I developed tinnitus five years ago and it’s getting worse. It makes me dizzy, I can’t sleep and my GP tells me nothing can be done. DR SCURR reveals why people suddenly develop the condition… and why distraction is the key treatment

I’ve had tinnitus since contracting Covid five years ago but it’s got worse. In addition to the background hissing, I now get a crackling sound in one ear. It makes me dizzy and affects my sleep. My GP and an ear, nose and throat (ENT) consultant say nothing can be done.

J. Stephens, Alton, Hampshire.

Dr Martin Scurr: Tinnitus after a respiratory infection such as Covid is common, possibly as a result of inflammation and excess mucus irritating nerves, though we don’t know for sure.

Usually this resolves over time, but, in your case, it has become chronic and disruptive. However, there are ways to minimise it.

The key is essentially distraction. Tinnitus is often worse at night because the surroundings are quiet, which heightens your awareness of it.

So as a first step, I’d suggest having a soft background sound playing throughout the night. But it’s important to keep the volume low – you’re not trying to drown out the tinnitus, just distract from it.

If this doesn’t work, try CBTi (cognitive behavioural therapy for insomnia), a talking therapy with practical steps, including relaxation techniques, to reprogramme your brain to improve sleep. You’ll find courses online.

Then there’s a specialist type of CBT for tinnitus, which can reduce the distress it causes. Essentially, it’s about understanding the cycle of your symptoms, noting how they trigger anxiety and physical tension – and then reducing a tendency to repeatedly monitor the sound.

This is recommended by the National Institute for Health and Care Excellence if the tinnitus reduces wellbeing. But you will need a GP referral and treatment tends to be available only at specialist clinics.

The added crackling sound you describe could be a problem with the Eustachian tube, which connects the ear to the back of the throat. It drains fluid and equalises air pressure. Any kind of malfunction (such as the result of a cold) can disrupt these functions, causing crackling or popping sounds, particularly when swallowing, or muffled hearing on that side.

There is also a phenomenon called middle ear myoclonus, which causes muscle contractions in the middle ear that can trigger the noises you describe.

The muscles here are tiny and alter the tension of the eardrum or muffle loud sounds, for protection. But stress or infection can affect their function.

This can be treated with medication, or Botox administered into the middle ear. Surgery may also be an option. I think you need an ENT consultant to check the movement of your eardrum during an episode.

I’m 64 and in good health. For the last year I haven’t needed to urinate during the night, nor even first thing in the morning. My urine is also now much darker.

Name and address supplied.

Dr Scurr replies: Your description suggests that you are producing more concentrated urine. This is usually because less water is available for excretion. Given that you are otherwise healthy, this could be due perhaps to less fluid intake in the evening or more sweating, possibly as a result of more exercise.

But if you then pass a large amount of darker urine when you eventually go, it might be that you are developing chronic urinary retention. This is often a sign of high blood pressure (affecting the blood flow to the kidneys, which regulate urine output), kidney issues or diabetes (which can alter bladder sensitivity).

So while not getting up to urinate at night is perfectly compatible with good health, I’d keep a three-day fluid/bladder diary to identify potential triggers: record your fluid intake, what times you empty your bladder, and measure the volume each time (collecting the sample with a measuring jug).

Some water is lost through the skin, even when not sweating – around 400ml a day – but essentially you should see fluid intake match fluid output in a 24-hour time frame. If your output is minimal, see your GP, who will check your blood pressure and do a blood test for kidney function and blood sugar.