Tinnitus

What is Tinnitus?

Tinnitus is the perception of a sound when there is no matching sound outside the body. It is a symptom, not a disease, and it is common in primary care.^{[1, 2]}

Common symptoms

Most people describe ringing, but the sound can also be buzzing, hissing, clicking or roaring, in one ear, both ears or the head. Most tinnitus is subjective, meaning only the person can hear it.^[2]

• Persistent sound that may be constant or come and go
• Trouble hearing, especially in noise
• Poor sleep, stress, anxiety or low mood from the noise^{[3, 4]}

Tinnitus that is pulsing in time with the heartbeat, or heard in only one ear, needs medical assessment.^[1]

Causes and risk factors

Most tinnitus is benign, has no single identifiable cause and is strongly linked to sensorineural hearing loss.^[1] Other risk factors include medicines that can harm the ear, head injury and depression.^[3] Noise exposure may contribute, and avoiding loud noise may help prevent it.^[1]

Less often, tinnitus has a treatable cause such as a vascular problem, jaw joint disease, a middle ear muscle spasm or a tumor on the hearing nerve.^{[1, 2]}

How it is diagnosed and treated conventionally

Evaluation begins with a targeted history and ear examination. An audiology (hearing) test is advised for tinnitus in one ear, tinnitus lasting six months or more, or tinnitus with hearing difficulty.^{[1, 5]} Imaging is not routine unless the tinnitus is one-sided, pulsing, or comes with nerve symptoms or uneven hearing loss.^[1]

There is no widely effective drug for tinnitus.^[3] Guidelines recommend hearing aids when hearing loss is present and cognitive behavioral therapy (CBT) for persistent, bothersome tinnitus. Sound therapy is an option.^[5] Reviews find CBT has the most robust evidence of any approach.^{[4, 6]}

Why Tinnitus calls for a whole-person approach

Tinnitus distress depends on more than the sound itself. Reviews describe it as a mix of physical and psychological processes, and reducing the psychological part reduces suffering.^[6]

Care that also addresses stress, sleep and mood is therefore a reasonable addition to ear and hearing care.

Hearing loss

Hearing loss is the most common association, and hearing aids are recommended when it is present, even if mild.^{[3, 5]} Any complementary care should sit alongside a proper hearing test.

Stress, anxiety and mood

Anxiety and depression are often present and should be considered when you are assessed for tinnitus.^[3] A German guideline review notes that the mental distress caused by the noise is a crucial element of chronic tinnitus.^[4]

Sleep

Sleep trouble is common with tinnitus. Melatonin and antidepressants may help with sleep and mood problems respectively, according to one primary care review, although they do not treat the tinnitus itself.^[1]

Acupuncture for Tinnitus

What the research shows

Acupuncture has been studied for tinnitus in many trials, but the evidence is low quality and mixed, so it should be seen as unproven. A 2023 meta-analysis of 34 trials with 3,086 people found that acupuncture and moxibustion lowered tinnitus handicap scores compared with controls, and the authors called the evidence low quality with considerable differences between trials.^[7]

A 2021 meta-analysis of eight trials with 504 people found no significant difference in tinnitus loudness scores but better handicap and severity scores. The authors concluded the evidence was insufficient for firm conclusions.^[8] An earlier review noted that nearly all Chinese studies were positive while most English-language studies were negative, and that many trials had methodological flaws.^[9] A review of five electroacupuncture trials found no convincing evidence of benefit because of poor study quality.^[10]

Sham-controlled trials are small. In a trial of 50 people, manual and electroacupuncture did not differ significantly from placebo needling.^[11] In a pilot trial of 33 people, real acupuncture did not differ from sham on most measures.^[12] A 2025 trial in Hong Kong of 90 adults aged 50 to 70 found electroacupuncture reduced loudness and distress compared with a waitlist, which does not control for the effect of simply receiving treatment.^[13]

The 2014 US clinical practice guideline made no recommendation for or against acupuncture for persistent, bothersome tinnitus.^[5]

How acupuncture may work

The mechanism is unknown. One review summarizes proposed explanations for how acupuncture might affect tinnitus, but it also notes that the causes and mechanisms of tinnitus itself are unclear.^[14] Any benefit may relate partly to relaxation and the treatment experience.

What treatment involves

Treatment uses fine, sterile, single-use needles at points on the head, around the ears, neck, hands and legs, usually left in place for about 20 to 40 minutes. Two sham-controlled trials used 6 and 10 sessions, once or twice a week.^{[11, 12]} We reassess after a short course of visits to see whether treatment is helping.

