Tinnitus (Ringing in the Ears): Symptoms, Causes, and Treatment

Tinnitus is the medical word for hearing a sound in one or both ears, or in the head, that is not coming from outside. People describe ringing, buzzing, hissing, whooshing, humming or clicking. It is very common: up to about 1 in 5 people have it at some time, and it is more troublesome in a smaller group. Tinnitus is a symptom, not a disease, and is most often linked to hearing loss from age or loud noise. It is usually not a sign of anything serious, but tinnitus in one ear only, tinnitus that beats in time with your pulse, or tinnitus with sudden hearing loss, dizziness or facial weakness needs prompt medical checking. There is no medicine that cures tinnitus, but treating any underlying cause, hearing aids, sound therapy, and cognitive behavioural therapy (CBT) help most people notice it less and cope better. Guidance from the NHS in the UK, the American Tinnitus Association and US clinical guidelines, and healthdirect in Australia all give the same overall approach.

In plain words

Tinnitus means you hear a sound that is not coming from outside. It can be ringing, buzzing, hissing, or whooshing. It can be in one ear, both ears, or in your head. It is very common. About 1 in 5 people get it at some point. It is a symptom, not a disease. Most of the time it is linked to hearing loss from age or loud noise. It is usually not a sign of anything serious. But get it checked soon if it is in one ear only, if it beats in time with your pulse, or if it comes with sudden hearing loss, bad dizziness, or a weak face. Those last signs need same-day care. There is no pill that cures tinnitus. What helps most people is treating any cause, using hearing aids if you have hearing loss, playing soft background sound, and talking therapy such as CBT. Many people find the sound fades into the background over time.

What is Tinnitus (Ringing in the Ears): Symptoms, Causes, and Treatment?

Symptoms

Early symptoms

A sound with no outside source: Ringing, buzzing, hissing, whistling, humming, roaring, clicking or whooshing, in one ear, both ears, or seeming to come from inside the head. It may be constant or come and go. (1) (6) (5)
A sound that pulses in time with your heartbeat: Pulsatile tinnitus is a rhythmic whooshing or thumping that matches your pulse. It is less common and is the pattern most likely to need a physical cause found, so it should be checked. (1) (6) (5)
Tinnitus that is louder when it is quiet: Many people notice it most in a silent room or at night, which can make it harder to fall asleep. (1) (4)
Tinnitus alongside reduced hearing: Tinnitus and hearing loss often go together. You may notice you turn the television up, or struggle to follow speech in a noisy place. (5) (6)
Being bothered, worried or low because of the noise: For some people the sound itself is mild but the distress, poor sleep and difficulty concentrating are the main problem. (1) (5)

Serious or emergency symptoms

Tinnitus with sudden hearing loss, a spinning sensation, or facial weakness: Losing hearing suddenly in one ear, severe dizziness or vertigo, or drooping or weakness of one side of the face together with tinnitus can point to an inner-ear or nerve emergency. Sudden hearing loss is treated best when treatment starts within a few days. Get emergency assessment the same day: call 911 in the United States, or go to accident and emergency (999) in the United Kingdom or the emergency department (000) in Australia, or contact an urgent ear, nose and throat service. (1) (5)
Tinnitus straight after a head injury: New tinnitus that starts right after a blow to the head can occur with concussion or damage to the ear or skull. Seek emergency care (911 / 999 / 000), especially if there is also loss of consciousness, repeated vomiting, worsening headache, confusion or fluid from the ear. (1) (5)
Tinnitus in one ear only, or that beats in time with your pulse: One-sided tinnitus and pulsatile tinnitus are the patterns most likely to have a treatable physical cause, such as a problem with a blood vessel or, rarely, a benign growth on the hearing nerve. Book an urgent appointment with your doctor, within a few days, for examination, a hearing test and, if needed, a scan. This is not usually a 999 emergency unless it comes with the features above. (1) (6) (5)

Causes

Primary causes

Hearing loss from ageing or loud noise: This is the most common association. Damage to the tiny hair cells of the inner ear, from years of loud noise or simply from getting older, changes the signals the brain receives and it can produce a phantom sound. (5) (1) (6)
Earwax, ear infection or a blocked ear: A build-up of earwax, an ear infection, or fluid behind the eardrum can muffle outside sound and bring on tinnitus. This type often settles once the ear is cleared. (1) (6) (5)
Inner-ear conditions: Ménière's disease (which also causes vertigo and a feeling of fullness in the ear) and otosclerosis (abnormal bone growth in the middle ear) can both cause tinnitus. (5) (1)
Jaw, head and neck problems: Problems with the jaw joint (temporomandibular joint), and injuries to the head or neck, can affect the nerves and muscles connected to hearing and set off tinnitus, often in one ear. (5) (4)

