Tinnitus: Why Are Your Ears Ringing?

Tinnitus is that annoyingly persistent sound in one or both ears. Learn why we sometimes get it and what you can do about it.

Do you hear a persistent ringing, buzzing or hissing sound in your ears? If so, you may be one of the millions of people with tinnitus. Tinnitus is a common condition that can affect anyone. It’s not usually a sign of something more serious, but it can be annoying and disrupt your quality of life.

What is tinnitus?

Tinnitus is often described as hearing sounds like ringing or humming, even when there's no external noise. It may sound like buzzing, clicking, hissing or roaring, and the noise could be intermittent or non-stop. The volume and pitch can vary — it can be soft or loud, low or high. You can have tinnitus in one or both ears, and it can even disappear and reappear over time.

“Tinnitus usually comes from hearing loss. The brain has lost input, so you can think of it as the brain overcompensating for the lack of audio signal from the ear,” explains William James Azeredo, MD, an ear, nose and throat (ENT) specialist at Geisinger.

Types of tinnitus

Subjective tinnitus is the most common type. Only the person who has it can hear the sounds. This is usually what people are referring to when talking about tinnitus or ringing in the ears, and it’s often caused by damage to the inner ear or auditory nerve.
Objective tinnitus is a rare type that can be heard by others as well. It’s typically caused by a physical problem in the ear such as a tumor, blood vessel abnormality or muscle contraction.
Pulsatile tinnitus is synchronized with the heartbeat. It often sounds like a rhythmic whooshing, thumping or throbbing in the ears to the beat of your pulse. “Pulsatile tinnitus is rare and would require significantly more clinical workup than other kinds,” Dr. Azeredo notes.

Tinnitus can also be classified by how long it lasts:

Acute tinnitus lasts for less than three months.
Chronic tinnitus lasts for three months or more.

And by how many ears are affected:

Bilateral or symmetric tinnitus refers to ringing in both ears.
Unilateral tinnitus means ringing in only one ear.

While the experience of tinnitus is unique to each person, one thing is certain: It can seriously impact your overall well-being. More than a minor annoyance for some, it can take a toll on physical and mental health — especially if it’s chronic.

“Even mild symptoms like a faint background noise can become exhausting, as your brain constantly filters all the sounds you hear throughout the day,” says Dr. Azeredo. The incessant noise can disrupt your concentration, interrupt sleep and lead to stress, anxiety, irritability and even depression.

What causes tinnitus?

So why did your ears suddenly start ringing? Understanding what causes tinnitus is crucial for treatment and management. Here are some common triggers:

Loud noises

This is the most common reason for tinnitus. Loud sounds like concerts, gun shots, fireworks or heavy machinery can damage the delicate cells of your inner ear. Even everyday situations like wearing headphones too loudly or for too long can cause it.

“Be sure to wear protective earplugs around loud noises and watch your daily noise input levels,” Dr. Azeredo advises.

Underlying health conditions

Meniere's disease, an inner ear condition, is commonly associated with tinnitus. Other underlying health conditions such as thyroid problems, diabetes and certain neurological disorders can also lead to tinnitus.

Medications

Some medications, including certain antibiotics, aspirin and chemotherapy drugs, are known to cause tinnitus as a side effect.

Age-related hearing loss

As we age, our hearing naturally deteriorates, a condition known as presbycusis. This gradual hearing loss can affect how the brain processes sound, leading to phantom noises like ringing or buzzing in the ears.

Earwax blockage

Earwax is our ear canal’s natural protection, but too much earwax buildup can cause tinnitus. It can clog the ear canal, blocking sound transmission, and result in ringing or buzzing sounds.

“As tempting as it is, avoid using cotton swabs to clean your earwax — they can push the wax in further and cause damage,” says Dr. Azeredo. Instead, he suggests using water, saline or hydrogen peroxide to gently clean out your ears by letting it soak for a minute, and then turning your ear towards the floor to let gravity do the rest.

Lifestyle factors

Some lifestyle factors can also trigger tinnitus or make it worse. Stress, anxiety, depression, poor sleep habits and lack of regular exercise can all increase your risk of tinnitus. Excessive stimulants like caffeine and nicotine may also worsen your symptoms.

When to see a doctor for tinnitus

If your tinnitus symptoms are disrupting your life, it may be time to see a doctor for a diagnosis. If your condition is ongoing, they’ll want to rule out that there’s nothing more serious going on. Typically, an otolaryngologist or audiologist specializing in ENT conditions can diagnose you. “In general, patients with unilateral or pulsatile tinnitus should be seen by ENT, while bilateral non-pulsatile tinnitus would first be evaluated by audiology,” Dr. Azeredo clarifies.

At your appointment, the doctor will thoroughly examine your medical history and physical symptoms. They might also conduct a hearing test to determine the degree of your hearing loss. In some cases, they may do an imaging test such as a CT scan or MRI to rule out any underlying conditions or structural abnormalities.

“The more clues we can uncover as to what’s behind your ear ringing, the more accurate your treatment plan can be,” says Dr. Azeredo.

Medical treatments for tinnitus

Here are some options for medical treatments that a doctor could recommend:

Sound therapy: Also called masking, sound therapy uses external noises to cover the tinnitus. This can include using white noise machines or hearing aids. “Nature sounds such as running water tend to work best,” says Dr. Azeredo.
Tinnitus retraining therapy: This is a form of cognitive behavioral therapy (CBT) that combines sound therapy with counseling, aiming to habituate the brain to tinnitus and make it less noticeable over time. It helps you develop coping strategies to reduce the psychological impact of tinnitus by changing the way you perceive and react to it.

Managing tinnitus at home

While there is no cure for tinnitus, some strategies can help you handle the challenges that come with it:

Hearing protection: Your two ears are the only ones you will have for life, so guard them well! Use earplugs or earmuffs in noisy environments to prevent further damage to hearing. You may want to check that your headphones are not too loud, too. Some devices have an option to monitor the audio levels, and these can be helpful reminders.
Relaxation techniques: Techniques such as deep breathing, meditation or yoga can help manage the stress associated with tinnitus.
Support groups: Connecting with others who have tinnitus can provide emotional support and other creative ideas for coping with it. Social support is especially important for those with chronic tinnitus.

Living with tinnitus can be challenging, but you don’t have to manage it alone. Protecting your ears from damage, managing your stress, maintaining a healthy lifestyle and reaching out for support can all help. Talking to your doctor to request a proper diagnosis can help you find treatments that could improve your quality of life.