James Valentine, a retired tech sergeant who spent 22 years in the Air Force, has a constant ringing in his ears. He says it sounds like "crickets going crazy on a quiet summer night."

Valentine is one of many service members and veterans who suffer from tinnitus, a symptom of hearing loss that causes people to hear a constant noise – typically described as a ringing or buzzing – even in the quietest settings.

Valentine served as an aircraft and fuel system mechanic. He believes his hearing loss and tinnitus are linked to his work environment that included constant exposure to loud jet engine noise and jet propellant.

In addition to loud noises, some research suggests that exposure to jet fuel fumes may also cause damage and lead to hearing loss.

The tinnitus affects the clarity of everything he hears, like music or voices on the telephone, he said. To block the tinnitus, he uses a fan as white noise when he sleeps and has an exhaust fan near him at work.

Diagnosing Tinnitus

More veterans make benefits claims for tinnitus and hearing loss at the Department of Veterans Affairs than any other disability or impairment. As of 2020, more than 2.3 million veterans received compensation for tinnitus.

Tinnitus is usually connected to hearing loss. It can also affect your concentration, reaction time and short-term memory. It can be associated with anxiety, depression and sleep disorders. Some people turn to substance abuse to try to block the sounds.

Tinnitus is most often caused by repeated exposure to loud noises, like explosives or aircraft engines. It's also linked to traumatic brain injury.

Tinnitus is actually a symptom of hearing loss. Yet some people experience the symptoms of tinnitus before noticing any loss of hearing. It is often not detected until service members get hearing tests as they approach separation, explained Air Force Lt. Col. (Dr.) Samuel Spear, branch chief, Hearing Center of Excellence (HCE), which is part of the Defense Health Agency's Research and Engineering Directorate.

Tinnitus may be under reported among the active duty military. Not all services require annual hearing tests, and service members may not report symptoms of tinnitus or hearing loss because they think it could affect their readiness status, Spear said. That's a misperception – there are no readiness standards related to tinnitus at this time.

Spear encourages service members to talk to a health care provider if they have symptoms of tinnitus or hearing loss.

"We want people to feel free to report hearing loss and get help," he said.

Overall, hearing loss is improving in the military. This change is due, in part, to increased awareness and better hearing protection.

The hearing protection many service members wear on duty protects against some hearing loss. But, even off duty, you can be exposed to loud noises in places such as crowded bars or music concerts.

"If you have to raise your voice to be heard, that puts you at risk for hearing loss," said Army Public Health Center research audiologist LaGuinn Sherlock. She suggests wearing hearing protection, such as ear plugs or ear muffs, if you know you are going to be exposed to loud noises at music concerts and other venues, or while operating loud equipment like saws or drills.

Some smartwatches can alert you to loud noise exposures, Spear said. Some ear buds also now limit loud noise exposure.

"Bothersome Tinnitus"

"Bothersome tinnitus" is more severe than regular tinnitus. It can affect quality of life and the ability to perform required duties, Sherlock said.

Bothersome tinnitus has been recorded in the hearing surveillance system for 17% of the soldiers screened, she said.

Sherlock's research is looking at how bothersome tinnitus can affect concentration, reaction time, and short-term memory.

Bothersome tinnitus can lead to chronic activation of the stress response, which in turn can lead to high blood pressure, heart disease, and stroke.

"It's really important to lower the stress response by taking regular breaks, doing breathing exercises, talking to a behavioral therapist, and reducing stress as much as possible," Sherlock said.

Mental health symptoms are also strongly associated with tinnitus severity, according to a 2021 study.

Other Causes and Treatments

Tinnitus can also occur when taking large quantities of medications and can go away when you stop. Specifically, some causes include high-dose aspirin and nonsteroidal anti-inflammatories, high doses and long exposure to antibiotics, or chemotherapy, Spear said.

For patients with bothersome tinnitus who have qualifying hearing loss, the first line of treatment should be hearing aids, said Amy Boudin-George, HCE's clinical section chief and a clinical audiologist.

"Hearing aids help by increasing access to environmental sound and speech, which can help give patients auditory input besides their tinnitus."

For patients with bothersome tinnitus who don't have hearing loss, education on strategies to manage tinnitus should be the first line of treatment, she said. "If this does not prove to be effective, ear-level tinnitus maskers can be used, which help by providing other sounds that patients can pay attention to."

Spear added: "Conservative treatment measures are generally adequate for treating tinnitus but in some cases, certain types of hearing aid maskers may also be considered." Talk therapy, and techniques such as masking (white noise), and biofeedback may make the tinnitus more tolerable.