Most of us take the sound of silence for granted.

Except for the millions of American afflicted with tinnitus. For them, the absence of noise is an elusive experience, though hearing experts say there are many ways to cope with tinnitus until a cure is found.

We talked with Cory Portnuff, an audiologist at the UCHealth Hearing and Balance Clinic on the Anschutz Medical Campus for clues about to deal with this frustrating malady.

“Tinnitus is a sound you hear that is not present in the room. It’s incredibly common, with one in six people experiencing it,” he said.

Some estimates put the number of people in the United States dealing with tinnitus at as many as 50 million.

Who suffers from tinnitus?

While tinnitus can occur at any time in a person’s life, it usually begins when people are in their 50s or 60s.

Researchers think that about 8 percent of children have it as well. It affects males and females equally, although in the past more men than women, because a higher number were employed in occupations and industries where they were exposed to loud noise.

What does tinnitus sound like?

Tinnitus can take many forms. The most common sounds include a buzzing, hissing or ringing in both ears. A less common version is known as pulsatile tinnitus. This version sounds like a throbbing heartbeat in the ear, can occur in one ear and can be more dangerous.

What causes tinnitus?

For those who remember stereos, Portnuff wants you to recall cranking up the volume without putting music on and hearing some electrical noise. In a sense, that’s what is happening for people with tinnitus.

“Think about tinnitus as overactive neurons in the brain. Tinnitus is actually happening in the brain — not the ears. It’s the brain’s reaction to changes in, and a loss of, hearing. In many cases, what we see is the brain trying to turn up the volume when it is not getting enough sound from the ear. In essence, you’re hearing your brain working. Tinnitus is the low level of neuron activity that you’re not supposed to be hearing, but you are.”

How long will I have tinnitus? 

Tinnitus is often accompanied with some level of hearing loss. That’s typically when people notice the onset of tinnitus. And what that happens, the condition is typically a permanent condition. Those who develop a sudden onset of tinnitus without a change in hearing have a good chance it will go away on its own.

How is tinnitus connected with hearing loss?

There are many potential causes for tinnitus, the main one being loss of hearing.

“Tinnitus is strongly associated with hearing loss, but that is because we lose hearing as we age. Tinnitus, itself, does not cause hearing loss,” said Portnuff, who is also a clinical audiologist at UCHealth University of Colorado Hospital and an assistant clinical professor at the University of Colorado School of Medicine.

Some other more rare causes for tinnitus include:

• Damage to the ear
• Genetics
• Diseases in the ear

Will my hearing get worse if I have tinnitus?

“As I mentioned before, tinnitus doesn’t affect your hearing. It usually is the brain’s response to your loss of hearing and trying to improve it.”

So, no, the tinnitus, itself, won’t cause hearing to decline although that may happen with age or for other reasons.

Tinnitus generally doesn’t worsen over time but remains at a consistent level even as a person’s hearing may decline.

For people who experience tinnitus for other reasons, specific triggers may temporarily exacerbate the condition.

Does tinnitus mean I’m sick?

Tinnitus is a symptom rather than a disease, Portnuff said. And while it is always worth learning more about the condition if you have it, in general tinnitus in both ears is not a sign of other illnesses.

Are there different types of tinnitus?

Yes, there are various types of tinnitus, including the most common type that sounds like ringing in both ears. There’s another type of tinnitus called pulsatile tinnitus.

Pulsatile tinnitus is a rare and specific type of tinnitus where a person hears a rhythmic whooshing, throbbing or beating sound, sometimes in both ears but usually in just one ear.

Since there can be underlying reasons for pulsatile tinnitus, people who hear rhythmic sounds in one or both ears need to see their health provider right away in case they have a serious health issue.

Similarly, if you have tinnitus in only one ear, you should see your doctor to make sure your ears are healthy.

I listen to a lot of music through headphones and ear buds. Could this cause tinnitus?

Listening to music at high levels with any type of headphones can cause injury to the ears, which can trigger tinnitus, Portnuff said.

