Ringing in the ears, known as tinnitus, affects roughly 1 in 9 adults in the United States, or about 27 million people. It can sound like ringing, buzzing, hissing, or roaring, and it ranges from a mild background nuisance to a persistent disruption. The causes span a wide range, from something as simple as earwax buildup to underlying vascular or neurological conditions.
Noise Exposure
Loud sound is one of the most common triggers. Sounds at or below 70 decibels, roughly the level of a washing machine, are unlikely to cause damage even after prolonged exposure. But repeated or sustained exposure at 85 decibels or above (think a busy restaurant, a lawnmower, or a motorcycle) can damage the delicate hair cells inside your inner ear. Once those cells are injured, they don’t regenerate. The louder the sound, the less time it takes to do harm.
This kind of noise-induced damage doesn’t always announce itself with pain. You might walk away from a concert or a day at a shooting range with temporary ringing that fades within hours. But over time, repeated exposures cause cumulative damage, and the ringing can become permanent. Many people with chronic tinnitus trace it back to years of occupational noise, recreational shooting, or regular use of earbuds at high volume.
How the Brain Creates Phantom Sound
Tinnitus isn’t always a problem in the ear itself. In many cases, it originates in the brain. When hearing loss occurs, the brain’s auditory processing center reorganizes. The neurons that once handled specific frequencies no longer receive input, so they start firing on their own, essentially filling in the gap with a phantom signal. Research published in the Proceedings of the National Academy of Sciences found that the brain area corresponding to a person’s tinnitus frequency physically shifts from its expected location, and the degree of that shift strongly correlates with how intense the tinnitus feels. This is similar to the mechanism behind phantom limb pain, where the brain continues to “feel” a limb that’s no longer there.
This helps explain why tinnitus often persists even after the original trigger is gone. The ear may have healed or the noise exposure may have stopped, but the brain’s rewiring maintains the signal.
Earwax Buildup
One of the most easily fixable causes is impacted earwax. When wax accumulates and presses against the eardrum, it can muffle hearing and create or amplify ringing. Professional removal often resolves the tinnitus entirely in these cases. If your ringing came on gradually and you also feel like sounds are muffled or your ear feels full, earwax is worth investigating before assuming something more serious.
Medications That Affect Hearing
Certain medications can damage the inner ear, a side effect called ototoxicity. The risk depends on the specific drug, the dose, and how long you take it. Most of the medications that commonly cause this problem are given at high doses, often in a hospital setting. They include:
- High-dose aspirin and related pain relievers: Tinnitus from aspirin is usually reversible once you lower the dose or stop taking it.
- Certain antibiotics: Particularly macrolide types like azithromycin and clarithromycin when prescribed at high doses for extended periods.
- Loop diuretics: These are prescribed for heart failure and kidney disease to reduce fluid in the body.
- Chemotherapy drugs: Platinum-based agents used in cancer treatment carry a well-known risk of hearing damage.
- Some biologic therapies: Including certain immunotherapy and disease-modifying drugs.
If you notice new ringing after starting a medication, bring it up with your prescriber. In some cases, switching to an alternative or adjusting the dose can resolve the issue.
Jaw and Neck Problems
The joint that connects your jaw to your skull sits very close to your ear canal, and problems in that area can produce or worsen tinnitus. When the muscles that control chewing are excessively tense or dysfunctional, they can affect nearby muscles that control the eardrum and the small bones of the middle ear. This abnormal stimulation of the ear’s structures generates tinnitus-like sounds.
If your ringing gets louder when you clench your jaw, chew, or turn your head, and you also have jaw pain, clicking, or difficulty opening your mouth fully, a jaw joint disorder may be contributing. Treating the jaw problem through physical therapy, a mouth guard, or stress reduction often improves the ear symptoms as well.
Ménière’s Disease
Ménière’s disease involves excess fluid buildup in the inner ear. It causes episodes of vertigo lasting anywhere from 20 minutes to 12 hours, along with fluctuating hearing loss, tinnitus, and a sensation of fullness or pressure in the affected ear. The tinnitus in Ménière’s disease tends to come and go with the episodes rather than being constant, though it can become more persistent over time. A diagnostic workup typically includes a hearing test and a test that measures how the inner ear responds to sound, which can reveal abnormal fluid levels.
Pulsatile Tinnitus: A Different Kind of Ringing
Most tinnitus is a steady tone or hiss. Pulsatile tinnitus is different: it throbs in rhythm with your heartbeat. This type almost always has a vascular cause, meaning it’s related to blood flow near the ear. Unlike the more common form, pulsatile tinnitus is often something a doctor can investigate and identify on imaging.
The list of potential causes is long. On the arterial side, narrowing of the carotid artery from plaque buildup, tears in the artery wall, abnormally formed blood vessels, and aneurysms can all create turbulent blood flow loud enough for the ear to detect. On the venous side, narrowing where the large veins drain behind the ear is the most common culprit. Chronic blood clots, small tissue growths that press into the vein, or compression from nearby bone structures can all restrict flow and produce turbulence that reverberates through the thin bone separating those veins from the ear.
A high-riding jugular bulb, where the large vein at the base of the skull sits abnormally close to the middle ear, is another recognized cause. The turbulent flow sits so close to the cochlea that it becomes audible.
Other Contributing Factors
High blood pressure can worsen tinnitus by increasing the force of blood flowing near the inner ear. Stress and sleep deprivation don’t cause tinnitus on their own, but they reliably make existing tinnitus louder and harder to ignore. Anxiety creates a feedback loop where you focus more on the sound, which increases your stress, which makes the sound more noticeable.
Among those with tinnitus in the U.S., about 41% report having symptoms constantly, and roughly 28% have lived with it for 15 years or more. For many of these people, the original cause may no longer be active, but the brain’s response to it has become self-sustaining.
Red Flags That Need Prompt Attention
Most tinnitus is benign, but certain patterns warrant quick evaluation. Ringing in only one ear is a common early sign of both acoustic neuroma (a benign growth on the hearing nerve) and Ménière’s disease. If one-sided tinnitus appears alongside sudden hearing loss, that combination is considered an ear emergency requiring same-day evaluation, because early treatment dramatically improves the chance of recovering hearing.
Pulsatile tinnitus that beats with your heart should also be evaluated, since it can point to arteriovenous malformations, vascular tumors, or significant artery narrowing. Tinnitus accompanied by facial weakness, severe vertigo, or a recent head injury may indicate a serious condition affecting the brain and should be assessed urgently. And any tinnitus paired with persistent ear pain or drainage from the ear canal suggests an infection or structural problem that needs medical attention sooner rather than later.