Nobody else can hear it. That doesn't make it imaginary.

Where it comes from

The prevailing understanding is that tinnitus is generated by the brain rather than the ear. When the auditory system stops receiving input at particular frequencies — usually because of hearing loss, and usually at the high end — the parts of the brain that were listening for that input do not go quiet. They turn their own gain up, and what you perceive is the noise floor of a system straining to hear something that is no longer arriving.

Which explains two things people find confusing. Why it is loudest at night: there is nothing else coming in to mask it. And why hearing aids often help a great deal even when someone did not think their hearing was the problem: restoring the missing input gives the system less reason to keep amplifying.

What management actually involves

Island Hearing Services uses a combination of sound therapy and educational counseling. Neither of those phrases means very much on its own, so plainly:

• A full hearing evaluation first. Almost always the first step, because underlying hearing loss is both the most common driver and the most treatable part.
• Sound therapy. Giving the auditory system something else to attend to — through hearing aids, dedicated sound generators, or straightforward environmental sound. The goal is not to drown the tinnitus out but to make it less salient, so it stops being the loudest thing in a quiet room.
• Counseling. This does more work than it sounds like it should. Tinnitus is enormously affected by attention and by distress, and the loop where the noise causes anxiety which makes the noise more prominent is the part that ruins people’s sleep. Understanding what it is and why it is doing this reliably reduces how much of your day it occupies.

An honest account of what to expect

There is no medication, supplement or procedure that reliably makes tinnitus stop, and anything sold to you on that promise should be treated with suspicion. What management does is shift how much territory it takes up — many people move from noticing it constantly to noticing it occasionally, and from lying awake to sleeping.

That is a smaller claim than a cure and a much bigger change than it sounds. The measure that matters is not whether the sound is still there. It is whether you are still thinking about it.

Protecting what you have

Noise exposure both causes tinnitus and makes existing tinnitus worse, and a great many people first notice theirs after a specific loud event. If you are around engines, saws, guns or amplified music, custom hearing protection is the most useful thing you can do for the version of this you have not got yet.