Tinnitus
Tinnitus is the perception of sound in the absence of an external acoustic stimulus. It is experienced differently by different people — commonly described as a ringing, buzzing, hissing, whooshing, clicking, or pulsing sound — and can occur in one ear, both ears, or appear to come from within the head. Tinnitus is not a disease in itself but a symptom of an underlying condition, and it is far more common than many people realise — affecting an estimated 10–15% of the population to some degree.
Causes
The most common underlying cause is damage to the sensory hair cells of the inner ear, often as a result of age-related hearing loss (presbycusis) or noise-induced hearing loss. Other frequent causes include earwax blockage, middle ear infections or fluid, Ménière's disease, otosclerosis, sudden sensorineural hearing loss, and certain medications — notably some antibiotics, chemotherapy drugs, diuretics, and high-dose aspirin. Less commonly, tinnitus can arise from temporomandibular joint (jaw) dysfunction, cardiovascular conditions (where a pulsatile sound corresponds to the heartbeat), head or neck injuries, and, rarely, acoustic neuroma (a benign tumour of the auditory nerve). Stress and fatigue are not direct causes but can significantly worsen perceived severity.
Impact
For many people, tinnitus is a mild background nuisance. For others, it can profoundly affect sleep, concentration, emotional wellbeing, and quality of life, leading to anxiety and depression. The severity of tinnitus is determined not just by its loudness but by the distress and functional limitation it causes.
Diagnosis
Assessment involves a thorough history, examination of the ear, and formal audiological evaluation. Imaging (MRI of the internal auditory meati) may be requested to exclude a structural cause such as acoustic neuroma, particularly in cases of unilateral tinnitus.
Management
There is currently no universal cure for tinnitus, but many strategies help manage it effectively. Treating the underlying cause — where identifiable — is the first priority. Hearing aids often reduce tinnitus in those with concurrent hearing loss by amplifying environmental sounds. Sound therapy (using background noise to reduce the prominence of tinnitus) can provide relief. Tinnitus retraining therapy (TRT) and cognitive behavioural therapy (CBT) are well-evidenced psychological approaches that help people habituate to the sound and reduce its emotional impact. Good sleep hygiene and stress management are also important.
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