Ringing in Ears (Tinnitus): Causes and Management Strategies

At-a-Glance

• Tinnitus (ringing in ears) affects about 15-20% of people, more common with age
• Most common causes include hearing loss, loud noise exposure, ear infections, and medications
• Tinnitus is usually a symptom of an underlying condition, not a disease itself
• While often not curable, many management strategies can reduce its impact
• Sudden tinnitus with hearing loss or dizziness requires prompt medical evaluation

What It Feels Like

Tinnitus is the perception of sound when no external sound is present. The phantom noise can vary in pitch and intensity and may affect one or both ears.

Common descriptions include:

• Ringing, buzzing, or humming sound
• Hissing, whistling, or roaring noise
• Clicking or pulsing sounds
• High-pitched or low-pitched tones
• Constant or intermittent noise
• Louder in quiet environments
• May worsen with stress or fatigue
• Can be mild annoyance or severely debilitating

The sound may be barely noticeable or loud enough to interfere with concentration and sleep.

Common Causes

Age-Related Hearing Loss

Gradual hearing loss with aging (presbycusis) is one of the most common causes of tinnitus.

Signs it might be age-related:

• Gradual onset, typically after age 60
• Difficulty hearing high-pitched sounds
• Trouble understanding speech, especially in noisy environments
• Tinnitus in both ears
• Family history of hearing loss

What helps:

• Hearing aids (often reduce tinnitus)
• Sound therapy
• Avoid loud noises
• Regular hearing evaluations

Noise-Induced Hearing Loss

Exposure to loud sounds damages inner ear hair cells, causing hearing loss and tinnitus.

Common sources:

• Concerts, sporting events
• Power tools, machinery
• Firearms
• Personal music devices at high volume
• Occupational noise exposure

What helps:

• Hearing protection (earplugs, earmuffs)
• Limit exposure to loud sounds
• Lower volume on personal devices
• Hearing aids if hearing loss present
• Sound therapy

Ear Infections and Blockages

Ear infections, wax buildup, or fluid in the middle ear can cause temporary tinnitus.

Signs it might be blockage or infection:

• Feeling of fullness in ear
• Muffled hearing
• Ear pain or discomfort
• Recent cold or sinus infection
• Discharge from ear

What helps:

• Ear wax removal by healthcare provider
• Treatment of ear infection with antibiotics
• Decongestants for fluid buildup
• Tinnitus usually resolves when underlying issue is treated

Medications (Ototoxic Drugs)

Certain medications can damage the inner ear or cause tinnitus as a side effect.

Common culprits:

• Aspirin (high doses)
• NSAIDs (ibuprofen, naproxen)
• Certain antibiotics (gentamicin, streptomycin)
• Loop diuretics (furosemide)
• Chemotherapy drugs (cisplatin)
• Quinine (for malaria)

What helps:

• Discuss with doctor—never stop medications without guidance
• Dose adjustment may help
• Alternative medications
• Tinnitus may improve after stopping medication

Meniere's Disease

Inner ear disorder causing episodes of vertigo, hearing loss, tinnitus, and ear fullness.

Signs it might be Meniere's:

• Episodes of severe vertigo (spinning sensation)
• Fluctuating hearing loss
• Tinnitus that comes and goes
• Feeling of fullness or pressure in ear
• Episodes last 20 minutes to several hours

What helps:

• Low-sodium diet
• Diuretics
• Medications for vertigo
• Hearing aids
• Vestibular rehabilitation

Temporomandibular Joint (TMJ) Disorders

Problems with the jaw joint can cause or worsen tinnitus.

Signs it might be TMJ:

• Jaw pain or clicking
• Difficulty chewing
• Facial pain
• Tinnitus worsens with jaw movement
• Headaches

What helps:

• Jaw exercises
• Bite guard or splint
• Physical therapy
• Avoid hard or chewy foods
• Stress management
• Dental evaluation

Acoustic Neuroma

Benign tumor on the nerve connecting ear to brain (rare but important to rule out).

