Unless you’ve dealt with issues before, your hearing health probably isn’t something you think about that often. Hearing issues aren’t just a sign of old age, though – they can affect everyone, especially in the age of headphones and unsafe listening practices.

Tinnitus, in particular, is a condition that affects people at all stages of life. Defined by the NHS as the name for “hearing noises that do not come from an outside source”, tinnitus is characterised by ringing, humming or whooshing noises in one or both ears. According to the latest research, it affects one in seven UK adults – a number equivalent to over seven million adults.

However, despite how common tinnitus is, it’s not always clear what causes it. A number of triggers have been linked to the condition, but research is ongoing to explore the links between tinnitus and factors such as hormone variability and mental health conditions like anxiety.

It can get a little confusing, so to give you more clarity on tinnitus as a condition, we asked audiologists and hearing experts some of the most commonly asked questions about the condition.  

The main characteristic of tinnitus is being able to hear noises in the ear when there are no sounds around you – for example, hearing ringing in your ears in a silent room. It can begin suddenly or come on gradually, and the sounds heard can vary depending on each person.

“The main sensation is often a ringing sound, but it can be individual to the person and other sounds that can be heard include buzzing, whistling, humming, hissing and grinding,” explains Gordon Harrison, Specsavers’ chief audiologist.

While some people with tinnitus hear a constant sound, others may experience variations in volume, or experience additional symptoms including dizziness, vertigo and fatigue.

As well as being a condition on its own, tinnitus can be a symptom of other conditions, Harrison adds. “Tinnitus can sometimes be a symptom of something underlying, such as age-related hearing loss, an ear injury or even a circulatory system disorder,” he says.

“Tinnitus is more frequently experienced by those who have hearing loss or other ear problems, but it can also affect people with normal hearing.” 

As we’ve already mentioned, it’s complicated. While in some cases it’s easy to tell what might have caused the tinnitus, in others, the cause can remain unknown.

“Tinnitus can be linked to a variety of different things, including hearing loss, exposure to loud noises, certain medications ear or head injuries, some ear conditions and emotional stress,” says Franki Oliver, audiology manager at the Royal National Institute for Deaf People (RNID).

“Sometimes, there’s no recognisable link at all. Many people with tinnitus also have hearing loss – it’s thought that hearing loss can cause tinnitus symptoms, especially if it isn’t managed with hearing aids.”

Some of the common possible causes of tinnitus include: 

Earwax build-up

If you’ve developed tinnitus without any obvious cause, it could simply be a case of earwax build-up.

“Too much earwax can block the ear canal, prevent normal hearing, disturb the eardrum and cause tinnitus,” Harrison says.

“If you think you have tinnitus due to earwax, visit an audiologist. Many local high-street opticians, such as Specsavers, also offer ear wax removal services.” 

Ear infections

Sudden tinnitus can be the result of an ear infection, when trapped fluid can muffle sounds.

“This should disappear once the ear infection has been resolved and treated, but visit your audiologist if symptoms persist,” Harrison says. 

Perforated eardrum

Ear injuries and infections can lead to a perforated eardrum, which in turn can lead to tinnitus.

“A perforated ear drum can cause pain, hearing loss, fluid drainage and tinnitus,” Harrison explains. “A small eardrum perforation can usually heal on its own, but a larger eardrum perforation may require surgery.” 

Loud noise exposure

If you’ve ever experienced ringing in your ears after a gig, then you’ll know tinnitus can be caused by exposure to loud noise. This isn’t inevitable, though – protecting your ears with ear plugs is a good way to protect yourself from permanent damage.

“If symptoms persist longer than a week, speak to your GP,” Harrison recommends. 

Cholesteatoma

Cholesteatoma is a benign growth of skin cells behind the eardrum which is often triggered by an ear infection. It can cause both hearing loss and tinnitus.

“If left untreated, the growth can erode the middle ear bones, causing hearing loss,” Harrison says. “Cholesteatoma can be treated by ENT doctors who will perform a procedure to remove the growth.” 

Stress

While research into the link between stress and tinnitus is still ongoing, studies have found that stress can play a role in the onset of symptoms.

“The exact reason for this is still unknown, but stress has often been reported to trigger tinnitus or make its symptoms worse,” Harrison explains. “In fact, one study actually found that being highly stressed increases your probability of developing tinnitus just as much as exposure to loud noise does.”

Oliver adds that the relationship between stress and tinnitus goes both ways. “Some people, though not all, find that tinnitus makes them feel stressed and anxious, so you may find yourself in a cycle: stress makes your tinnitus worse, which in turn makes you feel more stressed or anxious,” she says.

“The good news is that help is available, and there are things you can try to help reduce stress and manage tinnitus. These include relaxation exercises, mindfulness, daily exercise or joining a tinnitus support group.” 

Hormonal changes

According to Tinnitus UK, there may be a link between tinnitus and hormonal changes, especially during menopause. While the link is not yet fully understood, it’s been suggested that the decrease in oestrogen and progesterone levels during this time could be the cause.

This is because this decline can affect the auditory system, and potentially contribute to tinnitus.

“Oestrogen has been shown to play a role in the development and maintenance of auditory pathways in the brain,” the organisation adds. “A decline in oestrogen levels during menopause may contribute to tinnitus.” 

There’s no such thing as a ‘cure’ for tinnitus, but several treatments can help to minimise symptoms, and it can go away on its own.

“Some people find that they can manage tinnitus themselves, while others may prefer a combination of professional support and self-help,” Oliver says. “Tinnitus is not usually a sign of a serious health condition but if you’re concerned, or find it affects your day-to-day life, a chat with your GP can be a good place to start.”

The first step in treating any form of tinnitus is to check whether there are any obvious causes, such as ear wax build-up. In these cases, treating the cause will often completely resolve or reduce the tinnitus. In other cases, more investigations may be needed.

“Your GP may arrange blood tests to check for conditions that can sometimes be linked to tinnitus, such as diabetes or a problem with your thyroid gland,” Oliver says. “If there’s no obvious cause of your tinnitus, your GP should refer you to a specialist for further assessment.” 

Tinnitus specialists can help you to manage your condition using a number of different methods, depending on your needs. These might include hearing aids, sound enrichment, support groups and cognitive behavioural therapy.

They may also explain some self-help options you can try, such as relaxation techniques, breathing exercises and mindfulness.

However, Harrison adds: “If you have tinnitus sounds pulsating or in just one ear, go see your GP. When tinnitus is apparent in one ear only, further testing such as head imaging with MRI or CT scan may be required to identify the cause.

“If you have symptoms of both tinnitus and hearing loss, see your audiologist. They can test your hearing and check for problems they may be able to treat for you.” 

For information and support, you can visit rnid.org.uk. You can also visit tinnitus.org.uk or call the Tinnitus UK helpline on 0800 018 0527. If you have concerns about your hearing, you can book a hearing test by visiting specsavers.co.uk/hearing. 

Images: Getty