Tinnitus: What Causes Ringing in the Ears and What Helps

Tinnitus is hearing a sound, usually ringing, buzzing, hissing or humming, that has no source outside your body. It is common: a 2022 meta-analysis in JAMA Neurology of 83 prevalence studies found that 14.4% of adults have some tinnitus, and 2.3% have it severely. Most people with tinnitus have some hearing loss, and loud noise is one of the best known triggers. There is no cure yet, but the World Health Organization says chronic tinnitus "can be managed effectively", mainly with cognitive behavioral therapy (CBT), sound therapy and, for people with hearing loss, hearing aids.

Key facts

• 14.4% of adults worldwide have any tinnitus, rising to 23.6% of people aged 65 and over (Jarach et al., JAMA Neurology, 2022).
• The same review estimates tinnitus affects more than 740 million adults and is a major problem for more than 120 million (JAMA Neurology).
• Tinnitus lasting three months or longer is considered chronic (NIDCD).
• Tinnitus that beats in time with your pulse warrants an urgent appointment, according to the NHS.
• In a festival trial, new tinnitus appeared in 40% of people without earplugs and 12% of people with them (JAMA Otolaryngology, 2016).
• No medicine has been shown to cure tinnitus; the WHO states that no pharmacological treatments have been shown to be effective.

What is tinnitus?

The US National Institute on Deafness and Other Communication Disorders (NIDCD) defines tinnitus as the perception of sound that does not have an external source, so other people cannot hear it. The sound can ring, buzz, roar, whistle, hum, click, hiss or squeal. It may sit in one ear, both ears or inside the head, and it may be constant or come and go.

Two distinctions matter for what happens next:

• Subjective or objective. Almost all tinnitus is subjective: only you hear it. In rare cases the sound pulses with the heartbeat and a doctor can hear it with a stethoscope. NIDCD notes that this objective tinnitus often has an identifiable cause and is treatable.
• Acute or chronic. The WHO calls tinnitus acute when it has lasted less than three months and chronic beyond that. It also separates "tinnitus", the sound itself, from "tinnitus disorder", where the sound comes with emotional distress or problems with concentration.

The NIDCD says tinnitus is usually not severe enough to interfere with daily life, but for some people it affects mood, sleep and concentration, and in severe cases it can lead to anxiety or depression.

Where does the sound come from? A leading theory, described by NIDCD, is that damage in the inner ear changes the signals reaching the brain, and the phantom sound is generated in the auditory cortex rather than in the ear itself.

How common is tinnitus?

Estimates vary with how a study defines tinnitus, but the broad picture is consistent across agencies and countries.

Measure	Figure	Source
Adults worldwide with any tinnitus	14.4%	JAMA Neurology, 2022
Adults aged 18 to 44	9.7%	JAMA Neurology, 2022
Adults aged 45 to 64	13.7%	JAMA Neurology, 2022
Adults aged 65 and over	23.6%	JAMA Neurology, 2022
Adults with severe tinnitus	2.3%	JAMA Neurology, 2022
Adults with chronic tinnitus	9.8%	JAMA Neurology, 2022
US adults with tinnitus (survey estimates)	10% to 25%	NIDCD
Australians who have tinnitus at some point	Up to 1 in 5	healthdirect Australia

The JAMA Neurology review found no significant difference between men (14.1%) and women (13.1%), but a clear rise with age. The WHO links that rise partly to age-related hearing loss and notes that older adults with chronic tinnitus can find it louder and more distressing than younger people do.

How are tinnitus, noise and hearing loss linked?

Hearing loss is the strongest link. The WHO calls it "the most important risk factor for tinnitus", and NIDCD says most people with tinnitus have some degree of hearing loss. The link is not absolute: tinnitus can occur with normal hearing, and many people with hearing loss never develop it.

