Tinnitus is sound you hear that is not coming from the room. It can be a ring, a roar, a squeal, or a whine, in one ear or both, on and off or all the time.
What the noise is
It is common. For many people it is an annoyance. For some it is loud enough to crowd out sleep, work, and conversation. Other people usually cannot hear it. The exception is objective tinnitus, which a clinician can sometimes hear too. That type comes from blood flow near the ear or from tiny muscles in the middle ear clicking or crackling. It is the less common kind, and it gets a different workup.
Causes worth finding
The noise only you can hear has a long list of causes. Some are minor. A plug of wax can do it until the wax is removed. So can a middle ear infection, fluid, a hole in the eardrum, or stiffening of the middle ear bones (otosclerosis). Allergy, high or low blood pressure, diabetes, thyroid disease, and a head or neck injury can contribute. Some medicines do too, including certain anti-inflammatories, antibiotics, sedatives, and antidepressants. Aspirin, taken in high doses for your size, is a known trigger. Tell us if the ringing started after a new medicine.
Less often, tinnitus with hearing loss is a sign of an acoustic neuroma or a blood-vessel problem in the head and neck. Those are uncommon. They are why an ear exam and a hearing test come before anyone calls the noise "just ringing."
Most tinnitus that has no other finding comes from worn or injured nerve endings in the inner ear. Those endings carry sharp hearing. Damage brings hearing loss, and often tinnitus with it. Age does some of this. Loud sound does more of it now: job noise, firearms, concerts, and headphones played too loud.
What can be done
If we find a cause we can treat, the noise may leave with it. Wax, infection, and a repairable eardrum are examples. The visit can include a hearing test and, when the story suggests it, imaging or lab work. Many people have no single cause. A medicine trial is sometimes useful. It is not a cure for everyone.
When the cause stays unknown, the goal is to turn the volume down in daily life:
- Protect the ears from loud sound
- Have blood pressure checked, and treat it if it is high
- Cut added salt, which works against circulation
- Cut caffeine and nicotine
- Move most days, and sleep enough
- Stop treating the sound as a threat. It does not, by itself, mean you are going deaf, and attention makes it louder
A soft, steady background sound can cover tinnitus at night. Some people do well with a hearing aid when there is also hearing loss, because outside sound competes with the ring. Biofeedback is another option when the noise and the anxiety around it feed each other. A hearing aid trial is reasonable even for a mild loss if tinnitus is the main complaint. If the main goal is relief from tinnitus, say that before you buy a device.
Tinnitus is evaluated as part of our ear, nose, and throat care. Wax as a cause is covered in earwax. Inner ear pressure that also brings vertigo is covered in how the ear works.
