Tinnitus and Military Service: A Guide for Serving Personnel and Veterans

It is commonly described as ringing in the ears, but tinnitus can also sound like buzzing, humming, hissing, whistling, whooshing or another persistent or intermittent noise.

For serving personnel and veterans, tinnitus can be particularly relevant because military service may involve exposure to intense noise from weapons, explosions, artillery, aircraft, helicopters, armoured vehicles, machinery and other sources.

Noise can cause tinnitus.

But having tinnitus and having served around loud noise does not automatically establish that military service caused it.

Tinnitus has several possible causes, it can occur with or without measurable hearing loss, and in many people no single cause can be identified with certainty.

This guide explains what tinnitus is, its relationship with military noise and hearing loss, what Abbott v Ministry of Defence [2026] EWHC 941 (KB) decided about delayed-onset tinnitus, how tinnitus is assessed and managed, and how the civil claims system differs from the Armed Forces Compensation Scheme.

The short version

• Tinnitus means hearing sound without a corresponding external source.
• It can affect one ear, both ears or seem to come from inside the head.
• It may be intermittent or continuous.
• Noise exposure is a recognised cause of tinnitus.
• Military weapons and blast can expose personnel to particularly intense impulsive noise.
• Tinnitus commonly occurs with hearing loss, but it can also occur where conventional audiometry records normal hearing.
• An audiogram cannot objectively show whether somebody experiences tinnitus.
• Tinnitus often begins during harmful noise exposure or relatively soon afterwards.
• Abbott rejected a rigid time cut-off beyond which delayed tinnitus must automatically be treated as unrelated to military noise.
• Abbott also said that the longer the gap between noise exposure ending and tinnitus beginning, the more carefully causation must be examined.
• Tinnitus is not automatically permanent; it may improve or resolve in some people and persist in others.
• Persistent unilateral or pulsatile tinnitus can require further investigation.
• Tinnitus accompanied by sudden hearing loss, facial weakness, severe vertigo or a recent head injury requires urgent medical attention.
• There is no single treatment that removes tinnitus for everybody, but there are established ways of reducing its impact.
• Under the AFCS tariff, current official MOD material states that stand-alone tinnitus does not receive a separate award; hearing-disorder awards include an element for accompanying tinnitus.
• That AFCS rule does not mean tinnitus cannot form part of a civil military hearing-loss claim.

What is tinnitus?

Tinnitus is the perception of a sound that is not being produced by an ordinary external sound source.

The sound varies considerably between people.

It may be described as:

• ringing;
• buzzing;
• humming;
• hissing;
• whistling;
• whooshing;
• clicking;
• throbbing;
• another tone or noise.

For some people it is faint and rarely intrusive.

For others it can affect:

• sleep;
• concentration;
• communication;
• work;
• relaxation;
• mood;
• day-to-day quality of life.

The impact of tinnitus therefore cannot be understood simply by asking whether somebody "has ringing in their ears".

Is tinnitus a disease?

Tinnitus is better understood as a symptom or condition associated with the auditory system, rather than one single disease with one single cause.

It may occur alongside:

• hearing loss;
• noise damage;
• ear disease;
• certain medical conditions;
• head or ear injury;
• other changes affecting the auditory system.

Sometimes an underlying cause can be identified.

Sometimes it cannot.

That uncertainty is important in military hearing claims because a diagnosis of tinnitus does not automatically identify what caused it.

What is subjective tinnitus?

Most tinnitus is subjective.

That means the person experiencing it can hear the sound, but another person or clinician cannot directly hear or objectively measure the tinnitus itself.

This does not make the symptom imaginary.

It means tinnitus is diagnosed principally from the individual's account, clinical history and surrounding evidence rather than through a machine that objectively measures the tinnitus sound.

Abbott described tinnitus as inherently subjective and recognised the importance of the individual's history when determining diagnosis and causation.

What is objective tinnitus?

Objective tinnitus is much less common.

NICE defines it as tinnitus that occurs as a result of noise generated in the ear that can be detected by the examiner.