“Choosing moderate or low-listening levels is a good way to prevent tinnitus,” he said. “You can use the 80-90 Rule to stay safe: listen at 80 percent of the maximum volume for 90 minutes per day. If you turn the volume down, you get more safe time to listen. If you turn it up, you get less safe listening time.” 

Is tinnitus becoming more common?

While hearing experts expect to see lower rates of tinnitus in coming years because workers exposed to high noise levels are using improved hearing protection, other factors might counter that trend.

“We are seeing higher numbers of people who are exposed to recreation sound exposure. That includes music, fireworks, firearms and other noisy hobbies. It’s hard to say if we will see more tinnitus in the future because tinnitus is so common as we age.”

Do hearing aids help if I have tinnitus? 

Yes, hearing aids are a valuable tool to reduce the annoyance of the hum, buzz and ringing people hear, and about 75 percent of people with tinnitus find that hearing aids help reduce noise feedback.

Can I avoid tinnitus?

Yes, reducing exposure to loud sounds can help prevent tinnitus. Portnuff recommends doing all you can to keep all your ears healthy, including the following:

• Protect your ears from loud sounds.
• Adopt a healthy lifestyle that includes exercise.
• Don’t smoke.
• Eat a heart-healthy diet.

“The healthier you stay, the healthier your ears stay,” Portnuff said. “All of those things your primary care physician tells you, we recommend in the ear clinic as well.”

Do diet changes or vitamins help with tinnitus?

“Eating a healthy diet, getting proper rest and exercise and maintaining good mental hygiene is always beneficial,” Portnuff said.

Some studies have shown that certain cases of tinnitus can be caused by a Vitamin B12 and/or magnesium deficiency, but Portnuff noted that these vitamins and nutrients can be found in a healthy diet.

What makes my tinnitus worse?

Tinnitus can be exacerbated by certain triggers including:

• Muscle tension in the neck or jaw
• Stress
• Migraine headaches
• Sleep apnea
• Caffeine, alcohol and soda

At the UCHealth Hearing and Balance Clinic, staff work with patients to both recognize and avoid their tinnitus triggers, as well as treat them when they occur.

What treatments can you use to prevent or reduce tinnitus?

Treatments for tinnitus are complex, but can include the following:

• Taking medications to alleviate migraines or relieve stress and anxiety.
• Using physical therapy to reduce muscle tension in the neck and jaw.
• Receiving dental intervention for jaw clenching or teeth grinding.

Even so, medical experts estimate that about 80 percent of people with tinnitus never seek medical help and instead, manage it on their own without additional support.

What other things can I do to make my tinnitus go away or reduce the symptoms?

Portnuff is a big believer in cognitive therapy to reduce the negative impact of tinnitus, especially the emotional and psychological ones.

“While we can’t cure tinnitus in most cases, we have lots of ways to train the brain to get used to it, which enhances the quality of life for people living with it,” he said.

“It doesn’t get rid of tinnitus but does reduce how much you notice it and how much stress it causes you. Audiologists have lots of tools we use that can help reduce the stress in your daily life so you can live the life you want.”

Cognitive therapy is designed to retrain the brain to pay less attention to tinnitus to such a degree that the brain becomes habituated to any sound and no longer “hears” it.

Other low-tech solutions that people find helpful include running a fan or sound machine at night.

“We often recommend introducing sound into your world when tinnitus is more noticeable to help to make it less present.”

Are there any potential cures for tinnitus on the horizon?

“We sure hope so,” Portnuff said. “Scientists and my colleagues here are working on cures for tinnitus.”

Some promising research includes repairing damaged hair cells in the ear’s cochlea through genetic therapies and stem cell transplantation.

I think I have tinnitus. What should I do?

If you have tinnitus, you should ask your medical provider to evaluate your ears and your hearing. Start with your primary care provider, Portnuff said.

Then, get a referral to an audiologist or an ear, nose and throat expert (ENT) for further evaluation and a personalized treatment plan.

“The best way to treat tinnitus is from a multidisciplinary view, as well as a holistic view. You are more than just your ears.”