What is tinnitus?
The most important thing to clarify right at the start is this: tinnitus is not a disease in its own right, but a symptom. It is a signal that may have many different causes — from an earwax plug to noise damage and circulatory problems. That is why there is no single “tinnitus medicine”: treatment always depends on the cause and the nature of the complaint. This article takes you through the causes, types and treatment options available today — including a detailed protocol for at-home soft laser treatment.
Key point
The first step in treating tinnitus is never a device or a tablet, but an ENT examination: the cause must be clarified and underlying conditions requiring treatment must be ruled out. After that, there is still plenty you can do — chronic tinnitus rarely disappears completely, but its disruptive effect can be reduced meaningfully in most people by combining methods intelligently.
What can cause tinnitus?
Click on the one that fits your situation — but the exact cause must always be determined by a specialist examination.
The most common background cause. The sensory hair cells in the inner ear function less effectively because of noise, age or other damage — and the brain compensates for the missing sound input by effectively “turning up the volume”. We hear this as buzzing. Typical triggers include noisy workplaces, concerts and headphones at high volume. Age-related hearing loss (presbyacusis) often comes with high-pitched ringing.
These are the easiest causes to treat: an earwax blockage, inflammation of the ear canal or middle ear, fluid in the middle ear, Eustachian tube dysfunction or an eardrum problem. Otosclerosis (fixation of the stapes) and Ménière’s disease also belong here. Ménière’s disease causes episodes of dizziness, a feeling of fullness in the ear and fluctuating hearing. Treating the underlying condition may also help the tinnitus — which is why an examination is needed.
Circulatory problems affecting the tiny blood vessels of the inner ear — against a background of atherosclerosis, high blood pressure or diabetes — are also a common cause. Pulsatile tinnitus is a separate group: if the sound pulses in time with your heartbeat, it usually has a genuine blood-flow cause in the vessels of the head and neck (narrowing, turbulent flow or a venous abnormality). This form therefore always warrants imaging.
Few people know that signals from the temporomandibular joint (TMD), the chewing muscles and the cervical spine can also influence how the auditory system functions — this is somatosensory tinnitus. A warning sign is that the buzzing changes when you clench your teeth, chew, turn your head or move your jaw. In this situation, a bite splint, physiotherapy and relaxing the neck and shoulder area may also improve the tinnitus.6
Some medicines — high-dose salicylates, certain anti-inflammatory drugs, aminoglycoside antibiotics, some diuretics, chemotherapy agents and quinine derivatives — may cause tinnitus and hearing loss when taken in high doses or for a long time. Important: never stop taking a medicine on your own because of this — discuss with your doctor whether there is an alternative.
Less often, a neurological condition is behind it: migraine, multiple sclerosis, stroke — and the rare but important-to-rule-out auditory nerve tumour (vestibular schwannoma), which typically causes one-sided tinnitus and hearing loss. This is why specialists take one-sided, asymmetric symptoms seriously.
Stress is rarely the only cause, but it is almost always an amplifying factor — and this is where a troublesome cycle begins: the buzzing causes stress and sleep problems, while stress and lack of sleep make the buzzing seem louder. One aim of treatment is precisely to break this cycle — which is why the sound-based and behavioural methods described below are so important.
Types of tinnitus — what does the nature of the sound tell you?
The nature, side and duration of the sound reveal a lot about the possible cause. Here is how to orient yourself:
| Characteristic | What do you experience? | What may it indicate? |
|---|---|---|
| Non-pulsatile (continuous) | Whistling, ringing, buzzing, hissing | The most common form — hearing loss, noise damage, ear disease, medication effect |
| Pulsatile | Swishing or beating that pulses with the heartbeat | Vascular blood-flow problem — always warrants examination |
| Changes with movement | The buzzing changes when clenching your teeth, chewing or turning your head | Somatosensory origin — jaw (TMD), cervical spine, muscle tension |
| Acute (days to weeks) | Recent, for example whistling after a concert | Often temporary — but if accompanied by hearing loss, urgent examination is needed |
| Chronic (3+ months) | Persistent buzzing | “It will go away” is no longer a strategy here — a treatment plan is needed |
| One-sided | Only in one ear | A more important warning sign, especially when accompanied by hearing loss or dizziness |
When should you seek urgent medical attention?