Contributing factors

Medicines that can affect the ear: Some medicines can cause or worsen tinnitus, usually at higher doses and often reversibly. They include high-dose aspirin and other anti-inflammatory painkillers such as ibuprofen and naproxen, water tablets called loop diuretics such as furosemide, some antibiotics such as gentamicin, quinine, and platinum chemotherapy such as cisplatin. Do not stop a prescribed medicine on your own; ask the prescriber to review it. (5) (1)
Blood vessel and blood pressure problems: Pulsatile tinnitus can come from turbulent blood flow near the ear, and high blood pressure or narrowed neck arteries can make any tinnitus more noticeable. (1) (5) (6)
A growth on the hearing nerve (rare): An acoustic neuroma (also called vestibular schwannoma) is a slow-growing, non-cancerous lump on the balance and hearing nerve. It is uncommon but is a reason why one-sided tinnitus with hearing loss is checked with a scan. (5) (1)
Other health conditions: Diabetes, thyroid disease, migraine and, occasionally, multiple sclerosis are linked with tinnitus. Anxiety, depression and stress do not cause the sound but strongly affect how distressing it feels. (1) (5)

Risk factors

Exposure to loud noise

Work noise (construction, music, machinery, the military) and leisure noise (concerts, headphones at high volume) are the biggest avoidable risks. (5) (9) (10)

Older age

Tinnitus becomes more common with age, alongside age-related hearing loss. (5) (6)

Existing hearing loss or ear disease

Any condition that reduces hearing, from earwax to Ménière's disease, raises the chance of tinnitus. (5) (1)

Smoking, and heart or blood-pressure problems

Smoking and cardiovascular disease are linked with a higher rate of tinnitus and can make it louder. (5) (4)

Anxiety, depression and poor sleep

These do not cause tinnitus but are strongly linked with how severe and intrusive it feels, and each can make the other worse. (5) (1)

Diagnosis

There is no single test for tinnitus. A doctor will ask what the sound is like, whether it is in one or both ears, whether it pulses with your heartbeat, and how much it affects your sleep, mood and daily life. They will look in your ears for wax or infection, check your blood pressure, and usually arrange a hearing test (audiogram) with an audiologist. Imaging, such as an MRI or CT scan, is not needed for most people; it is used when tinnitus is in one ear only, pulses with the heartbeat, comes with one-sided hearing loss or balance problems, or when the examination points to a physical cause. Blood tests may be done to check for anaemia, thyroid problems or diabetes if the history suggests them. This step-by-step approach is shared by NHS and NICE guidance in the UK, US clinical practice guidelines and the American Tinnitus Association, and healthdirect in Australia.

Ear examination

Looks for earwax, infection or fluid behind the eardrum, which are simple, treatable causes. (1) (6)

Hearing test (audiogram)

Measures the pattern and degree of any hearing loss. One-sided hearing loss is a reason for a scan. (5) (6)

MRI or CT scan (only if indicated)

Used for one-sided or pulsatile tinnitus, or one-sided hearing or balance problems, to look for a nerve growth or a blood vessel cause. (5) (6)

Blood pressure and blood tests

Checks for high blood pressure and, when the history suggests it, anaemia, thyroid problems or diabetes. (1) (5)

Treatment

Medication options

There is no medicine that cures tinnitus

No drug removes the sound. Treatment aims to fix anything treatable, reduce how much the brain focuses on the noise, and protect sleep and mood. The steps with the best evidence are: treat any underlying cause (for example remove earwax, treat an ear infection, or review a medicine that may be responsible); fit hearing aids if there is hearing loss, which often make tinnitus less noticeable; use sound therapy, such as background sound, a bedside sound machine or a wearable sound generator, so the tinnitus stands out less; and cognitive behavioural therapy (CBT), which has the strongest evidence for reducing the distress and impact of tinnitus even though it does not change the sound. Tinnitus retraining therapy combines counselling with sound therapy. (1) (5) (6) (8)

Lifestyle and self-care

Protect your hearing (prevention): The main way to prevent tinnitus is to prevent noise damage to the inner ear. Wear ear protection around loud noise, keep headphone volume down and take listening breaks, and have loud hobbies and workplaces risk-assessed. Once noise damage is done it does not recover, so prevention matters more than any treatment. (9) (10) (5)
Use gentle background sound, especially at night: A fan, soft music, a radio tuned between stations or a sound machine gives the brain something else to listen to and can make it easier to fall asleep. (1) (6)
Look after sleep, stress and mood: Regular sleep habits, relaxation, exercise and treatment for anxiety or depression all reduce how intrusive tinnitus feels. Many people find it fades into the background over months as the brain habituates. (5) (6)
Cut back on things that make it louder for you: Some people notice caffeine, alcohol, nicotine, or being very tired make their tinnitus stand out more. It is worth testing whether reducing these helps you. (1) (5)
Get support: Tinnitus support organisations and groups help. In the UK see the NHS and the British Tinnitus Association; in the US the American Tinnitus Association; in Australia Tinnitus Australia, with Beyond Blue (1300 224 636) for mood support. (1) (6)

Always discuss dosing and treatment changes with your own prescriber.

