Amy has it down pat on her answer: there are many different causes of tinnitus. Frpm our research, the numero uno cause is high frquency hearing loss, the amelioration of which requires wide-band, three peak amplification. But, alas, most hearing impaired individuals will go anywhere else but that route and fail every time. They will spend thousands on useless, short-lived therapies, coming out the other end with exactly what they started out with and wondering why it's still ther. Humans are 4KHz species--hearing that pitch better than any other species--coming within 1.5 dB absolute Sound Pressure Level (SPL) in normal ears. Their heart sinus node tone is centered around the band of sounds of 4KHz, as well (the pre-set frequency of expensively implanted vagal stimulators). In our extensive experience with tinnitus, we find that a properly programmed hearing instrument that can reach past 10KHz is the best solution for such cases and a lot cheaper and less invasive. Yet many still will go around the block to visit their next door neighbor and go anywhere but with a hearing aid no matter how invisible they have become. Yes, hearing loss needing correction is only one cause of tinnitus, but it is the most common cause, so I thought I'd start with that one so we can digest that point. Then, we can go to ototoxic medications (there are many), food additives (MSG, Aspertame, etc.), lifestyle factors (drugs, alcohol, tobacco, high caffeine leading the list here), stress (lack of restorative sleep and exercise), and anything that closes down vascularization, for the cochlear where the noise is generated for most tinnitus is highly vascularized at the stria vascularis.  

There is no single best treatment for tinnitus because there is such a wide variety of causes of the condition.

You should see your doctor to see if he can narrow down possible causes, but in some cases no cause can be identified.  Sometimes its a vascular issue, sometimes a problem with the ciliae of the inner ear, sometimes a medication reaction (aspirin is a common issue), sometimes the result of constant exposure to loud noises (firearms, loud music).

If you can correct the cause, it may go away or lessen its intensity.  Medication may help the symptoms but only if you get the right one for the cause.  For example, a blood pressure med if blood pressure is the cause of the tinnitus.

White noise machines can help you sleep at night.

Physical therapy with teaching the patient relaxation techniques can be useful as complementary treatment, as well as cognitive behavioural therapy in order to learn how to handle the tinnitus and the stress of living with tinnitus.

https://www.researchgate.net/publication/256605363_How_to_Stop_or_Soften_RINGING_IN_THE_EARS%21

Data How to Stop or Soften RINGING IN THE EARS!

Amy has it down pat on her answer: there are many different causes of tinnitus. Frpm our research, the numero uno cause is high frquency hearing loss, the amelioration of which requires wide-band, three peak amplification. But, alas, most hearing impaired individuals will go anywhere else but that route and fail every time. They will spend thousands on useless, short-lived therapies, coming out the other end with exactly what they started out with and wondering why it's still ther. Humans are 4KHz species--hearing that pitch better than any other species--coming within 1.5 dB absolute Sound Pressure Level (SPL) in normal ears. Their heart sinus node tone is centered around the band of sounds of 4KHz, as well (the pre-set frequency of expensively implanted vagal stimulators). In our extensive experience with tinnitus, we find that a properly programmed hearing instrument that can reach past 10KHz is the best solution for such cases and a lot cheaper and less invasive. Yet many still will go around the block to visit their next door neighbor and go anywhere but with a hearing aid no matter how invisible they have become. Yes, hearing loss needing correction is only one cause of tinnitus, but it is the most common cause, so I thought I'd start with that one so we can digest that point. Then, we can go to ototoxic medications (there are many), food additives (MSG, Aspertame, etc.), lifestyle factors (drugs, alcohol, tobacco, high caffeine leading the list here), stress (lack of restorative sleep and exercise), and anything that closes down vascularization, for the cochlear where the noise is generated for most tinnitus is highly vascularized at the stria vascularis.  

I didn't realize MSG or Aspertame were ototoxic.  You learn something every day.

The vascularization issue makes perfect sense, especially in relationship to tobacco, but I do have one question:  is it because impaired perfusion affects the ciliae or the auditory nerve (CN VIII) or can the ear actually hear the sound of the blood rushing by, which is interpreted as ringing?

