Extremely common and usually benign — but one-sided tinnitus is a different question.
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Tinnitus is hearing a sound that has no external source — ringing, buzzing, hissing, whistling or humming. It is extremely common, most of it is harmless, and the brain can learn to filter it out, which is the basis of the treatments that work.
Three patterns are different and need prompt attention, because they are the ones people wrongly wait on:
For everyone else, the most important thing to say is this: being told "nothing can be done" is wrong. Nothing cures tinnitus, but a great deal reduces its impact — and where there is any hearing loss, hearing aids are frequently transformative.
Tinnitus is louder when you are anxious, tired or listening for it. That produces a loop: the sound causes distress, the distress focuses attention on the sound, and attention makes it more prominent. Understanding that loop is the first step in breaking it — and it is the mechanism the effective treatments target.
Tinnitus usually accompanies some degree of hearing loss. When the ear stops delivering certain frequencies, the brain increases its own gain — and generates sound in the gap. That explains why it is so often described in the frequencies a person has lost, and why restoring input with hearing aids helps so much.
Worth reviewing, because some of it is reversible:
Tinnitus is assessed from the history, which a video consultation does well — and the purpose is to sort the reassuring pattern from the few that need urgent action.
A hearing test. Most people with tinnitus have some hearing loss, and a large proportion have not noticed it — yet identifying it opens the single most effective treatment. Free hearing assessments are widely available on the high street, and it is worth arranging one even if your hearing feels normal.
Full blood count and ferritin, and thyroid function — both anaemia and thyroid disease can cause tinnitus and are easily corrected.
We cannot look in your ear or test your hearing remotely — so where wax or a middle ear problem is possible, that needs someone to look, and it is worth doing because those causes are reversible.
Where there is any hearing loss, hearing aids are the single most effective treatment for tinnitus. They restore the missing input, which reduces the brain's compensatory gain — and many people find the tinnitus becomes far less noticeable, sometimes within weeks.
This is consistently under-used, partly because people assume their hearing is fine and partly because of how hearing aids are perceived. Modern devices are small, discreet, and available free on the NHS. If you take one thing from this page, it is to get your hearing tested.
Earwax, middle ear fluid, and medication that may be contributing. Simple, and sometimes the whole answer.
Silence makes tinnitus louder. Low-level background sound gives the brain something else to attend to:
Cognitive behavioural therapy adapted for tinnitus has the strongest evidence of anything here. It does not make the sound quieter — it changes the relationship with it, breaking the attention-distress loop, and the effect on quality of life is substantial. Available through tinnitus services and increasingly online.
Tinnitus retraining and habituation approaches work on the same principle: the brain is capable of filtering the sound out, exactly as it filters the feeling of your clothes.
Poor sleep and anxiety amplify tinnitus, and tinnitus damages sleep — so treating either helps both. Sleep measures, and treating anxiety or depression where present, often reduce perceived loudness considerably.
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The single most useful action, even if your hearing seems fine — most people with tinnitus have some hearing loss they have not noticed. Free assessments are available on the high street, and identifying it opens the most effective treatment there is.
Honest and genuinely encouraging: most people habituate. The sound may not change, but the brain gradually stops flagging it as important, and it fades into the background the way a clock's ticking does. That process takes months rather than weeks, and it happens faster with sound enrichment, good sleep and treated hearing loss — and slower when you are anxious and monitoring it.
Worse days are normal. Tiredness, stress and illness all turn it up temporarily. A bad week is not a relapse.
The British Tinnitus Association provides information, a helpline and support groups. Peer support helps more than people expect, particularly with the isolation of a symptom nobody else can hear.
Ginkgo biloba, tinnitus supplements, "retraining" devices sold online and cure programmes. None has convincing evidence, and some are expensive. Cutting caffeine is also not supported by the evidence — keep your coffee if you enjoy it.
