# What tinnitus is, and what the evidence says about treating it

Canonical: https://romeoapps.app/en/tacet/what-is-tinnitus/
Author: Roméo Gambino · Published: 2026-09-09 · Updated: 2026-09-09 · App: Tacet (https://romeoapps.app/en/tacet/)

A plain account of ringing in the ears: what causes it, what the guidelines recommend, and which treatments have evidence behind them.

## A symptom, not a disease

Tinnitus is the perception of sound with no external source, most often a ring, a hiss or a buzz. It is a symptom rather than a disease, and the 2013 Lancet review describes it as common, usually associated with some degree of hearing loss, and only distressing for a minority of the people who have it. That last point matters: the same sound can be a background curiosity for one person and a daily burden for another, and what changes is largely the reaction, not the volume.


## What causes it

The most frequent association is hearing loss, including the kind that does not show up in ordinary conversation. Loud noise exposure, ear infections, earwax, some medicines and head or neck injuries are also recognised triggers. Occasionally tinnitus is pulsatile, beating in time with your heart, or one-sided with hearing loss; both of those warrant a medical assessment rather than self-management, and the American clinical practice guideline names them as prompts for referral.


## What actually helps, in order of evidence

Cognitive behavioural therapy has the strongest evidence: the Cochrane review found it improves tinnitus-related quality of life and reduces associated depression and anxiety, without changing the loudness of the sound itself. Sound therapy, meaning devices or generators that add background sound, is widely used and the Cochrane review found no strong evidence that it is better or worse than other approaches. Hearing aids help when there is co-existing hearing loss, though the evidence base there is thin.

Evidence for common tinnitus approaches

| Approach | What the evidence shows |
| --- | --- |
| Cognitive behavioural therapy | Improves tinnitus-related quality of life; loudness unchanged |
| Sound therapy | No strong evidence of superiority or inferiority to other options |
| Hearing aids with hearing loss | Used routinely; limited trial evidence |
| Medication for tinnitus itself | Guideline recommends against routine use |
| Dietary supplements | Guideline recommends against routine use |


## What the guidelines say not to do

The American guideline recommends against routine medication for persistent bothersome tinnitus: no antidepressant, anticonvulsant, anxiolytic or intratympanic drug has demonstrated benefit for the tinnitus itself. It also recommends against routine dietary supplements, including ginkgo biloba, melatonin and zinc. That is a useful filter for the many products marketed to people who are desperate for relief.


## Why habituation is the realistic goal

Most approaches that work do so by changing your relationship with the sound rather than removing it. This is what clinicians mean by habituation: the brain learns to stop treating the signal as important, and it fades into the background the way traffic noise does after a week in a new flat. It is slow, it is not the same as ignoring, and it is far more achievable than silence.


## When to see a doctor

Ask for an appointment if the tinnitus is one-sided, pulsatile, sudden, associated with hearing loss or dizziness, or if it is causing enough distress to affect your sleep or mood. A hearing test is the standard first step. Tinnitus that has been present for years is still worth assessing once, and the European multidisciplinary guideline sets out how assessment and stepped care are meant to work.


## Questions

### Is tinnitus curable?

For most people there is no cure that removes the sound. What is achievable is habituation, where the brain stops treating the sound as important. Cognitive behavioural therapy has the best evidence for reducing the distress it causes.

### Do supplements like ginkgo help tinnitus?

The American clinical practice guideline recommends against routine dietary supplements for persistent bothersome tinnitus, including ginkgo biloba, melatonin and zinc.

### When should tinnitus be checked by a doctor?

If it is one-sided, pulsatile, sudden, or comes with hearing loss or dizziness, and whenever it disturbs your sleep or mood. A hearing test is the usual first step.

## Further reading

- Baguley, McFerran & Hall (2013), Tinnitus, The Lancet — https://doi.org/10.1016/S0140-6736(13)60142-7
- Tunkel et al. (2014), Clinical Practice Guideline: Tinnitus, Otolaryngology–Head and Neck Surgery — https://doi.org/10.1177/0194599814545325
- Fuller et al. (2020), Cognitive behavioural therapy for tinnitus, Cochrane Database of Systematic Reviews — https://doi.org/10.1002/14651858.CD012614.pub2
- Sereda et al. (2018), Sound therapy (using amplification devices and/or sound generators) for tinnitus, Cochrane Database of Systematic Reviews — https://doi.org/10.1002/14651858.CD013094.pub2
- Cima et al. (2019), A multidisciplinary European guideline for tinnitus: diagnostics, assessment, and treatment, HNO — https://doi.org/10.1007/s00106-019-0633-7