The medical term for ringing in the ears is tinnitus, pronounced either “TIN-ih-tus” or “tin-EYE-tus” (both are accepted). It’s defined as a phantom auditory perception, meaning you hear sound without any external source producing it. About 11.2% of the U.S. adult population, roughly 27 million people, experience tinnitus. Of those, around 41% hear it constantly rather than intermittently, and nearly 28% have dealt with it for 15 years or longer.
What Tinnitus Sounds Like
While “ringing” is the most commonly described sensation, tinnitus can also sound like hissing, clicking, roaring, buzzing, or humming. Some people hear a single tone, others hear multiple tones, and the perceived pitch and volume can shift over time. The sound may be present in one ear, both ears, or seem to come from inside the head with no clear side.
Subjective vs. Objective Tinnitus
Doctors divide tinnitus into two categories. Subjective tinnitus is by far the more common type. Only you can hear it, and there’s no detectable sound coming from your ear. It’s driven by changes in the way your brain processes auditory signals.
Objective tinnitus is rare. A doctor can actually hear the sound emanating from your ear canal during an exam, often using a stethoscope. It’s typically caused by blood vessel abnormalities or muscle contractions near the ear. Some physicians use the term “somatosound” specifically for this type.
Why Your Brain Creates Phantom Sound
Tinnitus usually starts with some degree of reduced input from the ear to the brain, whether from noise damage, age-related changes, or another cause. When the brain receives less auditory information than it expects, it compensates by turning up its own internal volume. Neurons in the auditory system begin firing more frequently and more in sync with each other, even though no actual sound is triggering them. This hyperexcitability is what you perceive as ringing or buzzing.
Over time, the brain can reorganize its neural connections around this new pattern, a process called neural plasticity. That’s the same mechanism your brain uses to form memories and learn new skills, but in this case it works against you by reinforcing the phantom sound. This is one reason tinnitus often becomes harder to ignore the longer it persists. The changes also extend beyond the hearing centers of the brain into areas that process emotion and attention, which helps explain why tinnitus can feel so distressing relative to its actual volume.
The Hearing Loss Connection
Nearly all people with tinnitus have some measurable hearing loss, even if they haven’t noticed it yet. The relationship works in one direction more reliably than the other: tinnitus almost always accompanies hearing loss, but plenty of people with hearing loss never develop tinnitus.
The link is mechanical. When hair cells in the inner ear are damaged (from loud noise, aging, or infection), fewer signals reach the brain. That deprivation of input triggers the compensatory hyperactivity described above. Even mild hearing loss from a middle ear problem like fluid buildup or stiffening of the tiny ear bones can reduce input enough to kick off the process.
Common Causes and Triggers
Noise exposure is the single most recognized trigger. Prolonged exposure to loud environments or a single blast of intense sound can damage the delicate hair cells in the inner ear permanently. Age-related hearing decline is the other major driver, which is why tinnitus prevalence rises steadily after age 50.
A surprisingly long list of medications can cause or worsen tinnitus. Common over-the-counter pain relievers like aspirin, ibuprofen, and naproxen are known culprits, particularly at higher doses. Certain antibiotics, some blood pressure medications (especially loop diuretics, beta blockers, and ACE inhibitors), platinum-based chemotherapy drugs, and even some antidepressants can trigger it. In many cases the tinnitus resolves after stopping the medication, but not always.
Other causes include earwax buildup pressing against the eardrum, jaw joint disorders, head or neck injuries, and conditions like Meniere’s disease that affect the inner ear’s fluid balance.
Pulsatile Tinnitus Is Different
If the sound you hear has a rhythmic beat that matches your pulse, that’s called pulsatile tinnitus, and it has a distinct set of causes. Unlike regular tinnitus, pulsatile tinnitus often has a physical source that can be identified and sometimes fixed.
The most common cause of intermittent pulsatile tinnitus is uncontrolled high blood pressure. The most common cause overall is atherosclerotic carotid disease, where narrowing in the carotid arteries creates turbulent blood flow that you can actually hear. You’ll typically hear it on the same side as the affected artery.
In younger women, particularly those who are overweight, pulsatile tinnitus in both ears can signal a condition called idiopathic intracranial hypertension, where pressure from cerebrospinal fluid is elevated. These patients often also experience headaches and vision changes. Less common causes include small vascular tumors near the ear (called paragangliomas), anemia, thyroid overactivity, and even pregnancy, all of which increase blood flow enough to become audible.
How Tinnitus Is Diagnosed
There’s no single test that confirms tinnitus, since the experience is inherently subjective. Diagnosis starts with a clinical evaluation and a hearing test (audiometry) to check for underlying hearing loss. Your doctor will also look inside your ears with an otoscope to rule out visible problems like wax buildup or signs of a vascular mass behind the eardrum.
What happens next depends on the type. For standard nonpulsatile tinnitus that affects one ear, an MRI of the brain may be ordered to rule out a growth on the hearing nerve called a vestibular schwannoma. For pulsatile tinnitus, imaging focuses on blood vessels. A CT scan of the temporal bone can detect vascular tumors and abnormal vessel paths. CT angiography or MRI with specialized vascular sequences can identify artery narrowing, abnormal connections between arteries and veins, or problems with the venous sinuses in the skull.
Treatment and Management
There is no pill that cures tinnitus, but several approaches can significantly reduce how much it bothers you. The most effective strategy depends on the cause.
If hearing loss is a factor, hearing aids often help. By restoring the missing sound input, they reduce the brain’s compensatory hyperactivity. Many people find their tinnitus becomes less noticeable or disappears entirely while wearing hearing aids.
Tinnitus Retraining Therapy (TRT) combines low-level background sound with counseling to help your brain reclassify the tinnitus signal as unimportant. In one study of 57 patients, tinnitus completely disappeared in about 60% after treatment, and overall improvement was seen in 86%. The remaining 14% saw no change. Results are typically assessed over about three months.
Sound therapy on its own, using white noise machines, nature sounds, or specially designed apps, can mask tinnitus enough to make sleep and concentration easier. Cognitive behavioral therapy helps people change their emotional response to tinnitus, which often matters more than the volume itself. For pulsatile tinnitus caused by a specific vascular problem, treating the underlying condition (managing blood pressure, repairing an abnormal vessel, or removing a tumor) can eliminate the sound entirely.