Tinnitus

What tinnitus sounds like

Most tinnitus is subjective: only you can hear it. The sound and pattern help point to a cause.

Common causes

• Age-related hearing loss (presbycusis): the most common cause. Tinnitus often appears before people notice hearing loss.
• Noise exposure (acoustic trauma): concerts, power tools, firearms, headphones at high volume.
• Earwax blocking the canal.
• Ear infections and fluid behind the eardrum.
• Jaw and neck problems: temporomandibular joint disorders can cause tinnitus that changes when you clench, open your jaw or move your neck.
• Medicines: high-dose aspirin, some antibiotics (aminoglycosides), loop diuretics, some chemotherapy (cisplatin), quinine.
• Stress, anxiety and poor sleep: make tinnitus more noticeable.

Pulsatile tinnitus

Hearing your heartbeat in your ear is different from ringing. It comes from turbulent blood flow in vessels near the ear and is more likely to have a specific, treatable cause:

• high blood pressure, anemia or an overactive thyroid (faster, stronger blood flow)
• narrowing of the carotid artery
• idiopathic intracranial hypertension (raised pressure around the brain), often in young women with headaches and vision changes
• narrowing or abnormality of the venous sinuses
• vascular tumors of the middle ear (glomus tumors)
• arteriovenous malformations or fistulas

New pulsatile tinnitus usually needs a doctor's exam and imaging such as CT or MR angiography.

One ear vs both ears

Tinnitus in both ears with gradual hearing loss is usually age- or noise-related. Tinnitus in one ear is more likely to be due to earwax, infection, Meniere's disease, sudden hearing loss or, rarely, an acoustic neuroma, a benign tumor of the hearing nerve. One-sided tinnitus that persists usually leads to a hearing test and often an MRI.

Tinnitus with other symptoms

• Sudden hearing loss: sudden sensorineural hearing loss is an ear emergency
• Vertigo and ear fullness: Meniere's disease
• Headache and vision changes: raised intracranial pressure
• Jaw pain or clicking: TMJ disorder
• Anxiety, insomnia or low mood: common with bothersome tinnitus and worth treating directly

How tinnitus is assessed

A doctor will ask about the sound, which ear, onset, noise exposure, medicines and other ear symptoms. They will look in the ears, listen over the neck and ear for a bruit (vascular sound) in pulsatile cases, and check blood pressure.

A hearing test (audiogram) is the key test and is recommended for tinnitus that is one-sided, lasts 6 months or more, or comes with hearing problems. MRI is used for one-sided tinnitus or asymmetric hearing loss, and vascular imaging for pulsatile tinnitus.

What helps

• Treat the cause: remove earwax, treat infections, review medicines, control blood pressure.
• Hearing aids: often reduce tinnitus in people with hearing loss by making outside sounds louder.
• Sound enrichment: low background sound, such as a fan, nature sounds or a sound generator, especially at bedtime.
• Cognitive behavioral therapy: the treatment with the strongest evidence for reducing tinnitus distress.
• Protect your hearing: earplugs at loud events and keeping headphone volume below about 60 percent.

See tinnitus as a condition for how it develops and longer-term management.

Frequently asked questions

What does tinnitus sound like?

Tinnitus is most often a high-pitched ringing, but it can also sound like buzzing, hissing, whistling, humming, roaring, clicking or a pulsing whoosh. It may be constant or come and go, and can be in one ear, both ears or seem to be inside the head.

What does pulsatile tinnitus mean?

Pulsatile tinnitus is a whooshing or thumping sound in time with your heartbeat. It comes from blood flow near the ear and can be caused by high blood pressure, anemia, narrowed blood vessels, raised pressure around the brain or vascular tumors. New pulsatile tinnitus should be checked by a doctor.

Is tinnitus in one ear serious?

Usually not, as earwax, infections and noise exposure are common causes. However, persistent tinnitus in one ear, especially with hearing loss on the same side, should be assessed with a hearing test and sometimes an MRI to rule out an acoustic neuroma.

Can tinnitus go away on its own?

Tinnitus after loud noise, an ear infection or earwax often goes away once the cause resolves. Tinnitus linked to permanent hearing loss usually persists, but many people become far less aware of it over months as the brain habituates.

Why do I suddenly hear ringing in one ear for a few seconds?

Brief, sudden ringing in one ear that fades within a minute is very common and usually harmless. It may be accompanied by a feeling of fullness. If it becomes frequent, lasts longer or comes with hearing loss, see a doctor.