Why Your Ears Ring: Main Causes of Tinnitus

Tinnitus is the perception of sound when no external noise exists. It’s a symptom, not a disease, and may appear as ringing, buzzing, or whooshing in one or both ears. Main Causes of Tinnitus are hearing loss, noise exposure, medication effects, or vascular and muscle-related issues.

Key Takeaways

• Tinnitus has different types subjective, objective, pulsatile, and somatic which help identify its source.
• Most cases come from inner-ear or nerve damage, but some stem from blood flow, joint, or muscle disorders.
• Loud noise, aging, certain drugs, and ear infections are the top triggers.
• One-sided or heartbeat-synced tinnitus requires urgent medical evaluation.
• Diagnosis involves ear examination, hearing tests, and sometimes MRI or CT scans.
• Prevention focuses on noise protection, healthy habits, and managing medical conditions that affect hearing.

What is Tinnitus

Tinnitus is not a disease in itself, but a symptom of underlying physical or neurological.You may hear it in one ear, both ears or even inside your head. The noise may be constant or come and go, and it may vary in pitch or intensity.

Types of Tinnitus

Tinnitus falls into several types, and the type often helps point toward the cause and how we evaluate it.

1. Subjective Tinnitus

This is the most common type, making up over 95% of cases. The sound is heard only by you, no one else can detect it. It often comes from problems in the inner ear or the hearing nerve pathways.
Common causes include:

• Exposure to loud noise
• Age-related hearing loss
• Earwax build-up or infections
• Certain medications that affect hearing
  

Because the sound originates from within the auditory system itself, medical instruments cannot pick it up. However, doctors may still find clues through hearing tests or scans.

2. Objective Tinnitus

This type is very rare. In these cases, the sound can actually be heard by someone else, usually a doctor using a stethoscope or special listening device near your ear. It usually means there is a physical sound source inside the body  for example:

• Blood flow through abnormal blood vessels near the ear
• Muscle contractions in the middle ear or palate that create clicking or pulsing noises
  Objective tinnitus can often be treated once the underlying physical issue is identified.

3. Non-Pulsatile Tinnitus

This type is a steady ringing, buzzing, hissing or humming sound that does not match your heartbeat. It can be constant or come and go.
It’s most often caused by inner ear or auditory nerve problems such as:

• Hearing loss
• Noise exposure
• Ear diseases like Ménière’s or otosclerosis

The sound may vary in loudness and pitch, and while it can be annoying, it rarely signals a life-threatening condition.

4. Pulsatile Tinnitus

Here, the noise follows the rhythm of your heartbeat, a pulsing, whooshing or thumping sound in sync with your pulse. This pattern often points to blood-flow-related causes, such as:

• Narrowed or twisted blood vessels near the ear
• High blood pressure
• Vascular tumours (like glomus tumours)
• Increased pressure inside the skull

 Since pulsatile tinnitus can be linked to circulation or vascular issues, it needs medical assessment to rule out serious causes.

5. Somatic or Somatic-Modulated Tinnitus

This type is unique because the sound changes with movement of your head, neck, jaw or eyes. For instance, turning your head, clenching your jaw or pressing on your neck may make the sound louder or softer. This form is usually connected to muscle, joint or nerve problems rather than direct ear damage. Common sources include:

• Jaw joint (TMJ) disorders
• Neck muscle tension or posture strain
• Whiplash or cervical spine injuries
• Teeth grinding or jaw clenching

In somatic tinnitus, the brain may mix signals from sensory nerves in the jaw or neck with hearing signals, creating or modifying the perception of sound.

Core Mechanisms: How Tinnitus Happens

Before diving into specific causes, it helps to understand the basic mechanisms behind tinnitus.

• Damage or loss of hair cells in the inner ear (cochlea) can reduce the nerve input to the brain. The brain may increase neural “gain” (amplify signals) to compensate, leading to tinnitus.
• Changes in how the auditory nerve and brain process sound may lead to abnormal neural activity, which the brain interprets as sound.
• The brain’s filtering system may fail to suppress irrelevant internal noise, making tinnitus more noticeable.
• Emotional, cognitive and physical stress can amplify the perception of tinnitus even when ear damage is modest.

