Tinnitus: causes, diagnosis & what really helps with ringing in the ears

At a glance

FrequencyIn Germany, estimates suggest millions of people develop tinnitus each year; in a relevant share it becomes chronic
DefinitionChronic tinnitus = ear noises that have lasted at least three months and are distressing to the affected person
Not dangerousTinnitus is usually not a sign of a dangerous condition — but it can considerably impair quality of life
TreatmentCounselling, CBT, hearing aids, self-help — no medication with proven efficacy against chronic tinnitus
GuidelineS3 guideline Chronic Tinnitus (DGHNO-KHC, AWMF 017-064, updated 2021)
ICD-10H93.1 (tinnitus)

Table of contents

  1. What is tinnitus?
  2. Causes
  3. Symptoms and distress
  4. Diagnosis
  5. Treatment: what helps
  6. Treatment: what is NOT recommended
  7. Everyday life with tinnitus
  8. How brite helps you
  9. FAQ
  10. Related topics

1. What is tinnitus?

Tinnitus is the perception of sounds in the ear or head without any external sound source — beeping, whistling, rushing, humming or ringing. Almost everyone occasionally experiences brief tinnitus — that is normal and usually harmless.¹

It becomes a problem when the tinnitus no longer fades. It is considered chronic when it has lasted at least three months and is distressing to the affected person. The distress is highly individual — some people can ignore their tinnitus well, others suffer considerably from sleep disorders, concentration problems, anxiety or depression.¹,²

Tinnitus is usually not a dangerous sign The vast majority of cases are benign. Even so, an evaluation should be done to rule out treatable causes.

2. Causes

Tinnitus is a symptom, not a disease in its own right. The causes are diverse.¹

Hearing loss
The most common cause. Tinnitus almost always occurs together with a reduction in hearing — even if this has not yet been noticed. The tinnitus frequency usually lies in the range of the greatest hearing loss.
Noise damage
Noise exposure (e.g. concerts, occupational noise, headphones at high volume) can trigger both acute and chronic tinnitus.
Sudden hearing loss
Sudden one-sided hearing loss (sudden sensorineural hearing loss), often associated with tinnitus.
Ear conditions
Middle ear infection, earwax plug, otosclerosis.
Stress and psychological strain
Stress does not directly cause tinnitus, but it can considerably amplify the perception and distress. Depression and anxiety disorders frequently occur together with distressing tinnitus.
Jaw joint and cervical spine
Dysfunction of the jaw joint (temporomandibular disorder, TMD/CMD) or tension in the area of the cervical spine can trigger or amplify tinnitus.
Medications (ototoxic)
Certain medications can trigger tinnitus as a side effect — including certain antibiotics, NSAIDs in high doses, loop diuretics, chemotherapeutic agents.
Rare, but important: pulsatile tinnitus Acoustic neuroma (a benign tumour of the auditory nerve, also called vestibular schwannoma) and vascular anomalies (pulsatile tinnitus) are rare but important differential diagnoses. Pulsatile tinnitus (in sync with the heartbeat) should always be evaluated.

3. Symptoms and distress

Forms of tinnitus

  • One-sided or both-sided
  • Various sound characters: beeping, whistling, rushing, humming, ringing, chirping
  • Tonal tinnitus (a single tone) or rushing tinnitus
  • Pulsatile tinnitus (in sync with the heartbeat) — should always be evaluated

Accompanying complaints

Distress > loudness The guideline emphasizes: the distress caused by tinnitus depends less on the loudness of the noise than on the psychological processing and the accompanying comorbidities.¹

4. Diagnosis

  • ENT examination: otoscopy (looking into the ear), hearing test (audiogram). A hearing loss is usually found in chronic tinnitus.
  • Tinnitus questionnaire: standardized questionnaires (e.g. the Tinnitus Questionnaire by Göbel and Hiller, and the THI) capture the severity of the distress and help with treatment planning.
  • Tinnitus matching: determining the tinnitus frequency and loudness — can be helpful for treatment.
  • Evaluation of comorbidities: depression, anxiety disorders, sleep disorders, jaw joint problems, cervical spine problems.
  • Imaging: usually only for one-sided tinnitus (to rule out acoustic neuroma) or for pulsatile tinnitus (vascular evaluation). Not routinely necessary.

More: Preparing for a doctor's appointment.

5. Treatment: what helps

According to current knowledge, there is no medication that can cure chronic tinnitus. Treatment aims to reduce the distress and improve quality of life. The S3 guideline (DGHNO-KHC, 2021) recommends:¹

Foundation Counselling (tinnitus counselling)
Structured counselling
Those affected receive understandable information about how tinnitus arises and what it means. Aim: reducing fear and catastrophizing, and building a constructive way of dealing with the noise.
First line Cognitive behavioural therapy (CBT)
Most effective therapy for distressing chronic tinnitus
The best-studied therapy. Can demonstrably reduce tinnitus distress, sleep disorders, anxiety and depression. It is recommended by the guideline.¹
Recommended Hearing aids and cochlear implant
Hearing aids
With co-existing hearing loss — they improve hearing and can reduce the perception of tinnitus. They are recommended by the guideline.
Cochlear implant (CI)
With profound hearing loss and tinnitus, a CI can improve both hearing and the tinnitus.
Supplementary Self-help and background sounds
Self-help
The German Tinnitus League (Deutsche Tinnitus-Liga e. V., DTL) offers counselling and self-help groups. The guideline explicitly recommends taking part in self-help groups.
Background sounds
Quiet music, nature sounds or noise generators can help push the tinnitus into the background — especially when falling asleep.