There is no pill for tinnitus, and anything sold to you as one is not supported by evidence. That is the most useful and least welcome thing on this page, and it is worth saying before anything else — because tinnitus is a condition people spend a great deal of money on with very little to show for it.
What genuinely helps is free or NHS-provided: a hearing assessment, hearing aids where there is hearing loss (which frequently improves tinnitus substantially), sound enrichment, and CBT — which has the strongest evidence base of any tinnitus treatment and is available through NHS audiology and psychology services.
NHS audiology is the right route, and referral is free. British Tinnitus Association resources are free and genuinely good.
Where a consultation is worth paying for is the assessment — specifically, identifying the small number of presentations that need investigating rather than managing: one-sided tinnitus, pulsatile tinnitus that beats in time with your heart, or tinnitus with sudden hearing loss. Those need imaging or urgent referral, and they are regularly reassured away.
What we will not do is sell you supplements, sound-therapy devices or “tinnitus cures”. Ginkgo, zinc and the various proprietary formulations have been studied and do not work.
Sudden hearing loss with tinnitus is an emergency — treatable only if caught within days.
NICE NG155, Tinnitus: assessment and management, is the governing guideline. It sets out the support-based approach used here — information and reassurance, hearing aids where hearing loss coexists, sound therapy, and cognitive behavioural therapy, which NG155 identifies as having the best evidence for tinnitus-related distress.
NG155 explicitly does not recommend betahistine, ginkgo biloba, zinc or other supplements for tinnitus, which is the basis for what this page says about products sold for it.
NG155 defines the urgent and immediate referral criteria quoted above: tinnitus with sudden hearing loss developing over three days or less requires immediate referral; unilateral, pulsatile or objective tinnitus, and tinnitus with neurological symptoms, require urgent assessment.
NICE NG98, Hearing loss in adults, covers the audiological assessment that should accompany tinnitus, and British Tinnitus Association resources are the patient-facing standard.
Sudden hearing loss. If your hearing drops over hours or days, that is an emergency — steroids work, but the window is days, not weeks. It is very commonly mistaken for wax or a blocked ear, and people wait for an appointment while the chance of recovery passes. Go the same day, and use those words.
Yes, and it warrants proper assessment. Tinnitus in one ear only — particularly with hearing loss on that side — needs an MRI to exclude a benign nerve tumour. It is uncommon, and the point of the scan is to rule it out rather than because it is likely.
That is pulsatile tinnitus, and it is a different thing — you are hearing blood flow rather than a generated sound. It needs investigating with imaging, because the causes include narrowed or abnormal vessels and raised pressure inside the head. Worth pushing for rather than accepting reassurance.
That is wrong, and it is one of the most damaging things people are told. There is no cure, but there is a great deal of effective treatment: hearing aids where there is hearing loss, sound enrichment, and CBT adapted for tinnitus — which has strong evidence for reducing distress. Most people habituate over time, and the process can be actively helped.
Because most people with tinnitus have some hearing loss, and a large proportion have not noticed it — early loss shows up as difficulty in background noise rather than as obvious deafness. It matters because hearing aids are the single most effective treatment for tinnitus, and you cannot access that route without the test.
No — protect yourself from genuinely loud noise, but do not wear earplugs in ordinary quiet environments. Reducing normal sound input makes tinnitus more prominent and can increase sensitivity to everyday sound over time. Silence is the enemy here; low-level background sound is what helps.
The evidence does not support it, and withdrawal can make things temporarily worse. If you enjoy coffee, keep it. The same applies to most supplements sold for tinnitus — Ginkgo biloba has been studied repeatedly with no convincing benefit, despite being marketed heavily for exactly this.
Sometimes, particularly where a reversible cause like wax is found. More often the sound persists but stops mattering — the brain learns to filter it out, much as it filters the feeling of your clothes. That habituation takes months rather than weeks, and it happens faster with treated hearing loss, sound enrichment and good sleep.
August 23, 2026
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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