If tinnitus starts suddenly together with one-sided hearing loss, urgent specialist care is needed within 24 hours — the treatment window for sudden sensorineural hearing loss is short. Pulsatile tinnitus, and tinnitus accompanied by dizziness or balance problems, discharge from the ear or facial paralysis, are also urgent warning signs. Do not wait for the next available appointment in these cases.
What treatment options are available?
I’ll be honest: there is currently no treatment for chronic tinnitus that works like an “off switch”. What is available is a range of methods supported by evidence of varying strength. Combined, they can meaningfully reduce the disruptive effect of tinnitus in most people. Here is how the options compare:
| Method | What does it do? | Strength of evidence |
|---|---|---|
| Cognitive behavioural therapy (CBT) | It does not remove the sound, but changes how you react to it — reducing distress and anxiety | Strong |
| Sound therapy, white noise | Pushes the buzzing into the background with external sound; inexpensive and immediately available | Moderate to strong |
| Hearing aid | Dual effect: improves hearing and the amplified environmental sound masks the internal noise | Moderate to strong (when hearing loss is also present) |
| Tinnitus Retraining Therapy (TRT) | Counselling plus quiet background noise: the brain learns to ignore the sound; a 12-24-month programme | Moderate |
| Soft laser (photobiomodulation) | Supports inner-ear circulation and cellular metabolism with light | Limited and mixed: promising in the short term, but durability is uncertain |
| Ginkgo biloba, B12, magnesium | Supports circulation and nerve function; sensible when there is a deficiency | Weak to moderate |
Research suggests that combining methods brings the greatest benefit: behavioural therapy, sound therapy and — when hearing loss is present — a hearing aid together form the package supported by the strongest evidence.2 At-home methods (soft laser, white noise and stress management) can complement this.
Soft laser for tinnitus: how might it work?
Low-intensity laser light penetrates the tissues and may support cellular energy production (ATP formation) and microcirculation, while reducing local inflammatory processes. In tinnitus, the aim is to improve the blood supply and metabolism of the inner ear — the cochlea and its sensory cells. The method has been studied since the 1990s, mainly in Austrian, German and Danish centres.
Clinical experience suggests that soft laser produces the most promising results for tinnitus of circulatory origin — where impaired blood supply to the inner ear is involved. It has also been studied in noise-induced and age-related forms, with favourable partial results.5 It is not suitable for everyone, however: before treatment starts, an ENT specialist must rule out underlying conditions requiring treatment — such as an auditory nerve tumour and otosclerosis.
An important lesson from the studies is that some of the improvement achieved after short courses fades within 3-6 months.3 The explanation is straightforward: if the light supports microcirculation, the original circulatory state may return after treatment stops. For tinnitus, soft laser is therefore best considered not as a one-off course, but as regular maintenance — similar to exercise therapy. An important limitation, however, is that controlled studies have not yet tested long-term maintenance use — what we know about this comes from clinical observation.
How to carry out at-home soft laser treatment
Once you have been examined and your doctor has found no reason not to use it, at-home treatment consists of two phases. Treat both ears — even if only one is buzzing!
Phase 1: points around the ear
First, treat the acupuncture points around the ear: position the treatment head perpendicular to the skin and deliver 4 Joules of energy to each point (with the Personal Laser L400 this takes 10 seconds; the device gives an audible signal every 10 seconds, making it easy to count). The location of the points is shown in the illustration below:
Phase 2: illuminating the ear canal
The aim is to reach the inner ear through the ear canal. Preparation: clean the ear canal (earwax absorbs light), remove the focusing attachment if there is one, and wear the protective goggles supplied with the device. Direct the light into the ear canal and move the device slowly and continuously: tilt it by a few degrees and make small circles with its tip so that the energy is distributed evenly. Starting dose: 20 Joules (about 50 seconds), which can gradually be increased to 30-40 Joules if there is no reaction (with the L400 this takes about 1.5-2 minutes, and with the L500 Pro about 1-1.5 minutes). During treatment, you may feel mild warmth and hear popping or a “ship’s horn-like” sound — these are harmless accompanying effects.
