Tinnitus (Ringing in Ears): Causes, Symptoms, and Relief

Tinnitus is the perception of sound when no external sound is present. People with tinnitus hear ringing, buzzing, hissing, whistling, roaring, clicking, or other sounds in one or both ears or in their head. The sound can be constant or intermittent, soft or loud, high-pitched or low-pitched. For some people, tinnitus is a minor annoyance, while for others, it significantly impacts quality of life, interfering with concentration, sleep, and daily activities.

Tinnitus is extremely common, affecting approximately 15-20% of Americans, with higher rates among older adults, military veterans, and people exposed to loud noise. It's not a disease itself but rather a symptom of an underlying condition, such as age-related hearing loss, ear injury, circulatory system disorders, or noise exposure. In most cases, tinnitus is subjective—only you can hear it. Rarely, tinnitus is objective, meaning a doctor can hear it during examination, usually caused by blood vessel problems or muscle contractions.

While tinnitus can be frustrating and distressing, especially when it first develops, most people learn to cope with it over time. The brain often adapts to the sound through a process called habituation, making it less noticeable. Understanding the causes and triggers of your tinnitus, along with effective management strategies, can help you reduce its impact on your life. Though there's no cure for most cases of tinnitus, various treatments can help manage symptoms and improve quality of life.

Common Causes

Noise-Induced Hearing Loss

Exposure to loud noise is one of the most common causes of tinnitus. Prolonged exposure to loud sounds (like machinery, music, or gunfire) or a single very loud event (like an explosion or concert) can damage the tiny hair cells in your inner ear that transmit sound signals to your brain. This damage can cause both hearing loss and tinnitus.

Signs noise exposure might be the cause:

• You work in a noisy environment (construction, manufacturing, music)
• You've attended loud concerts or events without hearing protection
• You're a military veteran exposed to gunfire or explosions
• You regularly use loud equipment or machinery
• Tinnitus started after a particularly loud event

Age-Related Hearing Loss

As you age, the hair cells in your inner ear naturally deteriorate, leading to hearing loss (presbycusis) and often tinnitus. Age-related hearing loss typically begins around age 60 and affects both ears equally. The tinnitus associated with age-related hearing loss is usually high-pitched ringing or hissing.

Signs age-related hearing loss might be involved:

• You're over age 60
• You have difficulty hearing high-pitched sounds or understanding speech in noisy environments
• Tinnitus developed gradually over time
• Both ears are affected similarly

Earwax Blockage

Excessive earwax buildup can block the ear canal, causing hearing loss, irritation, and tinnitus. When earwax is removed, tinnitus often improves or resolves. This is one of the most easily treatable causes of tinnitus.

Signs earwax might be the cause:

• You have a feeling of fullness in your ear
• Your hearing seems muffled
• Tinnitus started suddenly
• You have a history of excessive earwax production
• Symptoms improve after earwax removal

Ear Infections and Disorders

Middle ear infections, Eustachian tube dysfunction, otosclerosis (abnormal bone growth in the middle ear), and Meniere's disease (an inner ear disorder) can all cause tinnitus. These conditions affect the ear's structure or function, leading to abnormal sound perception.

Signs an ear disorder might be involved:

• You have ear pain, pressure, or fullness
• You experience dizziness or vertigo
• You have fluctuating hearing loss
• You have drainage from your ear
• Symptoms affect primarily one ear

Medications (Ototoxic Drugs)

Certain medications can cause or worsen tinnitus. Common culprits include high doses of aspirin, NSAIDs (ibuprofen, naproxen), certain antibiotics (gentamicin, erythromycin), cancer chemotherapy drugs (cisplatin), diuretics (furosemide), and antimalarial medications (quinine). The effect may be temporary or permanent depending on the medication and dose.

Signs medications might be contributing:

• Tinnitus started or worsened after beginning a new medication
• You take high doses of aspirin or NSAIDs regularly
• You're undergoing chemotherapy or taking antibiotics
• Symptoms improve when you reduce or stop the medication (consult your doctor first)

Head or Neck Injuries

Trauma to the head or neck can damage the inner ear, hearing nerves, or brain areas responsible for processing sound, leading to tinnitus. This type of tinnitus often affects only one ear and may be accompanied by headaches, dizziness, or memory problems.

Signs injury might be the cause:

• Tinnitus started after a head injury, whiplash, or concussion
• You have other symptoms like headaches or dizziness
• Tinnitus is in one ear only
• You have jaw pain or temporomandibular joint (TMJ) problems

Circulatory System Disorders

Blood vessel problems near the ear can cause pulsatile tinnitus—a rhythmic sound that matches your heartbeat. Causes include high blood pressure, atherosclerosis (hardening of arteries), turbulent blood flow, blood vessel malformations, and tumors affecting blood vessels near the ear.

