When Paget’s disease involves the skull, it can lead to tinnitus. Tinnitus itself is common in the general population and often occurs for many different reasons.

Tinnitus is common in those with Paget's disease

When Paget’s disease affects the skull, it can sometimes cause tinnitus. In the general population, tinnitus is a common condition. 

According to Tinnitus UK, a charity that supports people with the condition, around one in three people experience tinnitus at some point in their lives, and about one in seven live with it regularly or all the time. Although it is often linked with older adults, tinnitus can affect people of any age.

What is tinnitus?

Tinnitus is the perception of sound without an external source, so it cannot be heard by others. The sound may be constant or occasional, loud or quiet, and can be heard in one ear, both ears or in the middle of the head. Some people look for what’s making the sound before realising it comes from within. Each person’s experience is different. For some, tinnitus can significantly affect quality of life.

Types of tinnitus

Non-pulsatile tinnitus
Non-pulsatile tinnitus is the most common form of tinnitus. It’s the perception of noises, such as ringing, buzzing, hissing, whistling or other noises. The sensation can present all the time or come and go. The volume of the noises heard can vary from one episode to the next.

Pulsatile tinnitus
In contrast, pulsatile tinnitus is a rhythmical noise that usually has the same beat as the heart. It can be identified by feeling the pulse at the same time as listening to the tinnitus. When doctors investigate cases of tinnitus, it is rare for them to find a single identifiable cause for the problem. However, with pulsatile tinnitus, the chances of finding a specific cause are more likely but still difficult. Pulsatile tinnitus is caused by a change in blood flow in the vessels near the ear or to a change in awareness of that blood flow. These vessels are located in the large arteries and veins in the neck and base of the skull, or the smaller ones in the ear itself. The change in blood flow can be caused by a variety of factors.

Musical tinnitus
Musical tinnitus, also known as musical hallucination, is the experience of hearing music when none is being played, but it tends to be longer lasting and doesn’t mirror any external music you may have heard recently. In most people with musical hallucination, there is no underlying cause. There is not thought to be a connection to mental health conditions.

Although anyone can experience musical hallucination, there are some groups of people where it is more common. This includes people who live alone and people with hearing loss. It is also more common in women than men and in people over is no underlying cause found. Very rarely, it can be caused by serious conditions, for example by problems with the blood vessels in the brain or by brain tumours. In these conditions, there are likely to be other symptoms, but your doctor might choose to perform some investigations to rule them out. Musical hallucination is also more common in individuals who have epilepsy or Alzheimer’s disease.

Is musical hallucination a psychiatric problem?
The majority of individuals with musical hallucination do not have any psychiatric problems. Musical hallucination is quite common in people who have obsessive compulsive disorder (OCD), in which they experience repetitive, intrusive and distressing thoughts and feel strong urges to repeatedly perform actions. It is estimated that around four in ten individuals with OCD will experience musical hallucination at some time. The majority of individuals with musical hallucination do not have OCD.

Can musical hallucination be treated?
If musical hallucination has an underlying cause, addressing the cause will often relieve the hallucination. The most common cause is hearing loss. Many people find that musical hallucination becomes less intrusive once the condition has been explained and they are reassured that there is no serious underlying cause. If it continues to be troublesome despite this, it can be managed with the techniques used to treat other forms of tinnitus.

Causes of tinnitus

The causes of tinnitus are varied. A change in the ear, such as an ear infection, a cold or wax blocking the ear, might start tinnitus. Loud noise over a long time, such as power tools, live music concerts, or noisy machinery, can cause it. It can also be started by a stressful life event. When the event is over, the tinnitus may stop.

Otosclerosis is another cause and happens when a tiny bone inside your ear, called the stapes, fuses with other parts of the ear and stops you being able to hear properly. It’s not known why otosclerosis happens, but you are more likely to get otosclerosis if a close relative has it.

Sometimes, but uncommonly, tinnitus can be linked to other medical conditions: head or neck injuries, cardiovascular disorders, such as high blood pressure, underactive thyroid (hypothyroidism) and diabetes. Some of you will be aware from experience that having Paget’s disease in the skull can also cause tinnitus.

What can be done?

Managing tinnitus can be easier if help is given early. You can have an audiological assessment. Speak with your GP, who may refer you to see an Ear, Nose and Throat (ENT) specialist or a special tinnitus clinic. You may be offered an MRI scan. Doctors will help you understand and manage your tinnitus, but they will not usually be able to stop persistent tinnitus from happening.

The most important thing is to keep doing the things you enjoy. You may do things differently, such as having background music on when you are reading. When it first starts, tinnitus can be frightening but with time, you usually notice it less.

The National Institute for Health and Care Excellence (NICE) recommends offering hearing aids to those with tinnitus who also have some hearing loss. Hearing aids work by making the sounds around you louder. They can help you hear more easily, but they will not stop your hearing from getting worse. NICE also recommend psychological intervention such as Cognitive Behavioural Therapy (CBT) which is a type of counselling therapy to help you change how you think and act. It can change your relationship with tinnitus.

Self-help to manage tinnitus

Sound therapy - Playing background music or sounds such as gentle waves or rainfall can help.

Tinnitus apps - There are tinnitus apps that you can place on your phone. Some apps offer a variety of white noise and nature sounds; some enable you to personalise the sounds and some include relaxation and mindfulness tools.

Reduce stress - A regular relaxation routine can help to reduce stress levels. As you become more relaxed, you may find it easier to manage your tinnitus and not notice it as much.

Protect your ears - Avoid exposure to loud noise which can worsen tinnitus. Wear ear protectors in noisy places.

Sleep well - Tinnitus can cause difficulty sleeping. It can help to keep a regular sleep routine, avoid caffeine and excess alcohol, wind down before bed and use relaxation or gentle music to help. Using an app at night for soothing sounds, such as nature or rainfall, helps some people. You can even get sound pillows so that the sound is directed closer to your ear.

Tinnitus UK Helpline

Information and resources are available, such as the Tinnitus UK Helpline (call 0800 018 0527 or chat online) and their website has tools for self-management. 

Research

Research continues to explore treatments and understand the mechanisms behind tinnitus. In a recent study by Fouad et al. (2025), they looked at treating tinnitus associated with otosclerosis with a bisphosphonate. They considered non-pulsatile tinnitus, which usually has no structural cause, and pulsatile tinnitus, which is more likely to have an identifiable cause. They treated individuals with the bisphosphonate risedronate, which is an oral treatment often used for Paget’s disease. They demonstrated significant improvement in those treated with the bisphosphonate compared to the control group.

Reference: Fouad, A., Mandour, M., Tomoum, M.O. et al. Effectiveness of bisphosphonate for alleviating tinnitus associated with otosclerosis: a prospective case–control study. European Archives of Oto‑Rhino‑Laryngology; 282, 647–658 (2025).