, fibromyalgia
  10. Cardiovascular disorders, high blood pressure, atherosclerosis
  11. Head/neck trauma


Although NICE guidelines specify their guidance this is most commonly:

  1. Thorough Clinical History
  2. Otoscopy - looking in ear canals
  3. Tympanometry  - check middle ear pressures and movement of the ear drum
  4. Audiometry - hearing test
  5. Loudness Discomfort Levels - No real usefulness as usually makes patients more anxious
  6. Tinnitus Matching - No real usefulness except to validate a patient's perception of the tinnitus.


This noise may be heard in one ear, in both ears or in the middle of the head or it may be difficult to pinpoint its exact location. The noise may be low, medium or high‑pitched. There may be a single noise or two or more components. The noise may be continuous or it may come and go. It may also vary in intensity, see tinnitus spikes below.


There is no known cure for tinnitus but the following have been shown to help:

  1. A good explanation of the condition - a form of counselling
  2. Reassuring the person that it is a symptom of a condition - patient feels less anxiety when they are believed and understood
  3. Various forms of counselling such as medical, private, lay or group counselling
  4. Cognitive Behavioural Therapy has been shown to be most effective
  5. Tinnitus Retraining Therapy
  6. Hearing Aids, restore lost hearing enabling environmental sounds and other surrounding sounds to override the tinnitus.

Management of Tinnitus Symptoms:

Human beings are fully capable of filtering out meaningless sounds and other sensory perceptions with a process called mental habituation. The problem lies in that the brain highlights important or new sounds that it subconsciously considers dangerous or problematic. So instead of ignoring the tinnitus we end up in a fight or flight situation that doesn’t ever end because the tinnitus doesn’t ever go away. If we allow negative thoughts, anxiety (about the tinnitus), frustration or anger to constantly accumulate we end up in a vicious circle where the tinnitus seems worse because of these negative connotations which then makes the tinnitus seem worse and so on. Mindfulness physical relaxation or breathing techniques can assist with reducing these negative thoughts and reduce stress.

Counselling, Sound therapy and distraction are the commonest forms of management for tinnitus symptoms. Counselling, in the form of Cognitive Behavioural Therapy, is not always readily available but has been shown to be very effective in managing tinnitus. Sound therapy uses sound to provide an alternative auditory stimulus to distract a person from their tinnitus, it is also known as 'sound enrichment' as it aims to replace the disturbing tinnitus with a more soothing sound that is less abrasive to a person.

Examples of these could be something as environmental sounds such as the sound of rain or rushing water or it could be relaxing meditation type music. Examples of both can be found by searching the internet for things like:

Tinnitus – Rain

Tinnitus – Waterfall

Tinnitus – Relaxation

Tinnitus – Sleep Music

Distraction, not just with alternate sounds, but involving as many other senses as possible will increase the chance of success in mitigating tinnitus symptoms. Examples of multi-sensory distractions are:

  1. Listening to environmental sounds in a hot bath with a scented candle
  2. Listening to a podcast whilst exercising/walking in the countryside
  3. Listen to music whilst playing a game on a phone/tablet


There are certain commercially available Sound and Noise generators (also called Tinnitus relaxers). They can be sourced on general shopping websites (such as, etc), Tinnitus dedicated websites (, etc) or Hearing Aid shops (like These can take the form of:

  1. Wearable items like hearing aids but produce white/pink/environmental noise instead.
  2. Bedside or desktop generators that play a soothing sound
  3. Sound Pillows, these have speakers inside that either play white noise or are connected to bedside generators.

Rehabilitation / Habituation of Tinnitus Symptoms

There are applications for smart phones that have been made specifically to alleviate and help rehabilitate the tinnitus symptoms and these are generally available for free from the leading hearing aid manufacturers or from other companies that may include inApp purchases.

Some examples of iOS/Android applications:


Oticon Tinnitus Sound



Phonak Tinnitus Balance



Resound Tinnitus Relief



Beltone Tinnitus Calmer



Widex Zen - Tinnitus Management



Starkey Relax



There are many other applications for Tinnitus rehabilitation but many require InApp purchase or subsciption plans, such as Endel and Headspace. The British Tinnitus Association produced an article on their thoughts, this can be found at BTA Mobile Apps

The principle of using sound-therapy products is not to block out the tinnitus completely but use the different sounds to distract your brain from focusing in on it. This will help your brain's filtering system learn to 'ignore' the tinnitus sounds, so you are no longer overly aware of them and eventually habituate or acclimatise to the tinnitus.

Tinnitus Spikes

Although tinnitus symptoms should remain consistent, unless the hearing degrades, the perception of the tinnitus sound can vary and should over time become less noticeable due to habituation. Sometimes it changes for the better but often it will appear to intensify and become worse, usually temporarily. This is known as a tinnitus spike. 

Tinnitus spikes are unavoidable and not an indication of a worsening of the condition. Once the underlying psychology and causation of the tinnitus spikes are understood you will become more resilient and confident during these difficult times. Tinnitus spikes are usually related to a combination of internal and external factors, it is key to try and figure the cause of the spike.

The commonest cause is stress, anxiety and sleep deprivation. These three causes will exacerbate any health problem. There is much research on triggers for tinnitus spikes, some of the research is strong and evidence based, others are from small studies and each listed trigger may or may not be relevant to you. Listed below from strongest evidence to weakest are common triggers:

Stress / Anxiety

Sleep deprivation

Certain noises

Loud noise


Certain medications

Supplements and vitamins

High Sodium diet / High sugar diet

Caffeine / Nicotine



Recreational drugs

Food sensitivities



Temporomandibular joint disorder

Weather / barometric changes

Extensive air travel.


A tinnitus trigger will vary in how long it will last, if you can source and eliminate the trigger then the intrusive symptoms will reduce sooner. Identifying the tinnitus trigger is not necessary for coping or habituation.

There is no perfect fix and you may have to endure some degree of discomfort. It can be useful to grade tinnitus on a 1-10 scale with 10 being the worst. If, during a severe tinnitus spike, you grade it at 10, there is little chance of reducing the discomfort to 1. Putting on background sound may reduce the discomfort by a few points, so you are still at 7 or 8. Introducing other tools, like mental relaxation or breathing exercises may reduce it by another point or two. Speaking with friends, playing a game or exercising may reduce it by a few more points. Even with all these strategies you may just reduce it to 5 on the scale but 5 is much better than 10.

Further Information

The following websites may provide more information:


Copyright © 2018 by Lee Boswell                                Disclaimer