Noise works through the same route. Loud sound tires and can damage the sensory hair cells in the inner ear. The WHO safe listening guidance describes the familiar pattern after a loud concert: muffled hearing and ringing that often fade as the cells recover. With repeated exposure, the damage can become permanent, leaving noise-induced hearing loss, tinnitus, or both. NIDCD adds that tinnitus is the most common service-related disability among US veterans, reflecting exposure to gunfire, machinery and blasts.

Other recognized causes and triggers, listed by NIDCD and the NHS, include:

• earwax or fluid from an ear infection blocking the ear canal
• certain medicines, especially at high doses, including NSAIDs such as ibuprofen and aspirin, some antibiotics and some chemotherapy drugs
• head or neck injuries
• in rare cases, a benign tumor on the hearing and balance nerve (vestibular schwannoma)

Some people develop tinnitus with no cause ever found.

When should you see a doctor about tinnitus?

The WHO advises seeing a doctor about tinnitus in general, and especially if it is sudden with hearing loss, dizziness or pain, has lasted more than three months, or affects your quality of life. The NHS sets out three levels of urgency that are a useful checklist wherever you live:

Situation	What the NHS advises
Tinnitus after a head injury	Emergency care now
Tinnitus with sudden hearing loss, facial muscle weakness or vertigo	Emergency care now
Tinnitus that beats in time with your pulse	Urgent GP appointment
Tinnitus that is regular or constant, getting worse, or affecting sleep, concentration or mood	Routine GP appointment

Source: NHS, Tinnitus. In Australia, healthdirect advises seeing your doctor if you have tinnitus or hearing loss symptoms and runs a 24 hour nurse helpline on 1800 022 222.

A first appointment usually means an ear examination to look for wax or infection, questions about medicines and health history, and a hearing test. Scans are not routine. The American Academy of Otolaryngology guideline recommends against imaging when tinnitus is in both ears, is not pulsatile, and comes without neurologic signs or uneven hearing loss. Pulsatile or one-sided tinnitus is more likely to be investigated.

What treatments for tinnitus have evidence behind them?

When there is a fixable cause, such as earwax or an ear infection, treating it can remove or greatly reduce the sound, according to NIDCD. For persistent tinnitus without a fixable cause, the aim shifts from silencing the sound to reducing its effect on your life. Guidelines in the US and UK agree on the main options.

Cognitive behavioral therapy

CBT has the strongest recommendation. The US clinical practice guideline from the American Academy of Otolaryngology, Head and Neck Surgery Foundation tells clinicians to recommend CBT to patients with persistent, bothersome tinnitus. A 2020 Cochrane review of 28 studies with 2,733 participants found that CBT may reduce the impact of tinnitus on quality of life, equal to a Tinnitus Handicap Inventory score 10.91 points lower than no treatment on a 100 point scale, above the 7 point change considered clinically meaningful. The evidence was rated low certainty.

In the UK, the NHS says people are usually offered digital CBT first, delivered through an online program or app.

Hearing aids

If you have tinnitus and hearing loss, a hearing aid evaluation is a standard next step. The US guideline says clinicians should recommend a hearing aid evaluation for persistent, bothersome tinnitus with documented hearing loss. healthdirect says good quality, properly fitted hearing aids can reduce and even stop tinnitus associated with hearing loss.

The research base is still thin. A 2014 Cochrane review found only one randomized trial of hearing aids for tinnitus, with 91 participants. For people with severe hearing loss or deafness, the WHO says cochlear implants can be highly effective at suppressing tinnitus.

Sound therapy

Sound therapy uses background sound to mask tinnitus, distract from it or help the brain get used to it. Options include bedside sound machines, phone apps, a fan or radio, wearable sound generators, and combination devices that amplify and generate sound, as NIDCD describes. The US guideline lists sound therapy as an option clinicians may recommend.

Be realistic about the evidence. A 2018 Cochrane review found no evidence that sound therapy beats a waiting list, placebo or education alone, and no clear winner among hearing aids, sound generators and combination devices. All device types were associated with clinically significant improvement within studies, and many people find sound helpful for sleep. The NHS advises avoiding total silence.

