Tinnitus: causes, assessment and treatment
Buzzing, ringing or high-pitched sounds in the ears can interfere with sleep, concentration and social activities. At Charlottenlund Private Hospital, the cause of tinnitus is assessed through a hearing test and an examination by an ear, nose and throat specialist – and treatment is provided when an underlying treatable cause is identified.
Measurement of hearing and middle-ear function (tympanometry).
Medical history, examination of the ear canal and eardrum with a microscope, and assessment of the jaw, neck, blood pressure and blood vessels.
For unilateral or pulsatile tinnitus, referral for an MRI scan may be required.
Treatment of the underlying cause, hearing aids, counselling or psychological treatment, depending on the findings.
What symptoms can tinnitus cause?
Tinnitus can be experienced in different ways: as ringing or whistling in the ears, buzzing, humming, roaring or a pulsating sound.
What these symptoms have in common is that the sound does not come from an external source. It may affect one ear or both ears, be constant or come and go, and is often most noticeable in quiet surroundings, for example at bedtime.
A sudden high-pitched tone in the ear after exposure to loud noise usually subsides on its own within hours or days.
Tinnitus may be accompanied by hearing loss, sensitivity to sound, pressure in the ears, sleep problems and difficulty concentrating.
What can tinnitus be a sign of?
Tinnitus is most often a symptom of changes in the ear, such as exposure to loud noise, age-related hearing loss or damage to the middle or inner ear.
Up to 90% of people with tinnitus also have measurable hearing loss (Ugeskrift for Læger 2023).
Other causes of tinnitus include a build-up of earwax, eczema or inflammation of the ear canal, a perforated eardrum, chronic middle-ear infection, hardening of the middle-ear bones or disorders affecting the balance and hearing nerve.
Certain medicines can trigger or worsen tinnitus.
In many cases, no single cause can be identified, and tinnitus can occur even when hearing is not measurably reduced.
Can tension in the jaw and neck cause tinnitus?
Yes. In so-called somatic tinnitus, the sound may be affected by movement or pressure involving the jaw, neck or shoulders – for example, it may change in volume or pitch when you clench your teeth or turn your head.
Stress and muscle tension are rarely the underlying cause of tinnitus, but they can make the sound feel more noticeable.
During the initial assessment at Charlottenlund Private Hospital, all possible contributing factors are considered – including the jaw joint, neck and blood vessels – so treatment can be directed at what is actually contributing to the tinnitus.
– around one in six adults. Up to half experience that the sound becomes less noticeable over time.
Sources: Danish National Health Profile 2021; Ugeskrift for Læger 2023
Why can you hear your pulse in your ear?
A rhythmic sound that follows the heartbeat is called pulsatile, or pulse-synchronous, tinnitus.
In some cases, the sound can also be heard by another person, for example by a doctor using a stethoscope. This is called objective tinnitus and occurs in up to 10% of people seeking treatment for tinnitus (Ugeskrift for Læger 2023).
The sound is often more noticeable when lying down, at night or during physical exertion.
What can pulsatile tinnitus be a sign of?
Unlike ordinary tinnitus, pulsatile tinnitus is more likely to have an identifiable cause.
The most common causes are harmless, such as earwax pressing against the eardrum, tension in the neck and chewing muscles or high blood pressure that makes blood flow more audible.
Other causes include narrowing or irregularities in blood vessels close to the ear, conditions associated with increased blood flow such as anaemia or pregnancy, and, rarely, a benign vascular tumour in the middle ear.
Is pulsatile tinnitus dangerous?
In most cases, no – but because a treatable underlying cause may be responsible, pulsatile tinnitus should always be assessed (Ugeskrift for Læger 2023).
During the initial examination at Charlottenlund Private Hospital, the specialist listens for the sound around the ear, skull and blood vessels in the neck, measures blood pressure and, if necessary, refers the patient for an MRI scan of the blood vessels around the ear.
If a cause is identified, it is treated. If no cause is found, sound therapy and cognitive behavioural therapy can help the brain shift the sound into the background.
How is tinnitus assessed?
The assessment begins with a hearing test followed by an examination by a specialist in ear, nose and throat conditions.
The specialist reviews the medical history and examines the ear canal and eardrum with an otoscope or microscope, together with measurement of middle-ear function using tympanometry.
The jaw joint, neck, blood pressure and blood vessels in the neck are also assessed when relevant.
For persistent tinnitus affecting only one ear, referral for an MRI scan is often recommended because, in rare cases, unilateral tinnitus can be the first sign of a benign tumour on the hearing nerve, known as a vestibular schwannoma.
If tinnitus is accompanied by dizziness or pressure in the ears, the balance organ and Eustachian tube are also assessed.
How is tinnitus treated?
There is no medication or operation that can eliminate chronic tinnitus (Ugeskrift for Læger 2023).
Treatment therefore focuses on three areas: the underlying cause, hearing and the brain’s response to the sound.
If tinnitus is caused by a build-up of earwax, inflammation of the ear canal, a perforated eardrum or chronic middle-ear infection, the tinnitus may disappear completely when the underlying condition is treated.