Common Auditory (Hearing-Related) Drivers

Here are the most frequent drivers of tinnitus tied to hearing and ear structures.

• Age-related Hearing Loss (Presbycusis): As we age, the tiny hair cells of the inner ear gradually degenerate. This leads to hearing loss, especially at high frequencies, and often to tinnitus.
• Noise-Induced Hearing Loss: Exposure to loud sound, either over many years (work, city noise, music) or from a sudden loud event, can damage the inner ear and trigger tinnitus.
• Impacted Earwax or Middle-Ear Problems: Wax build-up can change how sound is transmitted. It can cause hearing loss and trigger or worsen tinnitus. If you suspect wax build-up, it’s safer to clean your ears at home gently rather than using cotton swabs.
• Ear Infections and Eustachian Tube Dysfunction: Fluid in the middle ear, chronic ear infections or dysfunction of the eustachian tube (which equalizes ear pressure) can cause tinnitus.
• Otosclerosis and Bone Mobility Problems: When the small bones of the middle ear stiffen or do not move properly, hearing is affected and that can lead to tinnitus.
• Inner-Ear Disorders such as Ménière’s Disease: This condition involves fluctuating hearing loss, vertigo and tinnitus. The inner-ear fluid pressure changes are thought to trigger the symptoms.
• Retrocochlear Pathology (e.g., Acoustic Neuroma): In rare cases, a tumour or pathology of the auditory nerve or brainstem may cause tinnitus, especially if tinnitus is one-sided.

Medication & Toxin-Related Causes (Ototoxicity)

Some medications and toxins affect the inner ear or hearing nerve and can cause or worsen tinnitus.

• High doses of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) may trigger tinnitus, often reversible when the drug is stopped.
• Certain antibiotics (especially aminoglycosides), loop diuretics, chemotherapy agents and some painkillers have known ear toxicity.
• Some antidepressants, antimalarials, anti-seizure medications and acid-reducing drugs may contribute to sensitive individuals.
• Lifestyle substances like excessive caffeine, nicotine and alcohol may not directly cause tinnitus but can worsen it by affecting circulation or stress levels.

Ear & Skull-Base Structural Causes

Other structural problems around the ear and skull base may lead to tinnitus.

• Chronic middle-ear disease or ear surgery may lead to tinnitus due to altered ear mechanics.
• Superior semicircular canal dehiscence and other inner-ear changes can cause tinnitus by affecting fluid dynamics.
• Temporal-bone fractures, post-surgical changes or skull-base tumours may present with tinnitus.
• A patulous eustachian tube (abnormally open) may cause “autophony” that is mistaken for tinnitus.

Somatic or Muscle-Related Sources

In some cases tinnitus is influenced by joint, muscle or nerve activity around the head, neck or jaw.

• Disorders of the temporomandibular joint (TMJ) and related muscles often coincide with tinnitus. Movement of the jaw may change the tinnitus sound.
• Neck muscle tension, cervical spine injury or whiplash can modulate tinnitus.
• Jaw clenching, poor posture or grinding teeth at night may contribute.
• If moving the jaw or neck changes the tinnitus, a muscle or joint source is likely.

Pulsatile (Vascular) Causes-Urgent to Recognize

Pulsatile tinnitus (hearing your heartbeat in your ear) often signals vascular issues and needs evaluation.

• Venous causes such as a widened sigmoid sinus or high-flow blood channels near the ear.
• Arterial causes like atherosclerosis of the carotid or vertebral arteries, dissection or aneurysm.
• Dural arteriovenous fistula or arteriovenous malformation can present as pulsatile tinnitus and are potentially serious.
• Elevated intracranial pressure may cause pulsatile tinnitus.
• Paragangliomas (glomus tumours) in the middle ear or skull base can transmit vascular noise.

Systemic, Metabolic & Neurologic Associations

Some causes of tinnitus come from general health or nervous system issues.

• Metabolic problems such as diabetes, thyroid disorders, high cholesterol and hypertension.
• Autoimmune or inflammatory inner-ear disease.
• Neurological conditions such as multiple sclerosis, migraine or seizure disorders.
• Mental health factors  anxiety, depression, insomnia and stress  strongly influence how severe tinnitus feels.
• Some infections, such as viral, syphilis or Lyme disease, can affect ear nerves and trigger tinnitus.