Let me quickly parse out the issues you raised, Amy, in the few minutes I have available. The vascularization of the cochlea is separate from the vascularization of the TM (venous hum, hissing, pulsation, etc. and yes, the ear can hear the blood rushing around the constrictions at the TM and elsewhere). At the cochlea the vascularization is part of the electrolyte and ionic process that maintains the electrical potential at several junctures (Reissner membrane, organ of Corti, spiral ganglia, etc.) when hydraulic energy converts into neural energy. When we speak of the (temporary) toxicity of aspirin this is the part most effected. But the NSAIs are much more damaging from its constrictive action, and Aspertame from its toxic action than aspirin ever was. Plus, MSG (microcystallized sodium) causes an immediate imbalance between the chemistry of the electrical potential (major cause of vertigo). Mix the action of NSAI meds like Aleve with MSG and we really set the individual up for a fall--interrupting the resorption of endolymphatic fluid (endolymph hydrops, anyone?). Probably the worst damage to the hair cell population itself is from the resurrected but highly toxic sulfadrugs, aminoglycoside antibiotics (rapid hair cell loss 6-12 month after exposure), NSAI meds, and what I consider barbaric and highly toxic chemo therapeutic agents. These (the NSAIs, aminoglycoside antibiotics, sulfadrugs, and chemo) are used with abandon by the medical community today, devastating the lives of their patients in a very permanent way. Hence, tinnitus, the subject of this discussion, is merely one of the symptoms--the ear mechanisms crying out with "pain" begging us to stop whatever we are doing--of what begins as transient and becomes permament over time. 

Thanks for the answer; very informative.  While I've been aware for years about ototoxicity, your answer clarified some things for me that I never really gave much thought to.  Ironic, since I've had tinnitus for years.  It comes and goes, and my hearing isn't impacted so I usually ignore it until it goes away.

I've taken NSAIDS or aspirin for years for chronic pain, especially migraines (Excedrin).  I knew the ASA might be contributing to my tinnitus; could Motrin also be contributing?

I cut way back when my doctor told me he thought it was contributing to my hypertension.

The Motrin (one of the milder NSAIs)and Aspirin have opposite effects on vascularity. On the stria vascularis, for instance, capillary action is damped with Motrin--its tinnitus effects are less direct than with aspirin which weakens the vascular wall and causes dilation, even a cochlear a stroke in some cases. If you will look on the two charts on the attached monograph and describe your tinnitus I can give you more specific ideas on your tinnitus. We did several large scale quantitative and qualitative studies to arrive at these gradations. 

I suppose Nimodipine could be useful - neroprotective action lipid soluble calcium channel blocker with blood- brain barrier penetration.

But in all cases of tinnitus, the place to start (where obvious toxicity or pathophysiological conditions such as Meniere's, endolyphatic hydrops, etc. are not noted) is with hearing evaluation and, if sensorineural loss is found, amplification correction. Then, from there the other issues can be addressed. In three major studies of which I was a chief investigator I can attest that we found that 77% of long-term tinnitus cases involved hearing loss that needed appropriate correction. As I've said in other forums, tinnitus is the "search party" looking for the missing hearing. Once found--through appropriate amplification--the dogs are called off, and the mechanisms called "residual inhibition" and "environmental masking" is effected, make the tinnitus softer and more manageable.  

Tinnitus itself is not a disease but a symptom of different causes as has been described  by my colleagues. It is better to differentiate between bilateral & unilateral tinnitus. Unilateral tinnitus may be due to a simple cause like ear wax or due to a dangerous cause like vestibular schwannoma particularly when associated with SNHL & initial vertigo. So examination followed by investigations can leads to the cause & hence proper treatment. 

I agree, Hazem. the dangerous ones, though extremely rare (vestibular schwannoma) and very critical (glomus tumor) require utmost diligence in either detection or referring to someone that can diagnose them.