Buzz
Since the pandemic began, I’ve kept myself fit and (mostly) sane with daily walks around my neighborhood, listening to my favorite true crime podcasts and K-pop tracks. But one afternoon in the spring of 2020, I began hearing a ringing in my right ear. I had developed tinnitus: the sensation of hearing sounds when no external sources exist.
I realized the cause was the volume on my earbuds—I often couldn’t hear the occasional car coming around the bends of my neighborhood’s mountain roads. (I had set volume limits on my previous iPhone but didn’t ensure those settings transferred to my new one. They hadn’t.) Worse than the sound itself, though, was the awareness that I had caused this to myself, especially after watching my mother’s past struggles with the condition.
I was fortunate. Three months after abandoning headphones entirely, the persistent high-pitched sound with a bit of vibrato disappeared one afternoon just as suddenly as it had come. However, two-thirds of the estimated 45 million Americans—14 percent of the population—who experience tinnitus at some point in their lives, deal with it for at least a year. Some live with it for decades.
Tinnitus is often seen as a lifelong burden you simply have to endure. That’s not the case, says Dr. Melissa Wikoff, founder and director of audiology at Peachtree Hearing in Atlanta and a member of the American Tinnitus Association’s (ATA’s) Board of Directors.
“The most common misconception is that nothing can be done—that it's a lifelong sentence with no help available,” she explained. “There’s no miracle cure...but there are numerous ways we can assist [you] in managing it.”
Tinnitus can’t be fully cured, but its underlying causes and symptoms can be managed—and it can disappear. More importantly, most cases can be avoided by maintaining good ear health. Here’s what to do if you start hearing ringing in your ears, as well as how to stop it from affecting you or your loved ones in the first place.
What are the triggers for tinnitus?
Let’s settle one thing first: You can pronounce it either as TIN-uh-tus or ti-NIGH-tus, according to the ATA. (For the record, I’m Team TIN-uh-tus.) Regardless of pronunciation, though, tinnitus is a symptom, not a standalone condition. 80 percent of tinnitus cases are associated with hearing loss, but more than 200 other conditions can contribute, including:
Middle ear blockages (e.g., from wax or foreign objects)
Head and/or neck injuries
Sinus pressure (like during snorkeling, flying, or SCUBA diving)
TMJ (also known as lockjaw)
Medications (such as some NSAIDs, chemotherapy, and antibiotics)
Autoimmune diseases (particularly Lyme disease and fibromyalgia)
Blood circulation issues (e.g., high blood pressure—typically related to the pulse)
Metabolic disorders, such as thyroid imbalances
Psychological conditions (e.g., depression, anxiety)
Inner ear or vestibular issues (like Ménière’s Disease)
Certain tumors
Occasionally, Wikoff encounters tinnitus sufferers who have a serious underlying condition. “The ears are the window to so many other things in your body,” she remarked. In fact, my mother’s tinnitus was caused by a rapidly growing benign brain tumor near her ear canal. Once it was removed, her tinnitus disappeared.
For most individuals, however, hearing loss is the primary factor. While we often associate hearing loss with aging, and it’s true that age-related hearing loss (also known as presbycusis) affects 30 percent of adults over 65 and 40-50% of those over 75, it often results from years of continuous exposure to noise. Our increased use of on- and in-ear headphones in the iAge now puts everyone at risk for experiencing this damage earlier.
Think of hearing loss as similar to sun damage or CTE: Continuous exposure to loud sounds causes temporary damage, referred to as temporary threshold shifts (TTS), which builds up over time and eventually causes permanent harm, or a permanent threshold shift (PTS). Each time you leave a noisy concert, finish mowing the lawn, or pause your workout playlist at the gym, and your ears feel clogged, you’re effectively giving your ears mild concussions that, over time, may lead to irreversible hearing loss.
It may seem counterintuitive that hearing loss causes you to hear things others don’t, as with tinnitus. The reason is that our brains recognize the loss of ability to hear certain frequencies and generate these sounds to make up for it. Since we typically lose the ability to hear higher frequencies first, most tinnitus sounds—samples of which you can listen to here—are high-pitched. In addition to ringing, tinnitus can also sound like whooshing, buzzing, clicking, or roaring.
Although most tinnitus causes are not life-threatening, many, including hearing loss, are chronic conditions that worsen without treatment. Therefore, if you’re unsure why you have tinnitus, consult your primary care physician. Your ears are trying to send you a message.
How to manage tinnitus
Although there is no definitive cure for tinnitus at present, several strategies can help alleviate its effects on your daily life, and a few treatments can even eliminate the noise entirely. These treatments generally fall into three primary categories: devices or apps providing sound therapy, mental health therapies and lifestyle adjustments, and multidisciplinary methods combining both.
Sound therapy devices
In some cases, the answer might be as straightforward as using a hearing aid. If the frequency of your tinnitus aligns with the frequencies you're no longer able to hear, a hearing aid calibrated to those specific frequencies can either mute or significantly lessen the sound. According to Wikoff, 80-90 percent of her patients experience some degree of relief from hearing aids.
External or in-ear masking devices—some of which can be attached to hearing aids—can also provide relief by masking or drowning out the tinnitus with sounds such as white noise.
Therapies for Mental Health and Lifestyle Adjustments
Like any disruptive external noise, tinnitus can interfere with sleep and focus. It can also lead to heightened anxiety and depression, according to a 2014 ATA survey of 1,100 people with tinnitus. Research indicates that those with tinnitus experience depression at rates more than twice the national average.
“We refer to it as the vicious cycle,” Wikoff explains. “First, you hear the tinnitus, which triggers anxiety, depression, and fatigue... and then the tinnitus worsens, because without enough sleep, we’re not able to manage it effectively the next day.”
