Tinnitus happens when you hear ringing in your ears. The ringing you hear when you have tinnitus is not caused by an external sound and cannot be heard by others. Tinnitus can also sound like a crackling, whooshing, humming or cicada-like sound. Tinnitus is a common problem and is especially common in older adults.
Tinnitus is often a symptom of other problems within the inner ear and may be associated with conditions such as hearing loss, ear infections or exposure to loud noises. It is not a disease in itself, but rather a signal that something in the auditory system — or, less commonly, elsewhere in the body — is not working quite as it should.
Understanding How Tinnitus Happens
Hearing normally works through a chain of events: sound waves enter the ear, vibrate the eardrum, and are converted into electrical signals by tiny hair cells within the inner ear. These signals travel along the auditory nerve to the brain, which interprets them as sound.
Tinnitus most often arises when this chain is disrupted, typically due to damage to the delicate hair cells of the inner ear. When these hair cells are damaged or lost, the brain receives less genuine input than it expects. In response, it appears to increase its own internal activity in an attempt to compensate, effectively generating a phantom sound where none exists. This helps explain why tinnitus so frequently accompanies hearing loss, and why it can persist even when there is no ongoing external cause.
Types of Tinnitus
Tinnitus is generally categorised based on whether the sound can, in principle, be detected by anyone other than the patient, and whether it follows a rhythmic pattern.
- Subjective Tinnitus: By far the most common form, subjective tinnitus is a sound only the affected person can hear, generated somewhere within the auditory system itself rather than by an actual external sound. The great majority of tinnitus cases fall into this category.
- Objective Tinnitus: A much rarer form in which the sound is genuinely produced by a physical process within the body — such as blood flow through a nearby blood vessel or small muscle spasms near the ear — and can sometimes be heard by a doctor during an examination using a stethoscope.
- Pulsatile Tinnitus: A distinct pattern in which the sound is rhythmic and beats in time with the heartbeat, often described as a whooshing or throbbing sound. It is more frequently linked to blood vessel-related causes, such as high blood pressure or changes in blood flow near the ear, and is generally evaluated somewhat differently from other forms of tinnitus.
Symptoms of Tinnitus
Ringing in the ear is the most common symptom of tinnitus. However, tinnitus may also include other types of noises such as buzzing, roaring, clicking, hissing or humming. These noises may be constant or intermittent, may vary in pitch from a low hum to a high-pitched whine, and may be heard in one or both ears. In some cases, tinnitus may be so loud it interferes with your ability to concentrate or hear external sound.
The way tinnitus is experienced can also change over time. Some people notice it more in quiet environments, such as at night while trying to fall asleep, when there is less external sound to mask it. Others find that stress, fatigue or certain foods and drinks can make their tinnitus temporarily more noticeable, even though the underlying cause has not changed.
Causes of Tinnitus
Tinnitus is a common symptom of some medical conditions. Some common causes of tinnitus include:
- Age-related hearing loss: When hearing loss occurs, your brain receives less stimulation, but your auditory nerve may still be firing as it always had. This may cause you to hear sounds that aren't really there. About 1 in 3 older adults above the age of 65 develop tinnitus, making age-related hearing loss one of the most frequently identified underlying causes.
- Noise-induced hearing loss: Exposure to loud noises can cause hearing loss and tinnitus. This may happen over time, through years of exposure to moderately loud environments, or from a single accident such as an explosion or a close gunshot, which can cause sudden and sometimes permanent damage to the delicate structures of the inner ear.
- Ear injuries: Certain injuries may injure nerves or areas of the brain involved with hearing. People who get tinnitus after an injury usually only have ringing in one ear, and the tinnitus may appear immediately after the injury or develop gradually in the weeks that follow.
- Medications: Certain drugs, including some antibiotics, antidepressants, cancer drugs and NSAIDs, may cause tinnitus. This effect is sometimes dose-dependent and may improve once the medication is stopped or the dose is adjusted, though this should always be discussed with the prescribing doctor rather than stopping medication independently.
What Are the Risk Factors of Tinnitus?
Tinnitus may be experienced by anyone but there are factors that increases your risk:
- Age: As you age, the number of functioning nerves and hair cells in your ears decline, which may possibly cause hearing problems associated with tinnitus. This is part of why tinnitus becomes considerably more common from middle age onward.
- Sex: Men are more likely to experience tinnitus, a pattern seen consistently across studies, though the exact reasons for this difference are not fully understood and may relate to differences in occupational or recreational noise exposure.
- Exposure to loud noises: Loud noises are common sources of noise-related hearing loss. This could come from heavy machinery, firearms, or loud concerts. People who work in noisy environments, such as those working in construction, musicians or soldiers, are at a higher risk, particularly when adequate hearing protection is not consistently used.