6. Treatment: what is NOT recommended

The guideline explicitly lists procedures and substances that are NOT recommended for chronic tinnitus, because the evidence is lacking or side effects outweigh the benefits.¹

What the guideline explicitly does NOT recommend Ginkgo preparations · betahistine · zinc, melatonin and other dietary supplements · transcranial electrical and magnetic stimulation · invasive vagus nerve stimulation · notched-music apps and other acoustic neuromodulation procedures · medications in general — by current standards there is no approved medication against chronic tinnitus.
Beware of dubious promises of a cure There are numerous products and therapies that promise a cure for tinnitus. The guideline recommends sticking to the evidence-based therapies and critically questioning dubious promises of a cure.

7. Everyday life with tinnitus

  • Acceptance: the tinnitus is there — but the way you cope with it can improve. Over time, many people learn to notice the noise less (habituation).
  • Sleep: background sounds can make falling asleep easier. Good sleep hygiene is important. More: Sleep disorders.
  • Stress: stress amplifies the perception of tinnitus. Relaxation techniques (progressive muscle relaxation, mindfulness) can help.
  • Noise protection: avoid noise exposure, wear hearing protection at concerts or during loud work. But: excessive noise protection (e.g. wearing earplugs permanently in a normal environment) can amplify the perception of tinnitus.
  • Treat hearing loss: if there is a hearing loss, it should be treated (hearing aids). This not only improves hearing but can also relieve the tinnitus.

How brite helps you with tinnitus

There is no medication against chronic tinnitus — but medications can amplify the tinnitus or contribute to accompanying sleep disorders, anxiety and depression. This is exactly where brite comes in: making ototoxic medications visible and keeping accompanying therapies on track.

  • Medication reminder — take medications for the common accompanying conditions on time: antidepressants (e.g. for accompanying depression), sleep medications (short-term for trouble falling asleep), CBT homework during therapy. brite reminds you reliably. Set up a reminder
  • Interaction check — ototoxic medications are a real, often overlooked amplifier: certain antibiotics (aminoglycosides), NSAIDs in high doses (ibuprofen, ASA), loop diuretics (furosemide), chemotherapeutic agents (cisplatin). brite shows which medications can trigger or amplify tinnitus. Check now
  • Health history — document tinnitus distress (on a simple scale), sleep quality and mood over time. This self-observation is the basis of every CBT — and at your next ENT or psychotherapy appointment it provides the real course rather than a vague memory. Track your history
  • Digital medication plan — all your medications clearly laid out for ENT, psychotherapy and family doctor. Tinnitus treatment is usually multidisciplinary — a single medication plan shared across all your providers prevents prescribing errors. Go to medication plan
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FAQ: Common questions about tinnitus

Acute tinnitus fades on its own in many cases — especially when it was triggered by noise, stress or a sudden hearing loss. Chronic tinnitus (over three months) usually persists, but the distress can decrease considerably over time and with suitable therapy (habituation).¹
No — the S3 guideline explicitly does NOT recommend Ginkgo preparations for chronic tinnitus. Studies could not demonstrate any efficacy.¹
According to current knowledge, there is no approved medication that can cure chronic tinnitus or reliably relieve it. Medications can, however, be useful for accompanying conditions (depression, anxiety, sleep disorders).¹
A structured, understandable consultation about how tinnitus arises and what it means. Aim: reducing fear and building a constructive way of dealing with the noise. Counselling is the foundation of every tinnitus therapy and is recommended by the guideline.¹
Yes — cognitive behavioural therapy is the best-studied therapy for distressing chronic tinnitus. It can demonstrably reduce the distress caused by the tinnitus, sleep disorders and depressive symptoms.¹
Always. Pulsatile tinnitus (in sync with the heartbeat) can indicate a vascular anomaly and should usually be evaluated promptly with imaging (MRI/MRA or CT angiography).
Usually no — on the contrary. With tinnitus and co-existing hearing loss, hearing aids improve hearing and can reduce the perception of tinnitus. The guideline recommends fitting hearing aids for tinnitus with hearing loss.¹
The German Tinnitus League (Deutsche Tinnitus-Liga e. V., DTL) offers counselling and self-help groups. Specialized ENT practices, tinnitus centres and psychotherapists experienced in tinnitus CBT are further points of contact.

10. Related topics

Sleep disorders Depression Drug interactions Dietary supplements Side effects Stopping medications

Sources

  1. S3-Leitlinie Chronischer Tinnitus (DGHNO-KHC, AWMF Reg-Nr. 017-064, aktualisiert 2021). awmf.org
  2. gesundheitsinformation.de (IQWiG): Tinnitus. gesundheitsinformation.de
  3. Deutsche Tinnitus-Liga e. V. (DTL). tinnitus-liga.de
  4. Charité Tinnituszentrum. tinnituszentrum.charite.de
Medical disclaimer: This article is for general information and does not replace medical advice, diagnosis or treatment. In the case of sudden hearing loss, an ENT examination should be carried out promptly. Pulsatile tinnitus should always be evaluated. Ototoxic medications should not be stopped on your own. Last updated: April 2026.