Because objective tinnitus may have a different underlying mechanism, persistent objective tinnitus should be appropriately assessed rather than simply assumed to be ordinary noise-related tinnitus. NICE lists persistent objective tinnitus among the reasons to refer for assessment and management (NG155, 1.2.6).

What is pulsatile tinnitus?

Pulsatile tinnitus is a rhythmic sound that may beat in time with the pulse.

It can sometimes have a vascular or another identifiable physical cause.

It therefore deserves particular attention.

NICE recommends offering imaging to people with pulsatile tinnitus so that an underlying cause can be investigated (NG155, 1.4.9).

Pulsatile tinnitus should not simply be attributed to previous military noise exposure without appropriate medical assessment.

Can military noise cause tinnitus?

Yes.

Exposure to sufficiently intense noise is a recognised cause of tinnitus.

Military personnel can encounter both continuous and impulsive noise.

Examples include:

• rifle fire;
• machine guns;
• artillery;
• mortars;
• explosions;
• demolitions;
• grenades;
• blast;
• armoured vehicles;
• aircraft;
• helicopters;
• engine rooms;
• engineering machinery.

The intensity, frequency, duration and pattern of exposure all matter.

A single extremely loud incident can potentially cause acoustic injury.

Repeated exposure over time can also be relevant.

Why can weapons and explosions be important?

Weapons and explosions produce impulse noise — very intense sound occurring over a short period.

This differs from the relatively steady noise associated with some industrial machinery.

The distinction is relevant because military hearing damage does not always produce the same pattern as conventional long-term industrial noise exposure.

Abbott examined the particular characteristics of military impulsive noise when considering both hearing loss and tinnitus.

That does not mean every person who fired weapons or experienced blast has noise-induced tinnitus.

It means the exposure is medically relevant and needs to be considered alongside the individual's history.

Can tinnitus happen after one loud event?

Yes.

Someone may notice ringing or another sound following:

• weapons fire;
• an explosion;
• blast;
• another extremely loud event.

Sometimes tinnitus after loud noise is temporary.

Sometimes it persists.

If an incident causes a sudden change in hearing, do not assume it is simply tinnitus that will settle.

A sudden hearing loss requires urgent medical assessment.

Can tinnitus develop gradually?

Yes.

Some people cannot identify one particular incident.

Instead, tinnitus may become noticeable during a period involving repeated exposure to noise.

That can make the history more complicated.

Useful questions can include:

• when the tinnitus was first noticed;
• what military role the person was performing;
• whether symptoms followed particular exercises or deployments;
• whether hearing temporarily felt muffled after noise;
• whether tinnitus was mentioned to anyone at the time;
• whether it has been continuous or intermittent since then.

Is tinnitus always accompanied by hearing loss?

No.

Tinnitus and hearing loss frequently occur together.

But tinnitus can also occur in people whose conventional audiogram does not demonstrate measurable hearing loss.

The medical experts in Abbott recognised this expressly.

The judgment recorded that tinnitus can occur in people with normal hearing as well as people with hearing loss, and that exposure to very loud noise can still create a material risk of tinnitus where conventional hearing thresholds are normal.

This distinction matters.

Tinnitus is not simply another word for hearing loss.

Can I have military tinnitus but not military NIHL?

Potentially.

The two conditions require separate consideration.

The clearest example is one of the Abbott test claimants, Mr Jack Craggs.

The High Court did not find that his current hearing loss had been proven to result from military NIHL.

But the Court separately concluded that he had developed tinnitus during military service as a result of military noise exposure.

That illustrates why hearing-loss causation and tinnitus causation should not automatically be treated as the same question.

Our guide to noise-induced hearing loss explains the hearing-loss side separately.

Can an audiogram show tinnitus?

No.

An audiogram measures hearing thresholds.

It records the quietest pure tones somebody can detect at different frequencies.

It does not measure the sound that somebody with subjective tinnitus experiences.

So an audiogram cannot show "this person has tinnitus", or "this tinnitus was caused by the Army".