Signs a circulatory problem might be involved:

• You hear a rhythmic whooshing or pulsing sound matching your heartbeat
• You have high blood pressure or cardiovascular disease
• Tinnitus changes with physical activity or head position
• You can sometimes stop the sound by pressing on your neck

When to See a Doctor

While tinnitus is usually not a sign of a serious condition, you should consult a healthcare provider if:

• Tinnitus develops suddenly without an obvious cause
• Tinnitus affects only one ear (could indicate a tumor or other serious condition)
• You hear a rhythmic pulsing sound matching your heartbeat
• Tinnitus is accompanied by hearing loss, dizziness, or balance problems
• You experience ear pain, drainage, or signs of infection
• Tinnitus significantly interferes with your sleep, concentration, or quality of life
• You have depression or anxiety related to tinnitus
• Tinnitus developed after a head injury
• You have other neurological symptoms like facial weakness or numbness

Seek immediate medical attention if tinnitus is accompanied by sudden hearing loss, severe dizziness, or neurological symptoms like facial drooping or difficulty speaking, as these could indicate serious conditions requiring urgent treatment.

Self-Care and Coping Strategies

Sound Therapy and Masking

Use background noise to make tinnitus less noticeable. Try white noise machines, fans, soft music, nature sounds, or specialized tinnitus masking devices. Many people find relief by having gentle background sound, especially when trying to sleep or in quiet environments where tinnitus is most noticeable.

Protect Your Hearing

Prevent further damage by avoiding loud noises when possible. Wear hearing protection (earplugs or earmuffs) in noisy environments like concerts, when using power tools, or at work. Keep the volume down when using headphones or earbuds. Protecting your hearing can prevent tinnitus from worsening.

Manage Stress and Anxiety

Stress and anxiety can worsen tinnitus perception, creating a vicious cycle. Practice relaxation techniques like deep breathing, meditation, progressive muscle relaxation, or yoga. Regular exercise can also help reduce stress and improve overall well-being. Consider counseling or cognitive behavioral therapy (CBT) if tinnitus is causing significant distress.

Limit Caffeine, Alcohol, and Nicotine

These substances can affect blood flow to the ear and may worsen tinnitus in some people. Try reducing or eliminating caffeine, alcohol, and tobacco to see if your symptoms improve. Keep a diary to track whether these substances affect your tinnitus.

Ensure Adequate Sleep

Fatigue can make tinnitus more bothersome. Establish good sleep hygiene with a consistent sleep schedule, comfortable sleep environment, and relaxing bedtime routine. Use sound masking if tinnitus interferes with falling asleep. Avoid screens before bed and limit caffeine in the afternoon and evening.

Try Tinnitus Retraining Therapy (TRT)

TRT combines sound therapy with counseling to help you habituate to tinnitus. The goal is to train your brain to ignore the tinnitus sound, making it less noticeable over time. This approach requires working with a trained audiologist or hearing specialist and typically takes 12-24 months.

Consider Hearing Aids

If you have hearing loss along with tinnitus, hearing aids can help by amplifying external sounds, making tinnitus less noticeable. Many modern hearing aids include built-in tinnitus masking features. Improving your hearing can significantly reduce tinnitus perception.

Frequently Asked Questions

Prevention Tips

While you can't prevent all causes of tinnitus, you can significantly reduce your risk by protecting your hearing from loud noise exposure. Always wear hearing protection (earplugs or earmuffs) in noisy environments like concerts, sporting events, when using power tools, lawn mowers, or other loud equipment, and in occupational settings with high noise levels. If you work in a noisy environment, follow workplace hearing conservation programs and use provided hearing protection consistently. Keep the volume at safe levels when using headphones or earbuds—follow the 60/60 rule (no more than 60% volume for no more than 60 minutes at a time). Take breaks from noise exposure to give your ears time to recover. Maintain cardiovascular health through regular exercise, healthy diet, and managing conditions like high blood pressure and diabetes, as good circulation supports ear health. Avoid or limit ototoxic medications when possible—discuss alternatives with your doctor if you need to take medications known to cause tinnitus. Don't use cotton swabs to clean your ears, as this can push earwax deeper and cause blockages; let earwax naturally migrate out or have it professionally removed if needed. Limit exposure to caffeine, alcohol, and nicotine, which can affect blood flow to the ears. Manage stress through regular exercise, adequate sleep, and relaxation techniques, as stress can trigger or worsen tinnitus. If you have existing tinnitus, preventing it from worsening is crucial—continue protecting your hearing and avoiding loud noise exposure. Have your hearing checked regularly, especially if you're over 50 or work in noisy environments, as early detection of hearing loss can help prevent or minimize tinnitus. By taking these preventive measures, you can significantly reduce your risk of developing tinnitus or prevent existing tinnitus from getting worse.

The Bottom Line

Tinnitus is the perception of sound (ringing, buzzing, hissing, or other noises) when no external sound is present, affecting 15-20% of Americans. It's not a disease but a symptom of underlying conditions like noise-induced hearing loss, age-related hearing loss, earwax blockage, ear disorders, certain medications, head injuries, or circulatory problems. While tinnitus can be frustrating and distressing, especially initially, most people adapt to it over time through habituation. There's no cure for most cases of tinnitus, but various management strategies can significantly reduce its impact on quality of life. Effective approaches include sound therapy and masking, hearing protection to prevent worsening, stress management, limiting caffeine and alcohol, ensuring adequate sleep, tinnitus retraining therapy, and hearing aids if you have hearing loss. Some causes of tinnitus, like earwax blockage or ear infections, are easily treatable and may resolve completely. If you develop tinnitus, especially if it's sudden, affects one ear only, is pulsatile, or is accompanied by other symptoms, consult a healthcare provider for evaluation to rule out serious conditions and discuss treatment options. With proper management and coping strategies, most people with tinnitus can maintain good quality of life despite the condition.