Some research suggests that the connection between depression and tinnitus may not only be psychological but also physiological, stemming from a link between the auditory nerve and the limbic system, which governs our emotions, memory, and sleep. Therefore, any lifestyle changes that reduce stress could potentially help alleviate the effects of tinnitus.
Approaches Combining Multiple Disciplines
While many patients find relief with just devices or mental health therapies, Wikoff believes that a multidisciplinary approach is key for the most persistent cases of tinnitus.
One such method, Tinnitus Retraining Therapy (TRT), combines many of the same devices and mental health strategies used in traditional care. However, since it is based on the limbic system theory of tinnitus mentioned earlier, its goal is to neutralize our emotional responses to the sound, rather than masking it or simply learning to tolerate it.
When TRT is effective, individuals begin to perceive their tinnitus just like any other background noise (wind, birds, traffic, indoor and outdoor conversations)—sounds we naturally filter out as we go about our daily routines. Studies indicate that TRT performs as well or slightly better than traditional methods of care. Additionally, there are some experimental treatments currently being tested, such as non-invasive neuromodulators and electromagnetic stimulation targeting the brain and vagus nerve.
The choice of treatment ultimately depends on factors like budget, schedule, tinnitus severity, and others, says Wikoff. While many people anecdotally report improvement after undergoing some form of treatment—especially mental health therapy—there is relatively little clinical research on tinnitus, despite its widespread occurrence. Organizations like the American Tinnitus Association are working to change that.
How to Prevent Tinnitus from Developing in the First Place
The most reliable approach to addressing tinnitus is prevention. This truth holds for those who have never experienced tinnitus, as well as for those like me who suffer from temporary tinnitus and seek to avoid further damage to their hearing.
As a significant portion of tinnitus cases stem from exposure to loud noises, it’s vital to develop healthy hearing practices. This involves using hearing protection devices properly, ensuring that as little sound as possible escapes and causes damage.
It’s important for parents to introduce healthy listening habits to their children from a young age. Just as you regulate screen time, it’s essential to limit headphone usage whenever possible. A good guideline to follow is the 60-60 rule: 60 minutes of listening at no more than 60 percent of the maximum volume. If reducing headphone use is difficult, like during virtual learning, experts like Wikoff recommend investing in volume-limited headphones. For her own child, she prefers Puro Sound, a company known for creating high-quality, volume-limited headphones suitable for both kids and adults. They even offer specialized gaming headphones.
While many smartphones feature volume limiters, the standard earbuds that come with these devices often leak sound, leading us to increase the volume and raise the decibel levels entering our ears. It’s crucial to select headphones or earbuds that fit securely over, on, or in your ears. If you’re not keen on replacing your expensive earbuds, you can opt for custom sleeves, which typically cost between $100 and $200. These sleeves fit over your regular earbuds and help to seal in the sound.
For those who need to wear headphones for extended periods, or for audiophiles who are willing to invest in superior sound, in-ear monitors are the ideal choice. Prices range from $250 to $1,200, depending on whether you choose a standard or custom fit. If your profession involves music, theater, broadcasting, or any field where hearing is essential, investing in in-ear monitors could safeguard your career.
In fields like construction or motorsports, drugstore foam earplugs can provide excellent hearing protection—assuming they are inserted properly. The CDC offers an informative how-to guide that walks through each important step.
Those attending concerts can use concert ear plugs made specifically to safeguard your hearing while still allowing you to enjoy the music. However, even with earplugs, it's best to avoid standing too close to the speakers.
As an adult, make sure to get a hearing test to set a baseline for your hearing health
Hearing tests are often administered to children in elementary school, although the frequency and quality of these tests vary by state. However, once we move to middle school, we're typically responsible for monitoring our own hearing.
Even though the U.S. Preventive Services Task Force determined earlier this year that there is insufficient evidence to establish hearing screening guidelines for individuals over age 50, Wikoff emphasizes that we regularly test other senses. As she puts it, "Just like you clean your teeth twice a year [and] check your eyes annually," she said, "you should be checking your hearing."
Some primary care doctors may check your hearing during a physical, but many do not. A few affordable or free online hearing tests can provide a general sense of your hearing health: the $8 National Hearing Test (free for AARP members) and the free app hearScreenUSA.
Most insurance policies will cover an audiologist visit with a doctor's referral, and it's wise to schedule one after turning 18 to set a baseline. Research shows that many older adults fail to recognize the extent of their hearing loss, and Wikoff emphasizes that addressing it early helps slow its progression.
Wikoff advises adults over 40 to have their hearing checked every 1-2 years; some doctors suggest every 3-5 years. It's also recommended to get tested if you notice any of these signs of hearing loss:
Struggling to understand people during conversations and frequently asking them to repeat themselves
Increasing the volume on your electronic devices more than usual
Having difficulty hearing consonants
Perceiving speech as muffled
Keep the music going—just be a responsible listener
We’re exposed to more noise than ever, thanks to personal devices. The pandemic has made this issue worse, as many of us have been wearing headphones for hours each day to work or attend classes from home, often alongside family members or roommates.
So far, I’ve managed to avoid using headphones because I live in a relatively quiet home and usually walk in areas where my podcasts and music aren’t audible to neighbors. Eventually, though, I’ll encounter situations where headphones are simply the polite and respectful choice.
Since I already own AirPods, I’ll probably consider getting custom sleeves. I also want to have my hearing tested to assess how much hearing loss I’ve experienced. However, one thing I won’t do is give up the music and podcasts I enjoy.
“I don’t want anyone to stop enjoying music, especially after the difficult year and a half we’ve had,” Wikoff says. “Music is what connects us and provides an escape, [so] we should find ways to keep enjoying it while still protecting our hearing.”