The audiogram may still be relevant because tinnitus often coexists with hearing loss and because the pattern of hearing can provide useful context.

But the tinnitus itself is principally established through clinical history.

Our guide to how to read a military audiogram explains what an audiogram actually measures.

Does normal hearing mean my tinnitus cannot be noise-related?

No.

Normal conventional hearing thresholds do not automatically exclude noise-related tinnitus.

Abbott considered this point directly.

The experts recognised that tinnitus can occur in individuals with normal audiometric hearing as well as those with measurable hearing loss.

That does not mean military noise should automatically be blamed whenever a veteran with normal hearing reports tinnitus.

The clinician still needs to examine:

• the noise history;
• onset;
• timing;
• other potential causes;
• medical history;
• consistency of the account;
• later exposure.

When does noise-induced tinnitus normally begin?

Abbott provides an important answer.

Mr Justice Garnham concluded that tinnitus normally begins during exposure to noise or shortly after the noise exposure ends.

That timing can be powerful evidence when considering causation.

For example, tinnitus first noticed immediately after a particular blast presents a different causal history from tinnitus first recalled decades after all significant noise exposure ceased.

But the Court deliberately refused to turn that observation into an absolute rule.

What did Abbott decide about delayed-onset tinnitus?

Before Abbott, one of the major disputes was whether tinnitus beginning a significant time after noise exposure had stopped could still be attributed to that exposure.

The MOD argued for a much more restrictive approach.

The Court rejected a rigid cut-off.

Its conclusion was essentially: there is no arbitrary point in time beyond which a delayed tinnitus claim must automatically be rejected.

Instead, timing affects the strength of the causal inference.

The closer onset is to the dangerous noise exposure, the more likely the exposure is to be the cause.

The longer the delay, the greater the scrutiny required.

Does Abbott mean tinnitus starting 20 years after discharge was caused by service?

No.

Abbott means the claim cannot properly be rejected solely because an arbitrary number of years has passed.

A long delay makes causation more difficult and requires careful consideration of the evidence and alternative explanations.

Questions may include:

• exactly when symptoms were first noticed;
• whether tinnitus existed intermittently before becoming troublesome;
• whether significant noise exposure continued after service;
• civilian employment;
• recreational shooting or loud hobbies;
• hearing loss;
• age;
• medical conditions;
• medication;
• ear disease;
• other possible causes.

The longer the interval, the more important those questions become.

What if I cannot remember exactly when my tinnitus began?

That is not unusual where somebody is being asked about symptoms many years later.

But uncertainty should not be replaced with a false precision.

It is more useful to identify what can genuinely be remembered.

For example:

• during a particular deployment;
• after live-fire training;
• while still serving;
• around the time of discharge;
• during a later civilian job;
• many years after leaving.

Other records or witnesses may sometimes help place the symptoms in time.

The correct answer may simply be: "I cannot remember exactly."

That is better than inventing a date.

What evidence can help establish when tinnitus started?

Potential evidence can include:

• service medical records;
• hearing-surveillance records;
• reports following acoustic trauma;
• GP notes;
• audiology records;
• ENT records;
• occupational-health records;
• AFCS or War Pension paperwork;
• earlier claim forms;
• contemporaneous emails or correspondence;
• evidence from a spouse, partner, relative or colleague.

A family member may remember somebody:

• complaining about ringing;
• having difficulty sleeping;
• using background noise at night;
• becoming more sensitive to quiet environments;
• mentioning symptoms after training or deployment.

Such evidence does not automatically prove medical causation.

It may help establish the history.

Can tinnitus get worse over time?

A person's experience of tinnitus can change.

It may become:

• more noticeable;
• less noticeable;
• intermittent;
• more intrusive in quiet environments;
• more troublesome when sleep or concentration is affected.

That does not necessarily mean the original injury itself is progressively worsening.

The perceived impact of tinnitus and the underlying auditory condition are not identical concepts.

If tinnitus changes significantly or new symptoms develop, medical reassessment may be appropriate.

Why is tinnitus worse at night or in quiet places?