Tinnitus retraining therapy and counseling

Tinnitus retraining therapy combines counseling with low level sound from an ear-worn device so that the brain learns to treat tinnitus as neutral. The NHS says it may be available for severe or persistent tinnitus, but it is unclear whether it works for everyone.

What does not have support

The US guideline recommends against routine use of antidepressants, anticonvulsants, anti-anxiety drugs or injections into the ear for tinnitus, and against Ginkgo biloba, melatonin, zinc and other supplements. It also recommends against routine transcranial magnetic stimulation. NIDCD adds that no vitamin, herbal extract or supplement advertised as a tinnitus cure has been proven effective.

How can you prevent tinnitus?

Not every case can be prevented, but the most common cause, damage from loud sound, largely can. The WHO states that protecting the ears from loud sounds is highly effective at preventing hearing loss and reduces the risk of developing tinnitus.

Earplugs work at real events. In a randomized trial at an Amsterdam music festival, where the average sound level was 100 dBA over four and a half hours, 42% of unprotected ears showed temporary hearing loss compared with 8% of ears with earplugs, and new tinnitus appeared in 40% of the unprotected group against 12% of the earplug group.

How long you can safely listen depends on both level and time. The WHO's weekly safe listening limits show how quickly the allowance shrinks:

Sound level	Example	Safe listening time per week
60 dB	Normal conversation	Unlimited
80 dB	Doorbell	40 hours
85 dB	Heavy traffic, inside a car	12 hours 30 minutes
90 dB	Shouted conversation	4 hours
95 dB	Motorcycle	1 hour 15 minutes
100 dB	Hair dryer	20 minutes
105 dB	Car horn at 5 meters	8 minutes
110 dB	Shouting in the ear	2.5 minutes
120 dB	Standing near a siren	12 seconds

Source: WHO, Deafness and hearing loss: Safe listening.

Practical steps from the WHO and healthdirect:

• Keep personal audio at no more than 60% of maximum volume, and aim for an average below 80 dB if you track it with an app.
• Use well fitted or noise cancelling headphones so you do not turn the volume up to beat background noise.
• Wear earplugs at concerts, clubs and festivals, and earplugs or earmuffs with loud tools such as lawn mowers.
• If you have to raise your voice to be heard at arm's length, the place is too loud.
• Ask your doctor or pharmacist whether any medicine you take is linked to tinnitus.

Work limits differ by country. In the US, the OSHA legal limit is 90 dBA over an 8 hour day, while NIOSH recommends keeping exposure below 85 dBA. In the UK, HSE requires employers to provide hearing protection at 85 dB(A) and to assess risk and train workers from 80 dB(A).

Frequently asked questions

Does tinnitus go away on its own?

Often, yes, when it has a temporary cause. The WHO says tinnitus may resolve after an ear infection or short-term loud noise, and wax removal can relieve it. Chronic tinnitus, lasting more than three months, is less likely to disappear, though many people habituate so that they notice it far less, as healthdirect explains.

Is ringing in the ears after a concert normal?

It is common, but it is a sign your ears were overloaded. The WHO explains that ringing after loud music usually reflects tired sensory cells and often fades, but repeated exposure can make it persistent. If it lasts, get your hearing checked and wear earplugs next time.

Can tinnitus be a sign of something serious?

Rarely. NIDCD says tinnitus is only rarely associated with a serious medical problem. Seek urgent care for tinnitus after a head injury, with sudden hearing loss, facial weakness or vertigo, or tinnitus that pulses with your heartbeat, as the NHS advises.

Does stress make tinnitus worse?

The WHO says research shows an association between stress and tinnitus but no clear causal link. Relaxation exercises, mindfulness and CBT can reduce how much tinnitus affects you.

Are there pills or supplements that cure tinnitus?

No. The WHO states that no pharmacological treatments have been shown to be effective, and the US guideline recommends against Ginkgo biloba, melatonin, zinc and other supplements for persistent tinnitus.