At some point in their lives, many people experience a ringing, buzzing, hissing or other similar sound in their ears that isn’t audible to anyone else. This is called tinnitus, and it’s one of the most common clinical conditions in the United States.

The American Tinnitus Association reports that approximately 50 million people suffer from tinnitus. For most people, tinnitus is transient and minimally bothersome, but 20 million people will be so bothered by the condition that they will seek medical advice. Some of these patients may turn to tinnitus retraining therapy (TRT), which targets both the neural and perceptual (psychological) aspects of chronic tinnitus.

While it’s difficult to determine all tinnitus causes, the most common one is noise exposure, such as listening to loud music or being around explosions or firearms. In these cases, tinnitus may occur with or without hearing loss.

Other possible causes of tinnitus include impacted earwax, high doses of aspirin, certain antibiotics, jaw misalignment, Ménière’s disease (a disorder of the inner ear that can affect hearing and balance), head injury or, in rare cases, a tumor on the auditory nerve (which carries signals from the inner ear to the brain).

Some tinnitus or perceived noise is normal. For example, in a soundproof booth a person would likely become more aware of these “head sounds” because they aren’t drowned out by outside noises. For this reason, these sounds are more evident during an ear infection or when fluids block the ear canal and muffle outside noises.

Someone experiencing “pulsatile tinnitus,” when the sound is like a pulse or heartbeat in the ear, may have a vascular or middle-ear issue and should see an audiology specialist as well as an ear, nose and throat specialist. Someone experiencing tinnitus that isn’t pulsatile, or is related to sudden hearing loss or impacted earwax, should see an audiology specialist who can help determine the cause and arrange referrals as needed.

In some cases, the condition may have an important perceptual or psychological component. Chronic tinnitus may lead to depression, anxiety and insomnia in some patients. In these situations, TRT or a variation of this therapy may provide the best results.

The goal of TRT is habituation, or a change in the patient’s perception of tinnitus at both a conscious and subconscious level. This treatment targets both the neural and perceptual components of tinnitus through use of sound generators and directive counseling.

During TRT, a patient receives a tinnitus assessment, counseling and treatment using U.S. Food and Drug Administration-approved devices. These devices may include ear-level amplification, sound generators or units providing a combination of these approaches. TRT is a months-long process that includes the use of these devices in combination with counseling.

Tinnitus is a very common condition, and its causes and symptoms are wide-ranging. In some cases, the condition can be chronic and uncomfortable. If you’re experiencing bothersome tinnitus, please talk to your primary care physician or an audiologist who specializes in tinnitus management.

For more information, visit the American Tinnitus Association at www.ata.org or the Tinnitus Practitioners Association at www.tinnituspractitioners.com.

Amy Nelson is a doctor of audiology at the Palo Alto Medical Foundation. For more information, visit pamf.org.

The Palo Alto Medical Foundation and column editor Arian Dasmalchi provide this monthly column.

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