Many people become more aware of tinnitus when there is less environmental sound.

During the day, ordinary surroundings may partially mask it.

At night, or in a quiet room, there may be less competing sound and the tinnitus can therefore become more noticeable.

That is why sleep is a common area of difficulty for some people with persistent tinnitus.

Can tinnitus affect sleep?

Yes.

For some people tinnitus has little effect on sleep.

For others it can make falling asleep, returning to sleep, or relaxing in a quiet room more difficult.

NICE recommends that healthcare professionals consider the impact of tinnitus on emotional and social wellbeing and everyday activities when planning care, and asks clinicians to check whether tinnitus is causing sleep problems (NG155, 1.3.5).

The effect on an individual matters more than simply whether tinnitus is present.

Can tinnitus affect concentration and work?

It can.

Persistent intrusive tinnitus may affect:

• concentration;
• reading;
• quiet desk work;
• meetings;
• sleep and subsequent daytime functioning;
• communication where hearing loss also exists.

But impact varies considerably.

One person may experience tinnitus every day with little functional difficulty.

Another may find similar-sounding symptoms substantially intrusive.

That difference can be relevant both medically and, where appropriate, when assessing damages in a civil claim.

Does stress cause tinnitus?

Tinnitus can have several possible causes and should not simply be dismissed as stress.

However, a person's emotional state and the amount of attention given to tinnitus can affect how intrusive it feels.

Tinnitus can itself also cause distress.

So the relationship can work in both directions.

Where tinnitus is affecting mental wellbeing, that impact deserves treatment rather than being used as a reason to dismiss the underlying symptom.

How is tinnitus diagnosed?

There is no single objective test for ordinary subjective tinnitus.

Assessment usually begins with the history.

A healthcare professional may ask about:

• what the tinnitus sounds like;
• one ear or both;
• whether it is constant or intermittent;
• whether it pulses;
• when it began;
• noise exposure;
• hearing difficulty;
• dizziness or vertigo;
• ear pain or discharge;
• medication;
• head injury;
• effect on sleep and daily life.

The ears may also be examined for potentially treatable problems such as wax or infection.

Should people with tinnitus have a hearing test?

NICE recommends offering an audiological assessment to people with tinnitus (NG155, 1.4.1).

This is useful because hearing loss and tinnitus frequently coexist.

Depending on the circumstances, assessment may include:

• pure-tone audiometry;
• examination of the ears;
• tympanometry where middle-ear or Eustachian-tube dysfunction is suspected (NG155, 1.4.2);
• further ENT or audiovestibular investigation where indicated.

The purpose is not merely to produce evidence for a claim.

It is to identify hearing needs and investigate relevant causes.

Does everybody with tinnitus need an MRI?

No.

NICE does not recommend imaging for symmetrical, non-pulsatile tinnitus where there are no associated neurological, audiological, otological or head and neck signs or symptoms (NG155, 1.4.8).

The position is different where tinnitus is:

• pulsatile;
• persistently one-sided;
• associated with asymmetrical hearing loss;
• accompanied by other relevant symptoms.

Those situations may justify further investigation.

When is tinnitus urgent?

Some combinations of symptoms require prompt medical attention.

Sudden hearing loss. NICE recommends that people with tinnitus and hearing loss that developed suddenly — over a period of three days or less — in the past 30 days should be seen within 24 hours (NG155, 1.2.3). NHS patient guidance treats tinnitus with sudden hearing loss as requiring emergency attention.

Facial weakness or severe vertigo. Tinnitus with facial weakness or a severe spinning sensation can indicate a condition requiring urgent assessment.

Tinnitus after a head injury. NHS guidance advises emergency assessment where tinnitus occurs after a head injury.

Pulsatile tinnitus. If the tinnitus beats in time with your pulse, NHS guidance recommends an urgent GP appointment.

Severe psychological distress. Tinnitus can occasionally cause very severe distress. NICE recommends immediate referral to a crisis mental health team for assessment where tinnitus is associated with a high risk of suicide (NG155, 1.2.1).