If hearing loss is also present, a hearing aid is often the most effective treatment. By amplifying surrounding sounds, the hearing aid can make tinnitus less noticeable.
Hearing aids are fitted at the hospital’s hearing clinic.
Sound therapy – using gentle background sound to reduce the contrast between tinnitus and the surrounding environment – works on the same principle and is often combined with counselling to help the brain learn to pay less attention to the sound.
Cognitive behavioural therapy helps change thought patterns that make tinnitus distressing and is provided by the hospital’s psychology department.
According to Ugeskrift for Læger (2023), counselling, sound therapy and cognitive behavioural therapy are the main forms of treatment.
Patients may also be referred to municipal communication centres, which offer counselling on living with tinnitus.
There is no documented evidence of benefit from dietary supplements, acupuncture or electrical nerve stimulation (Ugeskrift for Læger 2023).
What can you do yourself about tinnitus?
Silence can make tinnitus more noticeable. Quiet music, a fan or nature sounds in the background can be particularly helpful at bedtime.
Hearing protection should be used around loud sounds to protect hearing, but the ears should not be overprotected in normal everyday environments, as this may increase sound sensitivity.
Good sleep, exercise and reducing stress, caffeine and alcohol can reduce symptoms for many people.
Understanding what tinnitus is – and what it is not – is also an important part of treatment.
Can tinnitus go away?
Yes. Tinnitus may disappear if it is caused by a temporary or treatable condition, such as a build-up of earwax, a middle-ear infection or exposure to loud noise.
For persistent tinnitus, there is no treatment that can reliably remove the sound completely, but up to half of people experience that it becomes less noticeable over time (Ugeskrift for Læger 2023).
Most people eventually find that the brain becomes accustomed to the sound so that it takes up less attention.
Treatment and counselling can support this process of habituation.
When should you see a doctor about tinnitus?
You should see a doctor if tinnitus has developed recently and does not disappear within a few weeks, if it affects sleep, concentration or mood, or if it occurs together with hearing loss, ear pain or dizziness.
Pulsatile tinnitus and tinnitus affecting only one ear should always be assessed.
If tinnitus appears suddenly together with significant hearing loss, you should seek medical attention the same day.
Tinnitus assessment at Charlottenlund Private Hospital
The initial assessment takes place at the main department in Charlottenlund, north of Copenhagen, or at the hospital’s clinics at several locations across Denmark.
The assessment is carried out by specialists in ear, nose and throat conditions. The hospital’s ENT department has also published on pulsatile tinnitus in Ugeskrift for Læger.
Hearing aids, psychological treatment and any further referrals can be arranged as part of the same treatment pathway.
Referral and payment
Most patients come through health insurance. Insurance companies typically require a referral from your GP and prior approval.
As a self-paying patient, no referral is required. Prices are available in the price list or by calling 44 98 19 21.
Frequently asked questions
What is tinnitus?
Tinnitus (ringing in the ears) is a sound in the ear or head with no external source – typically buzzing, ringing or a high-pitched tone. About one in six Danish adults has tinnitus.
Is pulsatile tinnitus dangerous?
Rarely. The most common causes are earwax, muscle tension and high blood pressure. But because the cause can often be treated – and is rarely a vascular abnormality or a benign vascular tumour – pulsatile tinnitus should always be assessed by an ENT specialist.
Can tinnitus go away?
Yes, if the cause is temporary or treatable – for example, earwax, a middle ear infection or exposure to a loud noise. Chronic tinnitus rarely disappears completely, but up to half of people find that the sound diminishes over time, and treatment can make it less distressing.
What helps with tinnitus?
Counselling, sound therapy and cognitive behavioural therapy are key treatments. If you also have hearing loss, a hearing aid can make the sound less noticeable.
Can earwax cause tinnitus? – Yes, a plug of earwax can cause tinnitus, which often disappears once a doctor removes the blockage.
Is tinnitus caused by stress?
Stress is rarely the underlying cause, but stress and tension in the jaw and neck can make the sound more noticeable (somatic tinnitus). This is assessed at the initial consultation..
Is there medication for tinnitus?
No. There is no medication that eliminates tinnitus, and there is no evidence that dietary supplements or acupuncture are effective. In some cases, medication can treat the underlying cause, such as high blood pressure.
Why can I hear my pulse in my ear when I lie down?
When you lie down, your surroundings are quiet and blood flow in your head changes, making the pulse sound from the vessels near your ear more noticeable. You should have the sound assessed if it is new, affects only one ear, or is accompanied by dizziness or a headache.
Do I need a referral for a tinnitus assessment?
If you are self-paying, no referral is required. Health insurance policies typically require a referral from your GP and prior authorisation.
Do hearing aids help with tinnitus?
Yes. If you also have hearing loss, a hearing aid is often the most effective treatment, as it amplifies the sounds around you and helps mask the tinnitus. Hearing aids are fitted at the hospital’s hearing clinic.
Can tinnitus be a symptom of high blood pressure?
Yes. High blood pressure increases the force of blood flow and can make your pulse audible in your ear. Your blood pressure is therefore measured at the initial consultation, and treating high blood pressure often reduces the sound.