Ringing in the Ears (Tinnitus)
Many people have ringing (or roaring, hissing, buzzing, or tinkling) in their ears now and then. The sound usually lasts only a few minutes. Ringing in the ears that doesn't get better or go away is called tinnitus. You may hear a sound, such as a ringing or roaring, that doesn't come from your surroundings. (So nobody else can hear it.) The sound may keep time with your heartbeat, or it may keep pace with your breathing. It may be constant, or it may come and go. Tinnitus is most common in people older than age 40. Men have it more often than women do.
There are two main types of tinnitus.
- Pulsatile (like a heartbeat) tinnitus is often caused by sounds created by muscle movements near the ear, changes in the ear canal, or blood flow (vascular) problems in the face or neck. You may hear sounds such as your own pulse or the contractions of your muscles.
- Nonpulsatile tinnitus is caused by problems in the nerves involved with hearing. You may hear sounds in one or both ears. Sometimes this type of tinnitus is described as coming from inside the head.
The most common cause of tinnitus is hearing loss that occurs with aging (presbycusis). But it can also be caused by living or working around loud noises (acoustic trauma). Tinnitus can occur with all types of hearing loss. It may be a symptom of almost any ear disorder. Other possible causes of tinnitus include:
- Medicines, especially antibiotics or large amounts of aspirin.
- Injuries. This may include whiplash or a direct hit to the ear or head.
- Blood flow problems. These include carotid atherosclerosis, arteriovenous (AV) malformations, and high blood pressure.
- Nerve problems, such as multiple sclerosis or migraine headache.
Most tinnitus that comes and goes doesn't need medical treatment. You may need to see your doctor if tinnitus occurs with other symptoms, doesn't get better or go away, or is in only one ear. There may not be a cure for tinnitus, but your doctor can help you learn how to live with the problem. Your doctor can also make sure that a more serious problem isn't causing your symptoms.
Check Your Symptoms
The medical assessment of symptoms is based on the body parts you have.
- If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
- If your symptoms aren’t related to those organs, you can choose the gender you identify with.
- If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.
Many things can affect how your body responds to a symptom and what kind of care you may need. These include:
- Your age. Babies and older adults tend to get sicker quicker.
- Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
- Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, herbal remedies, or supplements can cause symptoms or make them worse.
- Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
- Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.
Try Home Treatment
You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.
- Try home treatment to relieve the symptoms.
- Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
Many prescription and nonprescription medicines can cause ringing in the ears (tinnitus). A few examples are:
- Aspirin, ibuprofen (such as Advil or Motrin), and naproxen (such as Aleve).
- Some blood pressure and heart medicines.
- Some antidepressants.
- Some cancer medicines.
Vertigo is the feeling that you or your surroundings are moving when there is no actual movement. It may feel like spinning, whirling, or tilting. Vertigo may make you sick to your stomach, and you may have trouble standing, walking, or keeping your balance.
Seek Care Today
Based on your answers, you may need care soon. The problem probably will not get better without medical care.
- Call your doctor today to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care today.
- If it is evening, watch the symptoms and seek care in the morning.
- If the symptoms get worse, seek care sooner.
Seek Care Now
Based on your answers, you may need care right away. The problem is likely to get worse without medical care.
- Call your doctor now to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care in the next hour.
- You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.
Make an Appointment
Based on your answers, the problem may not improve without medical care.
- Make an appointment to see your doctor in the next 1 to 2 weeks.
- If appropriate, try home treatment while you are waiting for the appointment.
- If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.
These home treatment tips can help to reduce symptoms while you wait to see if tinnitus goes away. They can also help you cope if you have tinnitus for a long time.
- Limit alcohol and caffeine.
Cut back on or stop drinking alcohol and drinks that contain caffeine.
- Avoid tobacco.
Stop smoking, and don't use smokeless tobacco products. Nicotine use makes tinnitus worse by reducing blood flow to the structures of the ear.
- Be careful with NSAIDs.
Limit your use of aspirin, products containing aspirin, and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen.
- Exercise regularly.
Exercise improves blood flow to the structures of the ear. But avoid extended periods of exercise, such as bicycle riding, that keep your neck in a hyperextended position.
- Avoid loud noises.
Limit or avoid being exposed to the noises that may be causing your tinnitus. If you can't avoid loud noises, wear protective earplugs or earmuffs.
- Try to ignore the sound by directing your attention to other things.
- Practice relaxation techniques.
Try biofeedback, meditation, or yoga. Stress and fatigue seem to make tinnitus worse.
- Use other sounds to mask tinnitus.
Quiet rooms can cause tinnitus to seem more distracting. Background noise may reduce the amount of noise you hear. Play music or white noise when you are trying to fall asleep or anytime you find yourself in a quiet place. Try using a fan, a humidifier, or a machine that makes soothing sounds such as ocean waves.
- Try the herbal supplement ginkgo biloba.
Some studies suggest that it may help relieve tinnitus, but other studies don't show a benefit. Further studies are needed to find the best dosage.
When to call for help during self-care
Call a doctor if any of the following occur during self-care at home:
- New symptoms, such as hearing loss, dizziness, loss of balance, numbness or weakness on one side of the face, or nausea or vomiting.
- Tinnitus starts to occur in just one ear.
- Tinnitus or hearing loss does not improve.
- Symptoms occur more often or are more severe.
Preparing For Your Appointment
You can help your doctor diagnose and treat your condition by being prepared for your appointment.
Current as of: September 8, 2021
Author: Healthwise Staff
William H. Blahd Jr. MD, FACEP - Emergency Medicine
Kathleen Romito MD - Family Medicine
Adam Husney MD - Family Medicine