If tinnitus is substantially affecting your ability to function or your mental wellbeing, tell a healthcare professional rather than simply trying to tolerate it.

Can tinnitus be cured?

There is no single treatment that removes tinnitus for everybody.

Some tinnitus resolves or becomes much less noticeable over time.

Other tinnitus persists.

Management therefore focuses on:

• identifying treatable underlying problems where possible;
• addressing hearing loss;
• reducing tinnitus-related distress;
• improving sleep and communication;
• helping the person manage its effect on everyday life.

NICE specifically recommends reassuring people that tinnitus is a common condition, that it may resolve by itself, and that there are a variety of management strategies that help many people live well with it (NG155, 1.1.3).

Can hearing aids help tinnitus?

They can help some people where tinnitus occurs alongside hearing loss.

NICE recommends offering amplification devices to people who have tinnitus and hearing loss that affects their ability to communicate (NG155, 1.5.1).

It also says amplification can be considered where hearing loss is present even if communication difficulty is not substantial (NG155, 1.5.2).

Hearing aids are not recommended simply as a tinnitus treatment for somebody who does not have hearing loss (NG155, 1.5.3).

The reason is important: a hearing aid treats the person's hearing needs.

Any improvement in tinnitus is part of that overall management rather than proof that hearing loss caused the tinnitus.

What about sound therapy?

People with tinnitus sometimes use low-level environmental sound, bedside sound or other sound-based approaches to make tinnitus less intrusive.

However, NICE concluded that there was insufficient evidence to recommend a particular form of sound therapy on its own, and was unable to make a recommendation for practice in this area.

That distinction matters.

It would be misleading to tell veterans that purchasing a particular masking device or sound product is an established cure.

Does CBT help tinnitus?

Psychological therapy does not mean the tinnitus is imaginary.

The aim is to reduce the distress and disruption associated with tinnitus.

For adults whose tinnitus continues to affect emotional or social wellbeing and everyday activities despite tinnitus support, NICE recommends considering a stepped approach involving tinnitus-related psychological interventions (NG155, 1.5.4).

These can include:

• digital cognitive behavioural therapy;
• group-based CBT;
• mindfulness-based cognitive therapy;
• acceptance and commitment therapy;
• individual CBT.

The treatment targets the person's response to and impact of tinnitus rather than pretending the auditory symptom never existed.

Is there medication that cures tinnitus?

No medicine should be presented as a universal tinnitus cure.

NICE specifically recommends not offering betahistine to treat tinnitus itself (NG155, 1.5.5).

Betahistine may be used for other conditions, such as Ménière's disease, but that is different from prescribing it as a treatment for tinnitus alone.

Can protecting my hearing help?

Preventing additional harmful noise exposure is sensible.

That can include using appropriate hearing protection around hazardous noise.

But hearing protection should be appropriate to the environment.

For serving personnel, hearing protection may also need to accommodate communication and operational requirements.

Protection against future noise does not reverse tinnitus or hearing damage that has already occurred.

Should I avoid all sound if I have tinnitus?

No.

Someone with tinnitus does not ordinarily need to live in silence or avoid everyday sound.

The important distinction is between ordinary safe sound and potentially harmful noise exposure.

Excessive avoidance of normal sound is not a substitute for medical advice.

If ordinary sounds have become painfully or unusually uncomfortable, tell an audiologist or doctor because that may require separate assessment.

Tinnitus and the Armed Forces Compensation Scheme

The Armed Forces Compensation Scheme (AFCS) is a no-fault compensation scheme for injury or illness caused by service on or after 6 April 2005.

It is separate from a civil negligence claim against the Ministry of Defence.

There is an important tinnitus-specific distinction.

The MOD's Independent Medical Expert Group Seventh Report states that under the AFCS tariff, awards are not made for stand-alone tinnitus. Instead, hearing-disorder payments include an element for accompanying tinnitus.

This is a feature of the AFCS tariff structure.

It does not mean:

• stand-alone tinnitus is not a real medical condition;
• tinnitus cannot be caused by military noise;
• tinnitus can never be relevant to compensation;
• a civil court must approach tinnitus in the same way.

