Ringing in Your Ears: Symptoms, Causes, and Treatments

Tinnitus is the sensation of hearing a sound in or around the head when it is not coming from an external source. The sound is commonly described as buzzing, ringing, or hissing. It can be continuous or intermittent.

According to the American Tinnitus Association, an estimated 50 million people in the United States live with tinnitus, and 16 million people describe it as frequent.¹   

What Is Tinnitus?

There are two main types of tinnitus: subjective and objective.

• Objective tinnitus: Tinnitus is considered objective when someone else can hear the noise. Objective tinnitus is commonly caused by turbulence in blood vessels or movement of musculoskeletal structures.
• Subjective tinnitus: With subjective tinnitus, only the person experiencing tinnitus can hear it. Subjective tinnitus is thought to result from abnormal nerve activity in the part of the brain that processes sound.

The sounds from tinnitus are believed to come from the brain, except when there is an identifiable blood vessel or musculoskeletal cause.²

Common Causes of Tinnitus

Some health conditions cause or worsen tinnitus. Common causes of tinnitus include:

• Blood vessel disorders: A buildup of plaque, high blood pressure, or kinks or malformations in blood vessels can cause turbulence and sounds in and around the ear. High blood pressure and abnormal lipid levels are frequently associated with having an unhealthy body composition. High blood sugar and high cholesterol levels are also associated with an increased risk of age-related hearing loss.³
• Ear infection or eustachian tube dysfunction: The eustachian tube drains fluid from the middle ear to the back of the throat. It equalizes pressure between these two chambers. If pressure changes too much in the middle ear, it can cause tinnitus.
• Hearing loss: As you age and accumulate a lifetime of exposure to loud noises, it can cause damage to the delicate hairs in the cochlea (hearing organ). When these hairs are damaged, they can send inappropriate electrical impulses to your brain. Your brain interprets these as noise (tinnitus).
• Medications: Some medications are known to cause tinnitus or at least make it worse. Examples include nonsteroidal anti-inflammatory drugs, some antibiotics, and water pills (diuretics, antidepressants, and antimalarial medications).

Other Causes of Tinnitus

Other less common causes of tinnitus include:

• Meniere’s disease
• Otosclerosis: abnormal bone growth or repair in the middle ear
• Temporomandibular joint disorders
• Chiari malformations
• Neurologic disorders causing muscle spasms in the inner ear
• Nerve compression
• Genetic predisposition
• Acoustic neuromas
• Thyroid disease
• Multiple sclerosis
• Vitamin B12 deficiency

Risk Factors for Tinnitus

Increasing age is the biggest risk factor for tinnitus, with a peak prevalence of 14.3% between ages 60 and 69. Other risk factors and populations at increased risk include:^1,3

• Non-Hispanic whites
• Male sex
• History of hearing impairment
• Being a military veteran
• High blood pressure
• History of smoking
• Prolonged exposure to loud noises
• Having  generalized anxiety disorder
• Mood disorders and other cognitive health concerns

How To Prevent Tinnitus

You can decrease your risk for tinnitus by taking the following steps:

• Protect your ears from loud noises
• Have your hearing tested
• Maintain a healthy weight, blood pressure, blood sugar, and cholesterol levels
• Stop smoking
• Check your medications for side effects

Tinnitus Treatment Options

Treatment options for tinnitus depend on the cause. The first step in treating tinnitus is to treat any underlying medical conditions that may be causing or contributing to it.^3,4

• Correct hearing loss: Hearing aids to correct hearing deficits may ease or minimize tinnitus
• Treating ear conditions: Removing ear wax or treating an ear infection
• Treat temporomandibular junction (TMJ) disorders: Dental appliances or exercises can relieve tooth grinding or clenching
• Check medications: Some medications can cause or worsen tinnitus. If your medication is known to increase tinnitus, ask if another medication or dosage option is available
• Conservative management: Lifestyle changes to improve sleep, reduce stress, and reduce alcohol and caffeine consumption may improve symptoms
• Noise: Sound amplification, noise amplification, and white noise may relieve symptoms
• Medications: Melatonin may improve tinnitus and improve sleep. There are currently no FDA-approved medications to treat tinnitus
• Rehabilitation therapies: A combination of counseling and noise generators may help reduce anxiety associated with tinnitus
• Technology: Phone apps can help train your brain to ignore tinnitus⁵

Complications Related to Tinnitus

Tinnitus can interrupt sleep and cause anxiety, fatigue, depression, and problems with memory and concentration.

When To See a Doctor

Tinnitus can be a sign of a more serious condition. Contact your doctor if you have any of these symptoms or if your tinnitus persists, worsens, or is associated with other symptoms.

• Pulsatile noises
• Tinnitus in only one ear that persists
• Symptoms such as dizziness, feeling off balance, nausea, or vomiting
• Tinnitus that starts after a head injury
• High or low blood pressure
• A history of endocrine or autoimmune conditions
• Neurologic symptoms of any kind

Disclaimer

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References:

1. Shargorodsky J, Curhan GC, Farwell WR. Prevalence and characteristics of tinnitus among US adults. Am J Med. 2010 Aug;123(8):711-8. doi: 10.1016/j.amjmed.2010.02.015. PMID: 20670725.
2. Qiu C, Salvi R, Ding D, Burkard R. Inner hair cell loss leads to enhanced response amplitudes in auditory cortex of unanesthetized chinchillas: evidence for increased system gain. Hear Res. 2000 Jan;139(1-2):153-71. doi: 10.1016/s0378-5955(99)00171-9. PMID: 10601720.
3. Wu V, Cooke B, Eitutis S, Simpson MTW, Beyea JA. Approach to tinnitus management. Can Fam Physician. 2018 Jul;64(7):491-495. PMID: 30002023; PMCID: PMC6042678.
4. Folmer RL, Martin WH, Shi Y. Tinnitus: questions to reveal the cause, answers to provide relief. J Fam Pract. 2004;53(7):532–40.
5. Searchfield GD, Sanders PJ. A randomized single-blind controlled trial of a prototype digital polytherapeutic for tinnitus. Front Neurol. 2022;13:958730. doi:10.3389/fneur.2022.958730

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