- Tobacco and alcohol use: Smoking and drinking alcohol increases your risk of developing tinnitus, likely related to their broader effects on blood flow and circulation to the small, sensitive blood vessels supplying the inner ear.
- Pre-existing health conditions: Obesity, cardiovascular problems, high blood pressure, and arthritis are some conditions that may increase your risk of tinnitus, generally through their shared effects on blood flow, circulation, or the joints and muscles near the ear (in the case of jaw-related arthritis).
How Tinnitus Affects Daily Life
While tinnitus itself is not dangerous, its impact on quality of life can be considerable, particularly when it is persistent or loud.
- Sleep disturbance: Because tinnitus is often more noticeable in the quiet of night, many people find it disrupts their ability to fall or stay asleep, which can, over time, contribute to daytime fatigue.
- Difficulty concentrating: Persistent background noise can make it harder to focus on conversations, reading or work tasks, particularly in already quiet environments.
- Emotional impact: Living with an ongoing, uncontrollable sound can understandably contribute to stress, anxiety or low mood, especially when tinnitus is loud, constant, or not yet fully understood by the person experiencing it.
- Sound sensitivity: Some people with tinnitus also develop an increased sensitivity to everyday sounds, known as hyperacusis, in which normal noises are perceived as uncomfortably loud.
These effects vary considerably from person to person — some barely notice their tinnitus day to day, while others find it significantly affects their wellbeing, which is why management is generally tailored to how much distress or disruption the tinnitus is actually causing, rather than to the loudness of the sound alone.
How is Tinnitus diagnosed?
- Hearing Test (Audiogram): You'll be made to sit in a soundproof room wearing earphones that transmit specific sounds into one ear at a time, and you'll be asked when you can hear the sound. Your results will be compared to what is considered normal for your age, as tinnitus is very frequently accompanied by some degree of hearing loss.
- Tinnitus Pitch and Loudness Matching: A specific test in which you help identify the pitch and volume of the sound you are hearing by comparing it against reference tones, which can help characterise your tinnitus and track any changes over time.
- Tympanometry: Measures how well the eardrum moves in response to changes in air pressure, helping to identify any middle ear problems, such as fluid or a perforation, that could be contributing to tinnitus.
- Imaging Tests (CT or MRI): You may be asked to perform imaging tests such as CT or MRI scans depending on the suspected cause of your tinnitus, particularly if it affects only one ear, is pulsatile, or is accompanied by other symptoms suggesting a structural cause needs to be ruled out.
- Blood Tests: May be used to check for underlying conditions sometimes associated with tinnitus, such as thyroid problems, anaemia, or cardiovascular risk factors.
Management of Tinnitus
There is currently no single cure for most forms of tinnitus, but a wide range of approaches can meaningfully reduce how noticeable or bothersome it is, and treatment often starts with identifying and addressing any underlying cause.
Addressing an Underlying Cause When tinnitus is linked to a specific, identifiable cause — such as earwax blockage, a middle ear infection, or a particular medication — treating that underlying issue can sometimes resolve or significantly improve the tinnitus itself. For tinnitus related to hearing loss, hearing aids are often one of the most effective interventions, as amplifying external sound can reduce the relative prominence of the internal tinnitus sound and ease the brain's compensatory overactivity.
Sound-based Therapies - Using a noise machine: You can listen to white noise, nature sounds, or ambient soundscapes to help distract your brain and reduce your tinnitus symptoms, particularly useful in quiet environments such as at bedtime.
- Wearing in-ear noise generators: These are earbuds which emit a continuous white noise hum for tinnitus relief, offering a more discreet, portable option for managing tinnitus throughout the day.
- Tinnitus retraining therapy: A more structured, long-term approach that combines low-level sound therapy with counselling, aiming to retrain the brain to reclassify the tinnitus sound as unimportant background noise over a period of months.
Psychological and Behavioural Support Cognitive behavioural therapy (CBT) has a strong evidence base for tinnitus that is causing significant distress. Rather than aiming to eliminate the sound itself, CBT helps patients change their emotional and behavioural response to tinnitus, which can substantially reduce its impact on daily life even when the sound itself does not change. Relaxation techniques and stress management can also help, given how closely stress and tinnitus perception are linked for many people.
Lifestyle Adjustments
Reducing exposure to loud noises, using hearing protection in noisy environments, and moderating alcohol, caffeine and tobacco use can help manage symptoms and reduce the likelihood of further inner ear damage that could worsen tinnitus over time.
For most people, tinnitus is a manageable, long-term symptom rather than a sign of a dangerous underlying problem, though it can take some trial and adjustment to find the combination of strategies that works best for a given individual. Understanding what is driving the tinnitus, ruling out any specific treatable cause, and building a personalised management plan — often combining sound therapy, addressing any hearing loss, and psychological support where needed — allows most patients to substantially reduce how much tinnitus affects their daily life, even when the underlying sound itself cannot be completely eliminated.
