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Your outer and middle ear send messages from sound waves to your inner ear. Here, they are turned into signals that are passed on to the brain. Tinnitus is thought to be related to how your hearing system recognises sound and how your brain interprets it. Tinnitus often coincides with age-related hearing loss - your brain may be trying to compensate for sounds it cannot hear any longer from your inner ear.

Say that again

About 2 in 3 people with tinnitus have some hearing loss - although you may develop tinnitus before you even realise your hearing is getting less sharp. Age-related hearing loss tends to come on gradually, and the average person takes as long as 10 years before they seek help. High-pitched frequencies are often lost first. Voices have higher frequencies, so an early sign is not being able to hear conversation against a noisy background.

Even if you don't think you have a significant problem with your hearing, it's well worth getting your hearing checked if you develop tinnitus. A hearing aid can often improve tinnitus as well as hearing. And because tinnitus is worse in quiet surroundings, amplifying the sounds around you with a hearing aid can often masks the sound of tinnitus.

You can ask your GP for a referral to a hospital audiology clinic for assessment and hearing aid fitting if you need one. However, many branches of high street stores like Specsavers® and Boots® also offer free hearing checks and can fit you for a hearing aid if needed. They're commissioned to provide these services by the NHS under a contract called 'Any Qualified Provider'. This means they have to prove they offer the same quality of service, and the same hearing aids, as hospital clinics.

What else?

Sometimes, tinnitus is down to a temporary cause, such as an infection of the middle ear or a build-up of hard earwax - make an appointment with your practice nurse to check it out. It can also be caused by إصابة في الرأس or as an after effect of التهاب السحايا, and occasionally by other conditions such as فقر الدم, فرط نشاط الغدة الدرقية or some medications. These include some مضادات حيوية, anti-inflammatory tablets و الأسبرين, although it's rarely an issue except at high doses - always stick to the dose on the packet.

In rare cases, a non-cancerous tumour on your hearing nerve can give rise to tinnitus in just one ear, along with reduced hearing on that side. You must always see your doctor if you get one-sided tinnitus. A condition called مرض منيير can give rise to bouts of hearing loss, دوار (dizziness where the room spins around) and tinnitus, mostly lasting 2-3 hours.

Listen to the positives

Even though tinnitus can't be cured, there is still lots you can do to help with your symptoms. It's important to understand that with rare exceptions, tinnitus isn't caused by a serious condition and doesn't lead to other symptoms. It certainly isn't because you're going mad. Nor is it going to keep on getting worse - in fact, it often gets less noticeable over time.

Tinnitus is always worse when there's little or no background noise to cover it, so it tends to be more troublesome at night. Keeping the radio on quietly can help - it's worth getting one with a timer at night. You can even get a pillow with a built-in radio, or a soft headband with thin, removable speakers. Some people prefer a noise generator, which plays soothing background sounds from nature, like waves or rustling leaves.

When it's severe, tinnitus can get you down and even cause الاكتئاب. Many hospitals have a specialist tinnitus clinic, headed up by an audiologist with training in العلاج السلوكي المعرفي - a form of counselling which aims to help you challenge unhelpful negative thoughts. Sometimes you'll need to be seen first in an ENT clinic which can refer you on to a tinnitus clinic - but the sooner you get help, the more successful it's likely to be.

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