Those are separate questions.

Why does the AFCS treatment differ from a civil claim?

AFCS is a statutory compensation scheme with prescribed descriptors and tariff rules.

A civil claim is governed by different legal principles.

In Abbott, the High Court considered tinnitus independently.

Mr Craggs did not prove that his present hearing loss was military NIHL, yet the Court accepted that his tinnitus had been caused by military noise.

That illustrates why somebody should not assume the AFCS tariff treatment tells them how a civil tinnitus claim will be determined.

Can tinnitus form part of a civil claim against the MOD?

Potentially.

A civil claim still requires the necessary legal and medical elements to be established.

That can include:

• relevant military service;
• actionable exposure;
• duty and breach issues;
• Crown immunity;
• combat immunity where relevant;
• limitation;
• causation;
• the extent of injury and loss.

Tinnitus itself must also be considered individually.

Abbott is particularly important because it rejected an automatic temporal cut-off for delayed onset while still requiring increasingly careful scrutiny as the delay grows. Our guide to what Abbott decided covers the judgment as a whole.

Does tinnitus mean I qualify for the MOD Matrix?

Not automatically.

The Matrix is a particular arrangement within the Military Deafness Litigation.

It is not a medical diagnosis and it is not simply a tinnitus compensation scheme.

Whether somebody falls within the relevant litigation arrangements depends on matters beyond the presence of tinnitus.

Is there a three-year deadline from when tinnitus started?

Civil limitation is more complicated than simply counting three years from the first day somebody remembers ringing in their ears.

Questions can include:

• date of injury;
• date of knowledge;
• when a person knew or ought reasonably to have known relevant facts;
• the circumstances of the particular claim;
• the Court's discretion in some cases.

The Matrix also has its own separate registration deadline.

Our Military Hearing Loss Time Limits guide will explain these rules once its editorial review is complete.

A website should not decide from one symptom date that somebody is definitely in or out of time.

What should I record about my tinnitus?

For healthcare purposes, it can be useful to be able to explain:

• when you first noticed it;
• what it sounds like;
• which ear or ears;
• continuous or intermittent;
• pulsatile or non-pulsatile;
• whether it followed a particular noise event;
• whether hearing also changed;
• effect on sleep;
• effect on concentration;
• effect on communication;
• changes over time.

Do not manufacture a level of detail you do not actually remember.

Accurate uncertainty is more useful than false certainty.

What if nobody can hear my tinnitus?

That is normal for subjective tinnitus.

Most tinnitus cannot be heard by another person.

The absence of an externally measurable sound does not mean the symptom does not exist.

The clinical question is whether the history is credible and whether the surrounding medical evidence supports the diagnosis and proposed cause.

What if I never reported tinnitus while serving?

That fact may be relevant.

It does not automatically prove tinnitus did not exist.

There can be several reasons symptoms were not reported, including:

• they seemed minor at the time;
• they were intermittent;
• the person expected them to settle;
• they were more noticeable only later;
• the person did not appreciate their significance.

But the absence of contemporaneous complaints remains evidence that may need to be considered.

The correct approach is not to ignore missing records or automatically treat them as decisive.

What if my tinnitus started after civilian noise exposure?

Later civilian exposure can be important.

Examples include:

• construction;
• manufacturing;
• engineering;
• shooting;
• music;
• motorsport;
• other noisy occupations or hobbies.

Where significant noise exposure occurred both during and after military service, a clinician may need to consider which exposure is most likely to have caused or contributed to the tinnitus.

Can family evidence matter?

Potentially.

Tinnitus is subjective, so people close to the veteran cannot hear the tinnitus itself.

But they may have observed its effects.

Examples might include:

• difficulty sleeping;
• needing background noise at night;
• complaints about ringing;
• irritability associated with poor sleep;
• concentration problems;
• comments made years earlier about symptoms.

That sort of evidence may help describe the history and impact.

It does not replace medical assessment.

Frequently asked questions