Warning signs:

• Tinnitus in one ear only
• Progressive hearing loss in one ear
• Balance problems
• Facial numbness or weakness

Action: See a doctor for evaluation and MRI if suspected.

When to See a Doctor

Schedule a doctor's appointment if:

• Tinnitus persists for more than a week
• Tinnitus interferes with sleep or concentration
• You're experiencing anxiety or depression related to tinnitus
• Tinnitus is worsening
• You have hearing loss

Diagnosis

Your doctor may perform:

• Medical history: Medications, noise exposure, medical conditions
• Physical examination: Ear examination, jaw and neck assessment
• Hearing test (audiometry): Assess hearing loss
• Tympanometry: Check middle ear function
• MRI or CT scan: If acoustic neuroma or other structural problem suspected
• Blood tests: Check thyroid function, vitamin deficiencies, anemia

Treatment and Management

While tinnitus often can't be cured, many strategies can reduce its impact:

Sound Therapy

• White noise machines: Mask tinnitus, especially at night
• Hearing aids: Amplify external sounds, reducing tinnitus perception
• Tinnitus maskers: Devices that produce soothing sounds
• Apps and music: Background sounds to distract from tinnitus

Cognitive Behavioral Therapy (CBT)

• Helps change emotional response to tinnitus
• Reduces distress and improves coping
• Addresses anxiety and depression related to tinnitus
• Highly effective for many people

Tinnitus Retraining Therapy (TRT)

• Combines sound therapy with counseling
• Helps brain learn to ignore tinnitus
• Takes 12-24 months but can be very effective

Medications

• No FDA-approved medication specifically for tinnitus
• Antidepressants or anti-anxiety medications may help if distress is significant
• Treat underlying conditions (infections, thyroid problems)

Lifestyle Modifications

• Avoid triggers: Loud noises, caffeine, alcohol, nicotine
• Stress management: Meditation, yoga, exercise
• Adequate sleep: Fatigue worsens tinnitus
• Limit salt: Especially if you have Meniere's disease
• Stay active: Exercise and social engagement

Hearing Protection

• Use earplugs or earmuffs in loud environments
• Keep personal music device volume at 60% or less
• Take breaks from noise exposure
• Custom earplugs for musicians

Self-Care Strategies

Sound Enrichment

• Use fans, humidifiers, or sound machines
• Play soft music or nature sounds
• Avoid complete silence
• Background TV or radio at low volume

Relaxation Techniques

• Deep breathing exercises
• Progressive muscle relaxation
• Meditation or mindfulness
• Yoga or tai chi

Sleep Hygiene

• Consistent sleep schedule
• Sound machine or fan for background noise
• Avoid caffeine and alcohol before bed
• Relaxation routine before sleep

Support and Education

• Join tinnitus support groups
• Learn about tinnitus to reduce anxiety
• Connect with others who have tinnitus
• Stay informed about new treatments

Frequently Asked Questions

The Bottom Line

Tinnitus is a common condition affecting millions of Americans. While the phantom sounds can be frustrating and distressing, understanding that tinnitus is usually a symptom rather than a disease can help reduce anxiety.

Most tinnitus results from hearing loss (age-related or noise-induced), ear problems, or medications. Identifying and treating underlying causes is the first step. When tinnitus can't be eliminated, numerous management strategies—sound therapy, cognitive behavioral therapy, hearing aids, and lifestyle modifications—can significantly reduce its impact.

The key is not letting tinnitus control your life. With proper management, most people learn to habituate to the sound, making it much less bothersome over time. Support groups, education, and professional help can make a significant difference.

If you're experiencing new or worsening tinnitus, especially in one ear or with hearing loss, see a doctor for evaluation. Early intervention provides the best outcomes.

Remember: This information is educational and doesn't replace professional medical advice. If you're experiencing persistent or bothersome tinnitus, consult a healthcare provider for proper evaluation and treatment.