Tinnitus
Tinnitus is the sensation of hearing a sound when there is no external sound causing it. People describe it in different ways — ringing, buzzing, hissing, humming, whistling, clicking, or whooshing. It can be constant or intermittent, quiet or intrusive, in one ear, both ears, or in the head. Tinnitus is common, and although it can be very upsetting at first, there are always ways to make it better.
One of the most important things to understand is that the brain can learn to treat tinnitus as unimportant rather than as a threat. We all hear or create background sounds all the time that the brain filters out automatically — breathing, a fridge humming, distant traffic, or the rustle of clothes. Usually, we do not focus on them because the brain has decided they are safe and not worth attention. Tinnitus becomes much more intrusive when the brain starts treating it as important, worrying, or dangerous. A large part of treatment is helping the brain stop focusing on it in that way and allowing it to fade into the background.
I run a dedicated multidisciplinary tinnitus clinic in London, but I am very happy to see tinnitus patients from any location.
What is the difference between non-pulsatile and pulsatile tinnitus?
Most tinnitus is non-pulsatile. This means it does not beat in time with the heartbeat. It is often described as ringing, buzzing, hissing, or a high-pitched tone.
Pulsatile tinnitus is different. It is a rhythmic sound, usually in time with the heartbeat. People often describe it as a whooshing, pulsing, or thumping noise. This type of tinnitus deserves particular attention because it can sometimes be related to blood flow around the ear or other structural causes that may be treatable.
What can cause tinnitus?
There is no single cause of tinnitus. Common associations include hearing loss, noise exposure, ear wax, middle ear problems, certain medications, jaw or neck-related factors, stress, and changes in the hearing system itself. In many people, tinnitus is linked to hearing loss, even if that hearing loss is mild.
Less commonly, tinnitus can also be associated with medical factors such as anaemia, vitamin or other nutritional deficiencies, thyroid problems, and pregnancy-related changes. These are not the commonest causes, but they can occasionally contribute and may be relevant in the right clinical context. Pregnancy can make tinnitus more noticeable, often because of changes in circulation and hormones.
Pulsatile tinnitus has a different set of possible causes. It may be related to blood vessels near the ear, altered blood flow, raised pressure around the brain, or less commonly other structural causes around the ear and skull base. That is why pulsatile tinnitus is usually investigated more actively than standard non-pulsatile tinnitus.
When should tinnitus be assessed?
Tinnitus should be assessed if it is persistent, distressing, one-sided, associated with hearing loss, dizziness, a blocked feeling, neurological symptoms, or if it is pulsatile. Sudden hearing loss with tinnitus is particularly important and needs urgent assessment.
More generally, I am very happy to see patients if they are simply bothered by their tinnitus and want answers. Tinnitus can be unsettling, and a proper assessment is often the first step in making it feel much less worrying and much more manageable.
What investigations might be needed?
The starting point is always a careful history, ear examination, and hearing test. Hearing tests are important because tinnitus and hearing loss commonly occur together, and the result often helps guide treatment.
For non-pulsatile tinnitus, not everybody needs a scan. If the tinnitus is in both ears, the hearing test is symmetrical, and there are no unusual features, imaging is often not necessary. If it is mainly in one ear, associated with asymmetric hearing loss, or there are other atypical features, then a scan may be appropriate. This to look at the inner ear, the hearing nerve, and the nearby parts of the brain.
For pulsatile tinnitus, scans are more often needed. In simple terms, these scans are used to look at the ear, the surrounding bone, and the blood vessels in the head and neck to see whether there is an identifiable cause for the pulsating sound. Depending on the individual case, that may involve an MRI scan, a CT scan, or a scan specifically designed to look at blood vessels.
What conditions are you looking for?
For non-pulsatile tinnitus, I am often looking for associated hearing loss, wax, middle ear disease, Ménière’s disease, jaw or neck-related contributors, or more rarely a problem affecting the hearing nerve when the tinnitus is one-sided.
For pulsatile tinnitus, I am looking more specifically for vascular or structural causes. The important point for patients is that pulsatile tinnitus is often more explainable than standard tinnitus, which is why it is worth investigating properly. In a small number of patients, a cause such as an arteriovenous malformation or fistula may be found, and these can sometimes be treated by specialist neurosurgical or neuroradiology teams.
How is tinnitus treated?
Treatment depends on the type of tinnitus, what is driving it, and how much it is affecting your life.
If there is a specific treatable cause — for example wax, hearing loss, a middle ear problem, a vascular issue, or a jaw-related contributor — then that should be addressed first.
For many people, especially with non-pulsatile tinnitus, the most effective treatment is a combination of:
explanation and reassurance
hearing rehabilitation where appropriate
sound therapy or sound enrichment
tinnitus-focused counselling or education
cognitive behavioural therapy approaches
stress reduction and sleep support where needed
The aim is not always to make the tinnitus vanish completely. Very often, the aim is to make it feel much less intrusive, much less frightening, and much easier for the brain to filter out. That is where people usually start to feel that they have got their life back.
What about hearing aids?
If tinnitus is associated with hearing loss, hearing aids can be very helpful. By improving access to outside sound, they reduce the contrast between the tinnitus and the environment. For many people, that makes the tinnitus much less noticeable.
What about sound therapy?
Sound therapy can be helpful, particularly when tinnitus feels louder in quiet places. The idea is usually not to drown tinnitus out completely, but to reduce the contrast between the tinnitus and silence so that the brain has an easier time filtering it out. Used well, this can support habituation.
What about apps and self-management tools?
I like the Oto app. It can be a useful part of a wider tinnitus management plan, particularly for education, reassurance, and practical strategies. It is not a substitute for proper medical assessment where needed, but it can be a helpful tool alongside it.
Can tinnitus actually get better?
Yes — and this is the most important message on the page.
Even when tinnitus does not disappear completely, the distress it causes can usually be reduced very substantially. Many people reach a point where it no longer dominates their thoughts, no longer triggers the same anxiety, and fades much more into the background. There are always ways to make tinnitus better.
Helpful resources
Disclaimer
This page is intended as general information only. It does not replace a consultation, examination, hearing assessment, or individual medical advice.