Lifestyle Triggers & Exacerbators

Lifestyle factors often make tinnitus more noticeable even if they aren’t the original cause.

• Poor sleep, fatigue and chronic stress reduce the brain’s ability to filter internal sounds.
• Diet high in salt, caffeine, alcohol or nicotine can worsen tinnitus by altering circulation or fluid balance. Watch Your Diet: limit these and choose ear-healthy foods to support circulation and inner-ear function.
• Loud music, concerts or prolonged headphone use can trigger or worsen tinnitus.
• Sedentary lifestyle and poor posture may contribute indirectly.

Red-Flag Patterns Requiring Urgent Investigation

Certain signs of tinnitus call for immediate medical attention.

• One-sided tinnitus, especially with hearing loss or dizziness.
• Sudden tinnitus with new hearing loss or neurological symptoms.
• Pulsatile tinnitus (hearing your heartbeat in your ear).
• Tinnitus after head or neck trauma or with ear pain, discharge or infection.
• Tinnitus in people with cancer, immune problems or after radiation therapy.

Diagnostic Workflow: How Doctors Find the Cause

When someone visits a clinic with tinnitus, doctors use a step-by-step approach to find the underlying cause. The goal is to determine whether the sound is coming from the ear itself, from surrounding structures, or from another part of the body.

1. History and Symptoms

A detailed history gives the first and most important clues. Doctors ask specific questions to understand how and when the tinnitus started, what it sounds like, and what factors affect it.

• Onset: Whether the tinnitus appeared suddenly or gradually, and if it affects one ear or both.
• Sound Description: Is it ringing, buzzing, hissing, whooshing, or clicking? Is it steady or pulsating?
• Exposures: Any history of loud noise, ear infections, medication use, head or neck injury, or recent illness.
• Associated Symptoms: Hearing loss, dizziness or vertigo, a feeling of ear fullness, pain in the jaw or neck, sleep problems, stress, or mood changes.

This information helps narrow down whether the tinnitus is likely from ear damage, circulation issues, medication side effects, or muscle and nerve factors.

2. Physical Examination

After discussing your symptoms, the doctor examines the ears and nearby structures.

• Ear Inspection: Checking for wax build-up, infections, or changes in the eardrum.
• Hearing and Balance Checks: Using simple tools or tuning forks before formal testing.
• Jaw and Neck Palpation: Feeling for muscle tension or joint pain that might change the tinnitus when you move.
• Listening for Vascular Sounds: If the tinnitus matches your pulse, the doctor may use a stethoscope to detect any blood-flow noise near the ear or skull.

A careful physical exam can often reveal straightforward causes like wax blockage or middle-ear infection before more complex testing is needed.

3. Tests and Imaging

If tinnitus doesn’t have an obvious cause after the initial exam, doctors move to specialized testing.

Hearing Tests:

• Audiometry measures hearing across different pitches and volumes to identify any hearing loss pattern.
• Tympanometry checks how well the eardrum and middle-ear bones move, useful for diagnosing fluid buildup or stiffness.

Imaging Studies:

• MRI (Magnetic Resonance Imaging) is used if tinnitus is one-sided or there’s concern about nerve or brain causes like an acoustic neuroma.
• CT Scans or Vascular Scans (CTA or MRA) may be used if pulsatile tinnitus suggests a blood-flow problem.

Laboratory Tests:

• Doctors may order blood work for thyroid problems, diabetes, anemia, infections, or autoimmune markers.
• These tests help rule out systemic causes that can indirectly affect the ear.
  

4. Differential Diagnoses and Look-Alikes

Not every noise in the head is true tinnitus. Some conditions can mimic or overlap with it.

• Hyperacusis: Unusual sensitivity to normal sounds.
• Musical Ear Syndrome: Hearing songs or voices in silence, often due to hearing loss.
• Middle-Ear or Palatal Myoclonus: Muscle spasms in the ear or throat producing clicking sounds.
• Patulous Eustachian Tube: A condition where the tube stays open, making you hear your own voice or breathing loudly.

