Dear Dr. Gott: For years, I have had a constant ringing in both ears. It is around 6,000 hertz, as determined by numerous ear tests, and is at an intensity that, at times, actually hurts.

It is equal in both ears, and occasionally there will be an additional ringing at a different frequency on top of the constant one. Also, I will get a clicking sound at times, primarily on the right.

Not one doctor has suggested any sort of treatment except to give me a hearing aid to mask the ringing. They have said it might be something related to the auditory nerve but can't determine treatment.

The only question they have asked is whether I have had any head trauma or been subjected to loud noises for a prolonged time. The answer is no.

Is there any way to determine the cause of the ringing? Or do I just have to "live with it", as the doctors say?

Reply: Tinnitus (ringing or noise in the ears) is an annoying but common malady, affecting almost one out of five people. It can present as a whistling, buzzing, clicking, roaring or hissing sound.

It may be present in one ear only, vary in pitch, and come and go. The most common cause is inner-ear cell damage. The tiny hairs in the inner ear can become bent or broken, leaking electrical impulses to the brain and resulting in tinnitus.

Other common causes include earwax blocking the canal, benign tumours, head and/or neck injuries, depression, stress, Meniere's disease and exposure to loud noises.

In rare instances, hypertension, atherosclerosis, tumours that place pressure on blood vessels and other blood-vessel disorders, such as vasculitis, can be the culprit.

Still other causes not readily considered are the use of medications, such as antibiotics, diuretics, excessive amounts of aspirin and those taken for cancer.

You indicate you have had a number of tests. Has your blood pressure ever been checked and ears flushed for wax build-up? Has your physician listened for sounds through a stethoscope in the area of your head and neck near the ears?

Are you on any medications or herbal or vitamin supplements that can cause your symptoms? If so, have you asked your physician about a trial without the potential offending drug or drugs?

Suppression of the offending sound(s) and determining the underlying cause for your tinnitus is paramount.

If your hearing has been affected, hearing aids are a logical first step. Devices are available that produce soothing, environmental sounds, such as ocean waves or falling rain.

Medications such as triclycic antidepressants and those for stress/anxiety relief might be prescribed. Then there is acupuncture, hypnosis and yoga. There are also a couple of over-the-counter products that contain bioflavonoids, which may help.

Ask for a referral to an otolaryngologist for a second opinion. Take the results of your prior hearing tests and bring a list of all possible causes and the medications you are on.

Start fresh, and give it another try, but don't expect too much. Tinnitus is annoying but harmless in most cases. Sufferers often learn to live with the condition because the cause cannot be found and treatment doesn't always offer relief.

To provide related information, I am sending you a copy of my Health Report 'Ear Infections and Disorders'.

Other readers who would like a copy should send a self-addressed stamped number 10 envelope and a cheque or money order for $2 to Newsletter, PO Box 167, Wickliffe, Ohio 44092. Be sure to mention the title.

Dr. Peter Gott is a retired physician and the author of 'Dr. Gott's No Flour, No Sugar Diet' and 'Dr. Gott's No Flour, No Sugar Cookbook'. Contact him c/o United Media, 200 Madison Avenue, fourth floor, New York, New York 10016.