Frequency and realistic expectations
The recommended frequency is 2-3 times a week. If the method works for you, the first signs usually appear after 5-10 treatments, with most of the change around 15-20 treatments — but individual variation is considerable. If you notice improvement, 1-2 treatments a week are recommended for maintenance. And the honest part: it does not work for everyone, and complete resolution is rare — the realistic goal is a quieter buzzing and less disruption. If a neck-related cause also plays a role (the buzzing changes with head movement), supplement treatment with 4-8 Joules to the bone behind the ear (mastoid) and relaxation of the neck and shoulder area.
My advice: keep a tinnitus diary
Rate the intensity and disruptive effect of the buzzing from 1 to 10 every day, and record your treatments too. After four to six weeks, the diary will show what daily impressions can hide: whether the treatment is working for you. If there is no change after 15-20 treatments, do not force it — direct your energy towards sound therapy and stress management; they work through a different pathway.
What else can you do at home?
Do not sit in silence. Complete silence is tinnitus’s strongest ally — this is when the brain tunes in to the internal sound. Quiet background noise (radio, fan, white-noise app or nature sounds) throughout the day, especially when falling asleep, may help a great deal. Always use white noise quietly — just loud enough to push the buzzing into the background.
Break the stress cycle. Thirty minutes of exercise a day, a breathing exercise (4 seconds in — hold for 7 — 8 seconds out), an evening screen break and a regular bedtime are not “wellness tips”, but ways to break the vicious tinnitus-stress cycle. Many people associate afternoon caffeine and alcohol with worsening symptoms — it is worth trying to stop them.
Food supplements — in moderation. Vitamin B12 deficiency is more common in people with tinnitus, and supplementation is sensible when there is a deficiency. Ginkgo biloba (200 mg of standardised extract daily) may support circulation — results are mixed. Magnesium (200-400 mg daily) has been studied for protection against noise damage. None of these is a miracle cure; if a deficiency is suspected, ask for laboratory testing.
Protect what you have. Earplugs in noisy environments, a maximum volume of 60% on headphones and active noise cancellation at a noisy workplace — preventing further noise damage is especially important when tinnitus is already present.
Suitable devices for ear-canal treatment
Laser treatment of tinnitus requires a device that can deliver enough energy into the ear canal. I recommend two CE-marked medical devices suitable for home use — the protocol can be carried out with either device as described above.
Personal Laser L400
A 400 mW soft laser with a wavelength of 808 nm. Its design is well suited to treating points around the ear and the ear canal. It delivers the 40-Joule ear-canal dose in about 100 seconds. It can also be used for other at-home soft laser applications, including joints, wounds and skin problems.
Energy-Laser L500 Pro
An 808 nm device with 500 mW output — thanks to its higher power, the same energy dose can be delivered in less time (40 Joules in about 80 seconds). It is a good choice if, alongside ear treatment, you also plan to treat larger body areas and joints regularly.
Before you start treatment
Only start at-home treatment once an ENT specialist has clarified the cause of the tinnitus and ruled out underlying conditions requiring treatment:
- Uninvestigated tinnitus – do not treat without a diagnosis: the symptom may be caused by a condition requiring treatment.
- Auditory nerve tumour (vestibular schwannoma, acoustic neuroma) – ruling this out is a prerequisite for treatment, especially with one-sided symptoms.
- Otosclerosis and other ear diseases requiring treatment – specialist treatment of the underlying condition comes first.
- Cancer in the head and neck region – avoid laser treatment in the area.
- Pregnancy – use at-home laser treatment only after consulting a doctor.
Important information
Never direct the laser light into the eyes, and wear the protective goggles supplied with the device during ear-canal treatment. I have written a separate article about the general contraindications of soft laser therapy: Contraindications of soft laser therapy →
What does the research say?