Possible complications

Poor sleep and tiredness: Tinnitus that is worse in quiet often disturbs sleep, leading to daytime tiredness and low energy. (5) (1)
Trouble concentrating: The effort of listening past the noise can make it harder to focus at work or in conversation. (5) (4)
Anxiety, low mood and distress: In a minority of people tinnitus causes significant anxiety or depression. This is treatable, and CBT and mood treatment both help. If tinnitus ever leads to thoughts of harming yourself, seek help urgently. (1) (5)
A missed underlying condition: Rarely, tinnitus is the first sign of something that needs treatment, such as sudden hearing loss, a blood vessel problem or a nerve growth. This is why the urgent patterns above should be checked rather than ignored. (1) (5)

When to see a doctor

Routine follow-up

Book a routine appointment if tinnitus lasts more than a few weeks, keeps coming back, or affects your sleep, concentration or mood, so your ears and hearing can be checked and an audiology referral arranged if needed. (1) (6)
Book an urgent appointment, within a few days, if tinnitus is in one ear only, beats in time with your pulse, or comes with one-sided hearing loss. (1) (6) (5)

Seek emergency care

Get emergency care the same day, 911 in the United States, 999 in the United Kingdom or 000 in Australia, if tinnitus comes on with sudden hearing loss, severe dizziness or a spinning sensation, weakness or drooping on one side of the face, or straight after a head injury. Sudden hearing loss is treated best when it is started within a few days. (1) (5)

Frequently asked questions

Is tinnitus a sign of something serious?

Usually not. Most tinnitus is linked to hearing loss and is not dangerous. But tinnitus in one ear only, tinnitus that pulses with your heartbeat, or tinnitus with sudden hearing loss, severe dizziness or facial weakness should be checked promptly, and the last group needs same-day care. (1) (6) (5)

What causes ringing in the ears?

The most common cause is hearing loss from ageing or loud noise. Other causes include earwax, ear infections, Ménière's disease, jaw joint problems, head or neck injury, high blood pressure, some medicines (such as high-dose aspirin, certain water tablets and some antibiotics), and, rarely, a growth on the hearing nerve. Anxiety and stress do not cause it but make it feel worse. (5) (1) (4)

Is there a cure or a pill for tinnitus?

No medicine cures tinnitus, and no supplement has been shown to. What helps most people is treating any underlying cause, using hearing aids if there is hearing loss, sound therapy, and cognitive behavioural therapy (CBT), which has the best evidence for reducing distress. Medicines are used only for linked problems such as anxiety, depression or insomnia. (1) (5) (6)

Will my tinnitus go away?

Tinnitus from earwax or an ear infection often goes once the ear is cleared. Tinnitus linked to lasting hearing loss usually does not disappear, but for most people it becomes much less noticeable over months as the brain gets used to it, and treatment speeds that along. (6) (1)

What is pulsatile tinnitus?

Pulsatile tinnitus is a rhythmic whooshing or thumping that beats in time with your pulse. It is less common and is more likely than usual tinnitus to have a physical cause, such as turbulent blood flow near the ear, so it should be assessed by a doctor, usually with a hearing test and sometimes a scan. (1) (5) (6)

Can loud noise or headphones cause permanent tinnitus?

Yes. A single very loud exposure, or repeated loud noise over years, can damage the inner ear and cause lasting tinnitus and hearing loss. This damage does not recover, so ear protection and keeping headphone volume moderate matter. (9) (10) (5)

Which medicines can cause or worsen tinnitus?

High-dose aspirin and other anti-inflammatory painkillers, loop diuretics such as furosemide, some antibiotics such as gentamicin, quinine, and platinum chemotherapy such as cisplatin are the main ones, usually at higher doses and often reversibly. If you think a medicine is affecting your ears, ask the prescriber to review it rather than stopping it yourself. (5) (1)

How is tinnitus assessed?

The doctor asks about the sound and its effect on you, examines your ears, checks your blood pressure and usually arranges a hearing test. A scan is only needed if the tinnitus is one-sided or pulsatile, or comes with one-sided hearing or balance problems. (1) (5) (6)

Does stress make tinnitus worse?

Stress, anxiety, poor sleep and low mood do not cause tinnitus but they strongly affect how loud and intrusive it feels, and tinnitus can in turn raise stress. Breaking that cycle with relaxation, good sleep habits and, if needed, CBT or treatment for anxiety or depression is a core part of management. (5) (1)

Can hearing aids help even if my hearing loss is mild?

Often, yes. By restoring the missing outside sound, hearing aids frequently make tinnitus less noticeable, and modern aids can add built-in sound therapy. An audiologist can advise whether they are likely to help you. (6) (5)

References

NHS — Tinnitus source 1
NHS — Tinnitus: treatment source 2
NHS — Tinnitus: when to see a GP source 3
MedlinePlus (US National Library of Medicine) — Tinnitus source 4
StatPearls / NCBI Bookshelf — Tinnitus source 5
healthdirect (Australia) — Tinnitus source 6
Mayo Clinic — Tinnitus: Symptoms & causes source 7
Mayo Clinic — Tinnitus: Diagnosis & treatment source 8
US CDC — Noise and Hearing Loss source 9
US NIDCD — Noise-Induced Hearing Loss source 10