Ringing in the ears, known as tinnitus, affects roughly 10% of U.S. adults each year. The sound can show up as ringing, buzzing, hissing, or humming, and its causes range from something as simple as earwax buildup to underlying conditions involving the blood vessels, jaw, or inner ear. In most cases, hearing loss is the driving factor: about 8 to 9 out of 10 people with long-term tinnitus have some degree of hearing loss behind it.
Hearing Loss Is the Most Common Cause
The tiny hair-like cells inside your inner ear convert sound vibrations into electrical signals your brain interprets as sound. When those cells are damaged or bent, they can misfire, sending signals to your brain even when no external sound is present. Your brain reads those signals as ringing, buzzing, or hissing.
Two types of hearing loss account for most tinnitus cases. Age-related hearing loss is the single most common trigger. As you get older, the delicate structures in your inner ear gradually wear down, and the resulting gap in hearing can prompt your brain to “fill in” the missing input with phantom sound. The second major cause is noise exposure. A single blast of loud sound, like gunfire or a concert at close range, can damage those inner ear cells permanently. So can years of working around machinery, power tools, or loud music. Once those cells are damaged, they don’t regenerate.
Earwax and Physical Blockages
Sometimes the cause is surprisingly simple. When earwax builds up enough to block the ear canal, it can muffle incoming sound and create pressure changes that trigger ringing. The tinnitus from earwax impaction often comes with a feeling of fullness, mild pain, or muffled hearing. The good news is that once the blockage is removed, the ringing typically resolves. A healthcare provider can safely clear impacted wax in a quick office visit.
Medications That Can Trigger Ringing
Certain medications are known to affect the inner ear, a property called ototoxicity. The ringing may appear during treatment and sometimes fades after stopping the drug, though in some cases the damage is permanent. Common culprits include:
- High-dose aspirin and similar pain relievers
- Certain antibiotics (particularly macrolides like azithromycin when taken at high doses over extended periods)
- Loop diuretics used for heart failure and kidney disease
- Some chemotherapy drugs, especially platinum-based agents
- Newer biologic therapies, including some immunotherapy and disease-modifying drugs
Combining two or more of these medications raises the risk significantly. Taking a chemotherapy drug alongside a loop diuretic, for instance, can cause far greater hearing damage than either one alone. Most of the highest-risk scenarios involve drugs given at high doses during hospitalization, but even outpatient prescriptions can contribute if you’re already prone to tinnitus.
Jaw Problems and Meniere’s Disease
Your jaw joint sits remarkably close to your ear canal, and dysfunction in that joint (TMJ disorder) can produce or worsen tinnitus. Clenching, grinding, or misalignment in the jaw creates tension in the surrounding muscles and can irritate structures near the ear. People with TMJ issues often notice that their tinnitus changes when they open their mouth wide or clench their teeth.
Meniere’s disease is a chronic inner ear condition that causes episodes of vertigo, hearing loss, ear fullness, and tinnitus. It’s thought to stem from abnormal fluid buildup in the inner ear. The tinnitus in Meniere’s disease tends to come and go with flare-ups rather than staying constant, and it usually affects one ear.
Pulsatile Tinnitus: When You Hear Your Heartbeat
If the sound in your ear pulses in time with your heartbeat, that’s a distinct type called pulsatile tinnitus, and it has different causes than the more common steady ringing. Pulsatile tinnitus is generated by actual blood flow near the ear rather than misfiring nerve signals, which makes identifying the source especially important. Some of these causes carry a real risk of stroke or vision loss.
Vascular causes fall into two broad categories. On the venous side, abnormalities in the large veins draining blood from the brain can create turbulent flow that you hear as a rhythmic whooshing. This includes narrowing of the sinuses inside the skull, abnormally positioned jugular veins (present in 10 to 15% of people), and a condition called idiopathic intracranial hypertension, where pressure inside the skull rises without an obvious reason. On the arterial side, narrowed carotid arteries, tears in artery walls, aneurysms, and abnormal connections between arteries and veins near the ear can all produce pulsatile sounds.
High Blood Pressure, Stress, and Diet
High blood pressure can contribute to tinnitus by increasing the force of blood flow through vessels near the ear. Ironically, some medications used to treat high blood pressure, including diuretics and certain other classes, may also trigger or worsen ringing as a side effect.
Stress and anxiety don’t cause tinnitus on their own, but they reliably amplify it. The relationship runs in both directions: tinnitus increases stress, and stress makes tinnitus louder and harder to ignore. People who manage their stress effectively often report that the ringing becomes less intrusive even when it hasn’t objectively changed.
The connection between diet and tinnitus is less clear-cut. A large U.K. study of over 34,500 people found that higher fat intake was associated with tinnitus, and some individuals report that caffeine, salt, or alcohol worsens their symptoms. Reducing coffee intake helped a subset of people who drank moderate amounts (roughly one to two cups daily), though heavier coffee drinkers saw less benefit. Keeping a food diary to track your personal triggers is one of the more practical steps you can take.
How Tinnitus Gets Diagnosed
Figuring out the cause typically starts with a hearing test. You’ll sit in a soundproof booth wearing earphones and indicate when you can hear tones at different pitches. The results map out which frequencies you hear well and which you’ve lost, and that pattern often points directly to the cause. Age-related loss looks different from noise damage, for example.
Your provider will also examine your ears, head, and neck. You may be asked to move your eyes, clench your jaw, or turn your head while listening to whether the tinnitus changes. If it shifts with jaw or neck movement, that suggests a physical (somatic) cause like TMJ dysfunction. Blood tests can check for anemia, thyroid problems, heart disease, or vitamin deficiencies that sometimes contribute. Imaging with a CT or MRI scan is reserved for specific situations, particularly pulsatile tinnitus, one-sided ringing, or cases where a growth needs to be ruled out.
Signs That Need Prompt Attention
Most tinnitus is not dangerous, but certain patterns signal something more serious. Ringing that appears only in one ear is a common presenting sign of both acoustic neuroma (a benign growth on the hearing nerve) and Meniere’s disease, and warrants a hearing test followed by an MRI if the results show uneven hearing between ears.
Pulsatile tinnitus that beats with your heart should always be evaluated, since the vascular causes behind it can carry stroke risk. Sudden hearing loss with new tinnitus is treated as an emergency because early treatment within the first few days dramatically improves the chance of hearing recovery. And any tinnitus accompanied by facial weakness, severe dizziness, or head trauma needs same-day evaluation.