“What helps most with chronic tinnitus?”
According to a recent, comprehensive review of current treatment options, the approach supported by the strongest evidence is a combination: cognitive behavioural therapy (which reduces the emotional burden caused by the buzzing), sound therapy and — when hearing loss is also present — a hearing aid. Together.2 None of these “switches off” the sound. They help the brain pay less and less attention to it, allowing everyday life to take back its space. In tinnitus treatment, this is currently the realistic gold standard.
“Does soft laser help with tinnitus?”
An unusually large number of studies have now examined this question — a comprehensive analysis from 2023 brought together data from 28 studies involving nearly 1,500 participants. The result is mixed: in the short term, buzzing measurably eased in some people treated with laser, and the method performed better than placebo — but the durability of the effect has not been established, and the studies used such different settings that the optimal protocol is still unclear.3,4 Favourable partial results have also been reported for noise-induced tinnitus.5 In summary: it is a safe complementary method worth trying — with realistic expectations, repeated in courses and not treated as a miracle cure.
“Can my neck and jaw really cause buzzing in my ear?”
Yes — and this is one of the most treatable forms. According to a recent review summarising the effects of treating temporomandibular disorders (TMD), bite splints and physiotherapy may also improve ear-related accompanying symptoms, including tinnitus.6 If your buzzing changes when you clench your teeth, chew or turn your head, it is worth pursuing this route with the help of a dentist specialising in gnathology and a physiotherapist — because here the cause can be treated, not just the symptom.
Frequently asked questions
Acute, recent tinnitus — such as whistling after a loud concert — often disappears on its own within days or weeks. Chronic tinnitus that has lasted for more than 3 months rarely disappears completely on its own — but its disruptive effect can be reduced significantly in most people with the methods described above. Taking action is a better strategy than simply waiting.
At night, environmental noise fades, and in the silence the brain “turns up the volume” on the internal sound. Evening tiredness and stress also worsen perception. This is why quiet evening background noise works well (white noise or nature sounds beside the bed): it does not suppress the buzzing, but takes the stage away from it.
Not at an appropriate volume. The rule is simple: it should be just loud enough to push the buzzing into the background — never louder. The aim is not to overpower the buzzing, but to create a neutral sound carpet in which it gets lost.
The first step is always an ENT specialist: a hearing test (audiometry), followed by further examination if necessary. Imaging may be indicated for pulsatile tinnitus. If the tinnitus is emotionally very burdensome, involving a psychologist is not a sign of weakness. It is the gateway to CBT, the treatment element supported by the strongest evidence.
It may be worth considering once you have been examined, no underlying condition requiring treatment has been found, and especially when a circulatory factor is likely to be involved. The method is safe and can be combined well with other treatments — but start with realistic expectations: the aim is to reduce the buzzing, not eliminate it completely, and regular treatment will probably be needed to maintain the effect. The tinnitus diary will show after 15-20 treatments whether it is worth continuing.
Summary – Quick overview
Sources
- Saeed S, Khan QU. (2021). The pathological mechanisms and treatments of tinnitus. Discoveries. DOI: 10.15190/d.2021.16
- Park KW, Kullar P, Malhotra C, Stankovic KM. (2023). Current and emerging therapies for chronic subjective tinnitus. Journal of Clinical Medicine. PubMed: 37892692
- Nikookam Y, et al. (2023). The effect of photobiomodulation on tinnitus: a systematic review. The Journal of Laryngology & Otology. PubMed: 37994052
- Abdali HM, et al. (2025). Low-level laser therapy and photobiomodulation for tinnitus. Cureus. DOI: 10.7759/cureus.96234
- Mollasadeghi A, et al. (2013). Efficacy of low-level laser therapy in the management of tinnitus due to noise-induced hearing loss. Journal of Lasers in Medical Sciences. PubMed: 24288494
- Ferrillo M, et al. (2024). Efficacy of rehabilitative therapies on otologic symptoms in patients with temporomandibular disorders. Journal of Oral Rehabilitation. DOI: 10.1111/joor.13716