Ruling out these conditions ensures that the treatment focuses on the right cause.

Special-Population Considerations

Different groups may experience tinnitus for different reasons. Doctors take these factors into account.

• Children and Teens: Often linked to ear infections, congenital hearing loss, or loud music exposure.
• Musicians, Soldiers, Factory Workers: Usually from repeated loud-noise exposure without adequate hearing protection.
• Pregnant or Postpartum Women: Hormonal changes, increased blood flow, and fluid retention can trigger tinnitus.
• Older Adults: Hearing loss, multiple health conditions, and long-term medication use increase risk.

Prevention and Risk-Reduction Tips

Most tinnitus-related issues can be reduced or prevented with practical daily steps:

• Protect Your Ears: Use earplugs or earmuffs in loud environments or when using power tools.
• Lower the Volume: Keep headphone and earbud levels below 60% of maximum volume and take breaks.
  
• Monitor Medications: Ask your doctor to review your prescriptions if you notice ringing after starting a new drug.
• Control Health Factors: Maintain healthy blood pressure, cholesterol, and thyroid balance.
• Adopt a Healthy Lifestyle: Regular exercise, good sleep, and stress management reduce tinnitus perception.
• Watch Your Diet: Limit salt, caffeine, alcohol, and smoking, which can all worsen symptoms.
• Avoid Ear Damage: Follow safe listening habits and general hearing loss prevention strategies to protect your ears long term.

FAQs

What is the difference between subjective and objective tinnitus?
Subjective tinnitus is heard only by you, while objective tinnitus can sometimes be heard by a doctor with equipment.

Which medications most often trigger tinnitus and is it reversible?
Aspirin, certain antibiotics, chemotherapy drugs and diuretics are common culprits. It often improves when the drug is stopped.

When do I need imaging for tinnitus?
When tinnitus is one-sided, pulsatile, sudden, or associated with hearing loss or other symptoms.

Can jaw or neck problems really cause or worsen tinnitus?
Yes. Disorders of the jaw joint and neck muscles can change or intensify tinnitus sounds.

How do loud headphones or concerts affect tinnitus risk?
Loud noise damages inner-ear hair cells, reducing nerve signals and triggering tinnitus.

Does caffeine, alcohol, or salt make tinnitus worse for everyone?
Not for everyone, but these can alter circulation and worsen tinnitus in many people.

Could a tumour cause one-sided tinnitus?
Rarely, yes. Acoustic neuroma or similar conditions may present this way and need testing.

What does pulsatile tinnitus usually mean?
It often points to a blood-flow or vascular problem that needs evaluation.

Can tinnitus after a concert or infection go away on its own?
Yes, temporary tinnitus can resolve as the ear heals, but persistent ringing should be checked.

Which specialist should I see first?
Start with your primary doctor or an ear, nose and throat (ENT) specialist. They may refer you to an audiologist or neurologist if needed.

Conclusion

Tinnitus is a condition where a person hears ringing or buzzing without an actual sound source. It’s often linked to hearing loss, loud noise exposure, medications, or blood flow problems. Doctors diagnose it by examining the ears, testing hearing, and using imaging if necessary. Pulsatile tinnitus or one-sided ringing may need urgent attention. Most tinnitus cases can be managed through ear protection, healthy lifestyle choices, stress control, and medical review of underlying causes. Prevention focuses on avoiding noise exposure, maintaining heart and thyroid health, and limiting caffeine, salt, and alcohol.

Reference

• Mayo Clinic – Tinnitus: Symptoms and Causes
  https://www.mayoclinic.org/diseases-conditions/tinnitus/symptoms-causes/syc-20350156
  
• National Institute on Deafness and Other Communication Disorders (NIDCD) – What Is Tinnitus?
  https://www.nidcd.nih.gov/health/tinnitus
• National Health Service (NHS, UK) – Tinnitus Overview
  https://www.nhs.uk/conditions/tinnitus/
  
• ENT UK – Tinnitus: Ringing in the Ears
  https://www.entuk.org/patients/conditions/17/tinnitus_ringing_in_the_ears_update