Ringing in the ear, known as tinnitus, is almost always caused by changes in the way your brain processes sound. About 8 to 9 out of 10 people with long-term tinnitus have some degree of underlying hearing loss. The ringing itself isn’t a disease but a symptom, and the list of things that can trigger it ranges from everyday noise exposure to jaw problems to certain medications.
Hearing Loss Is the Most Common Cause
Age-related hearing loss is the single biggest driver of tinnitus. As the tiny hair cells inside your inner ear wear down over time, they stop sending complete sound signals to your brain. Your brain compensates by turning up its own internal volume, essentially filling in the gaps with phantom sound. That phantom sound is what you hear as ringing, buzzing, or hissing.
This compensation happens through a process called neural plasticity. When your auditory system receives less input from the ear, nerve cells in the brain’s hearing centers start firing more on their own. Research on the brain’s auditory relay station shows that it’s this increase in spontaneous nerve activity, not a decrease, that drives the phantom sound perception. Groups of neurons also begin firing in sync with each other, creating patterns the brain interprets as a real sound even though nothing external is producing it.
This is why tinnitus so often accompanies hearing loss in older adults, but it can happen at any age if the hair cells are damaged by other means.
Noise Exposure and Damage Thresholds
Loud noise is the second most common cause. A single blast of gunfire, a concert without ear protection, or years of working around heavy machinery can all damage those same inner ear hair cells permanently. Once they’re gone, they don’t grow back.
Sounds at or below 70 decibels, roughly the volume of a washing machine, are unlikely to cause damage even with long exposure. But repeated or prolonged exposure at 85 decibels or above (think heavy traffic, a busy restaurant, or a lawnmower) can cause permanent hearing loss and tinnitus. The louder the sound, the less time it takes. A rock concert at 110 decibels can cause damage in minutes. Many people first notice tinnitus as a temporary ringing after a loud event. If the exposure is repeated, that ringing becomes permanent.
Earwax Blockage and Middle Ear Problems
Sometimes the cause is purely mechanical. A buildup of earwax can press against the eardrum, block the ear canal, and create or amplify ringing. This is one of the most easily fixable causes: removing the wax often resolves the tinnitus completely.
A condition called otosclerosis can also produce tinnitus. This happens when one of the three tiny bones in the middle ear, specifically the stirrup bone, becomes stuck in place due to abnormal bone growth. When that bone can’t vibrate freely, sound can’t travel through the ear properly. People with otosclerosis often experience gradual hearing loss, tinnitus, and sometimes dizziness or balance problems.
Jaw and Neck Problems
Your jaw joint sits right next to your ear canal, and the nerves that serve both areas are closely connected. Problems with the temporomandibular joint (TMJ) can produce tinnitus because nerve fibers from the jaw and upper neck feed directly into the brain’s auditory processing centers. When those nerve signals are disrupted by inflammation, muscle tension, or joint dysfunction, the brain can misinterpret them as sound.
Tight muscles in the jaw, particularly the deep chewing muscles, have been linked to middle ear symptoms. The same nerve that controls sensation in the jaw also controls tiny muscles inside the ear that help regulate pressure and dampen loud sounds. Deep pain affecting this nerve can trigger ear symptoms including ringing, a feeling of fullness, and referred pain. Physical therapy targeting the jaw, head, and neck can reduce tinnitus in people whose ringing stems from these areas. Dental treatment for jaw misalignment or grinding can also help.
Medications That Affect the Ear
Certain medications can damage the inner ear or trigger tinnitus as a side effect. The categories most commonly associated with this include:
- High-dose aspirin and related pain relievers: tinnitus from aspirin is usually temporary and resolves when the dose is lowered
- Certain antibiotics: macrolide antibiotics like azithromycin and clarithromycin, especially at high doses or over long courses
- Loop diuretics: often prescribed for heart failure or kidney disease, these can affect hearing at higher doses
- Chemotherapy drugs: platinum-based agents used in cancer treatment are among the most ototoxic medications
- Some biologic therapies: including immunotherapy and certain disease-modifying drugs
If you notice ringing that starts or worsens after beginning a new medication, that timing is worth mentioning to your prescriber. In many cases, the tinnitus resolves or improves when the medication is adjusted.
Pulsatile Tinnitus: Ringing That Beats With Your Heart
If your ear ringing has a rhythmic, whooshing quality that matches your heartbeat, that’s a distinct type called pulsatile tinnitus. Unlike the more common form, pulsatile tinnitus usually has a identifiable physical cause related to blood flow near the ear. Conditions that can produce it include:
- High blood pressure, which puts extra pressure on blood vessel walls near the ear
- Atherosclerosis, where plaque buildup makes blood flow uneven and noisier as it passes through nearby arteries
- Anemia, which increases blood flow volume and the turbulence your ear can detect
- Hyperthyroidism, which speeds up the heart and boosts blood flow
- Abnormal tangles of blood vessels (arteriovenous malformations) near the ear
- Increased pressure of fluid around the brain (idiopathic intracranial hypertension), which presses on blood vessels
Pulsatile tinnitus is worth getting checked promptly because the underlying vascular conditions are often treatable, and some require attention on their own.
One-Sided Ringing Can Signal a Growth
Tinnitus that affects only one ear, particularly when paired with hearing loss on that same side, can occasionally point to a benign tumor called an acoustic neuroma (vestibular schwannoma). This slow-growing growth develops on the nerve connecting the inner ear to the brain. About 9 out of 10 people with an acoustic neuroma experience hearing loss in just one ear, typically worsening gradually over months to years. Other signs include loss of balance, dizziness, and facial numbness.
Acoustic neuromas are not cancer and don’t usually cause the symptoms associated with other brain tumors, like headaches or memory problems. But one-sided hearing loss combined with ringing in that same ear is a pattern worth having evaluated, since early detection gives more treatment options.
Lifestyle Factors: What Actually Matters
People with tinnitus are frequently told to cut out caffeine, alcohol, and certain foods. The evidence behind most of this advice is weak. Several large scientific reviews have found no association between caffeine and tinnitus. Multiple studies also show that alcohol is not a meaningful risk factor. For most people, general diet does not appear to be a major contributor.
One lifestyle factor that does have strong evidence behind it is smoking. A substantial body of research shows that tobacco use is a genuine risk factor for developing tinnitus, likely because nicotine and other compounds in cigarette smoke constrict blood vessels and reduce blood flow to the delicate structures of the inner ear. Dietary supplements also lack evidence for most tinnitus sufferers, with a narrow exception: people with a confirmed vitamin or mineral deficiency may benefit from correcting that deficiency, but supplementation beyond that has no proven effect.
Head and Neck Injuries
Trauma to the head or neck can trigger tinnitus by damaging the inner ear structures, disrupting blood vessels near the ear, or injuring the nerves that carry sound signals to the brain. Whiplash injuries, concussions, and skull fractures are all potential causes. The tinnitus may appear immediately after the injury or develop in the weeks that follow. Chronic headaches and dizziness following a head injury often accompany the ringing, and addressing those broader post-injury symptoms can sometimes improve the tinnitus as well.