Clinical research is now saying that the most likely tinnitus causes are really microscopic changes in the cells that are part of the hearing system. You may want to know what caused the changes in those cells.,We know that some drugs may affect some of the cells in the hearing system, especially in people who happen to be particularly sensitive. The most common example of this is the painkiller aspirin, which will produce tinnitus in anyone when given in sufficiently large doses. There are a lot of drugs that, even in small doses over short periods of time, can produce temporary changes in some of the hearing system cells so that tinnitus may be the outcome.,Sustained exposure to high levels of noise can also produce tinnitus. The effects of loud noise may be addictive and accumulative and can ultimately produce tinnitus many years after your exposure to them. People exposed to explosions or gunfire in the Second World War may now be developing tinnitus as a result.,In a few unusual cases, injuries to the head and neck, and surgery .around the head, neck or the ears, may produce the sort of cell damage, or changes in brain ‘programmes’, that have been thought to be capable of giving rise to tinnitus. However, this is still a matter of some speculation.,Finally, and most common of all as a probable cause of tinnitus, is cellular ‘wear and tear’; damage from the effects of accumulated environmental ‘assaults’ on the cells over a period of time, and just general old age may lead to cells failing. Tinnitus is a sort of ageing phenomenon, the majority of people with tinnitus being over 40.,Tinnitus is nearly always a result of something wrong within the hearing system. However, hearing disorders, with their many causes (there are others besides drugs, noise and ageing), may not be immediately noticeable. They too affect more people with increasing age.,Will It Get Worse?,Evidence from research suggests that one can give a firmly reassuring ‘not often’ in answer to this question. Only for a few people does it get worse, and that is usually early on. Even then it steadies off sooner or later, usually to recede a bit. The real answer is a bit more complicated in that the actual loudness of the tinnitus and its qualities seem to be related to its ‘noticeability’. It can be confidently said that, with time and for most people, tinnitus does get less noticeable. It may seem to get worse at the beginning, but this is likely to be due to a person’s own anxiety over it and the attention he or she is paying to it.,What we are interested in doing is getting the tinnitus to be less noticeable for you sooner rather than later. Of course, there are exceptions to the rule and if you have tinnitus in one ear it is possible that it might start in the other, as indeed it did with me: it started in the left ear four years after I’d had tinnitus in the right ear. Nevertheless, if you have tinnitus in one ear the likelihood of it starting in the other is probably not much greater than it is for somebody starting with tinnitus in the first place.