Tinnitus risk factors: what raises the chance of ringing in the ears

What tinnitus is

Tinnitus is the perception of sound that does not have an external source, so other people cannot hear it. It is commonly described as a ringing sound, but some people hear roaring or buzzing (NIDCD). MedlinePlus adds clicking and hissing, and says it can be soft or loud, high or low pitched, in one or both ears (MedlinePlus).

Tinnitus is common: surveys estimate that 10 to 25% of adults have it, and children can have it too. It may improve or even go away over time, but in some cases it gets worse. When it lasts three months or longer, it is considered chronic (NIDCD).

There is no score or calculator on this page; the factors below are the ones NIDCD and MedlinePlus name.

What is linked to tinnitus

The exact causes are not fully understood, but most people who have tinnitus have some degree of hearing loss. NIDCD links tinnitus to these factors (NIDCD):

• Noise exposure. Many people get tinnitus after loud noise at work, a sporting event or a concert. It is the most common service-related disability among veterans, because of noise from gunfire, machinery, bomb blasts and similar sources.
• Hearing loss. Hearing loss, which can come from aging or loud noise, is strongly associated with tinnitus. Some people with hearing loss never develop it. See hearing loss risk factors.
• Medicines. Tinnitus can be a side effect of some medicines, especially at high doses. NIDCD names non-steroidal anti-inflammatory drugs (such as ibuprofen, naproxen and aspirin), certain antibiotics, anti-cancer drugs, anti-malaria medicines and antidepressants.
• Earwax or an ear infection. A blocked ear canal, from earwax or fluid from an infection, can trigger tinnitus.
• Head or neck injuries. An injury can damage the ear, the nerve that carries sound signals to the brain, or the parts of the brain that process sound.

Less common risk factors NIDCD lists (NIDCD):

• Meniere's disease, an inner ear disorder that can also cause balance problems and hearing loss. See vertigo risk factors.
• Jaw joint problems. The jaw joint sits close to the ear; jaw clenching or tooth grinding can damage nearby tissue and cause or worsen tinnitus.
• Tumors, such as a vestibular schwannoma (acoustic neuroma), a benign tumor on the nerve from the inner ear to the brain, and other head, neck and brain tumors.
• Blood vessel problems. High blood pressure, atherosclerosis or malformed blood vessels, especially in or near the ear, can change blood flow and cause tinnitus.
• Chronic conditions. Diabetes, migraines, thyroid disorders, anemia and certain autoimmune disorders such as lupus and multiple sclerosis have been linked to tinnitus.

Some people develop tinnitus for no known reason (NIDCD).

MedlinePlus lists these causes: hearing loss in older people, exposure to loud noises, ear and sinus infections, heart or blood vessel problems, Meniere's disease, brain tumors, hormonal changes in women, thyroid problems and certain medicines (MedlinePlus).

Symptoms

Symptoms vary a lot from person to person. The sound may be in one ear, both ears or the head, and may ring, buzz, roar, whistle, hum, click, hiss or squeal. It may come and go or be there all the time. Sometimes moving the head, neck or eyes, or touching parts of the body, brings it on or changes it; this is called somatosensory tinnitus (NIDCD).

Most tinnitus is subjective, meaning only you can hear it. In rare cases the sound pulses in time with your heartbeat, and a doctor may be able to hear it with a stethoscope. This is objective tinnitus, which often has a cause that can be found and treated (NIDCD).

Tinnitus is only rarely linked to a serious medical problem and usually does not interfere with daily life. Some people find it affects their mood, sleep or concentration, and in severe cases it can lead to anxiety or depression (NIDCD). See anxiety risk factors and insomnia risk factors.

How tinnitus is checked

NIDCD advises seeing your primary care doctor first. They check for earwax or fluid from an ear infection and ask about your medical history and medicines. You may be referred to an ear, nose and throat doctor (ENT), who examines your head, neck and ears, and to an audiologist, who measures your hearing. The ENT may order MRI, CT or ultrasound, especially if your tinnitus pulses, to look for a structural problem or an underlying condition (NIDCD).

What can help

There is no cure for tinnitus, but there are ways to reduce symptoms (NIDCD). When there is a physical cause, such as earwax or a jaw joint problem, treating it can stop or greatly reduce the sound. Options NIDCD describes (NIDCD):

• Sound therapy: tabletop or smartphone sound generators, hearing aids (one of the main options for people who also have hearing loss), wearable sound generators, and combination devices.
• Behavioral therapy: education and counseling, cognitive behavioral therapy, and tinnitus retraining therapy.
• Medicines: there are no medicines specifically for tinnitus, but a doctor may prescribe antidepressants or anti-anxiety medicines to help mood or sleep. Vitamins, herbal extracts and supplements advertised as cures have not been proven to work.

Counseling can teach ways to avoid making symptoms worse, such as limiting your exposure to loud noise (NIDCD). MedlinePlus says treatment depends on the cause (MedlinePlus).

Common questions

Can loud music or concerts cause tinnitus?

Yes. NIDCD says many people get tinnitus after loud noise at work, a sporting event or a concert (NIDCD).

Can medicines cause ringing in the ears?

Some can, especially at high doses, including NSAIDs such as ibuprofen, naproxen and aspirin, certain antibiotics, anti-cancer drugs, anti-malaria medicines and antidepressants (NIDCD).

Is tinnitus a sign of something serious?

Only rarely. In rare cases the sound pulses in time with your heartbeat; if a doctor can hear it with a stethoscope, it is called objective tinnitus and often has a cause that can be found and treated (NIDCD).