Serious problems from acupuncture are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as brief bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[15] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture).

Ayurvedic medicine for Tinnitus

The Ayurvedic view

In Ayurveda, tinnitus is described as Karnanada or Karnakshweda, a disorder of the ear in which the sound is linked to aggravated Vata, the principle said to govern movement and the nervous system. This is a traditional framework for choosing treatment, not a biomedical diagnosis.

Therapies that may be used

Care is chosen for the individual and traditionally combines:

• Regular meals, steady sleep hours and stress-calming routines
• Gentle oil massage of the head and neck, and warm oil applied to the scalp (Shirodhara)
• Yoga, breathing practices and meditation
• Individually prescribed herbs, discussed below under herbal medicine

Panchakarma is not appropriate during pregnancy, acute illness or frailty, and is used only when a medically sensible reason exists. Ear drops or oils should not be used in the ear unless a doctor has confirmed the eardrum is intact. About one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic, so sourcing matters.^[16]

What the research shows

No clinical trials of Ayurvedic herbal formulas, Shirodhara or Panchakarma for tinnitus were found in a PubMed search, so there is no evidence on whether they help.

The closest research is on yoga, a companion practice. One small uncontrolled study of 12 people with chronic tinnitus who practiced yoga for three months reported lower stress, handicap and severity scores. With no control group and so few people, it cannot show that yoga caused the change.^[17]

Herbal medicine for Tinnitus

Herbs and formulas that have been studied

Ginkgo biloba is an herb that has been tested in randomized trials for tinnitus.^[18] Chinese herbal formulas are also traditionally used, often chosen according to patterns such as kidney deficiency or liver fire, but no clinical trials of them for tinnitus turned up in our search.

Transdermal medication therapy, herbal preparations applied to the skin, is offered at the clinic, but we found no trials of it for tinnitus.

What the research shows

The evidence is limited. A review of three systematic reviews covering four randomized trials concluded that ginkgo probably does not reduce tinnitus severity or intensity or improve quality of life.^[18] The US guideline recommends against ginkgo biloba and other dietary supplements for persistent, bothersome tinnitus.^[5]

A general review of alternative treatments describes research as scarce and inconclusive, with some studies pointing toward positive effects of herbal remedies and acupuncture, and inconsistent results.^[19]

Safety and herb-drug interactions

Herbs are active substances and can interact with medicines. Case reports describe serious problems, including bleeding, when warfarin was combined with herbs including ginkgo, dang gui (Angelica sinensis), dan shen (Salvia miltiorrhiza), ginger, ginseng and Boswellia.^[20] People taking blood thinners need a practitioner's review before using any herb.

Herbs should come from tested sources and be prescribed individually. Tell us if you are pregnant or breastfeeding, or have liver or kidney disease.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine often links tinnitus to kidney deficiency, rising liver fire or phlegm, depending on the pattern. Researchers have proposed biological explanations for acupuncture in tinnitus, but these are not settled and tinnitus mechanisms remain unclear.^[14]

Ayurveda's aggravated Vata describes restlessness and disturbed sleep. It loosely echoes the link between stress, poor sleep and tinnitus distress studied in modern research.^{[3, 6]} No study has shown that a dosha or a pattern corresponds to a specific biological process.

How this care fits with your medical care

Integrative care for tinnitus is complementary. Keep your primary care physician, ear, nose and throat specialist and audiologist, and do not stop or change prescribed medicines without talking to your prescriber. Hearing aids and CBT have the strongest support for persistent tinnitus.^{[5, 6]}

We do not diagnose the cause of tinnitus. Tinnitus in one ear, tinnitus that pulses, or new hearing loss should be medically evaluated before complementary care begins.^[1] Please bring your diagnosis, hearing test results, any imaging reports, and a full list of medicines and supplements.

When to seek urgent medical care

Some tinnitus points to a serious cause and needs prompt medical assessment.^[1]

• Sudden hearing loss in one or both ears
• Tinnitus in one ear only, or a one-sided drop in hearing
• A pulsing sound that beats with your heartbeat
• Tinnitus with dizziness, facial weakness, numbness, vision change or trouble speaking
• Tinnitus after a head injury or with severe headache
• Ear pain, discharge or fever with the ringing

If any of these occur, call 911 or go to the nearest emergency department.