Tinnitus (Ringing in the Ears): Causes, When to Worry and How It Is Assessed

AudiologyOctober 6, 20268 min read

Tinnitus is hearing a sound, such as ringing, buzzing, hissing, humming or whooshing, that does not come from anything around you. It is very common, it is not a disease in itself, and it is often linked to hearing loss, exposure to loud noise, ear wax or other ear problems. For many people it is mild and comes and goes; for others it is persistent and bothersome.

Most tinnitus is not a sign of a serious condition, but some patterns need prompt medical attention: tinnitus in one ear only, tinnitus that pulses in time with your heartbeat, or tinnitus that comes with sudden hearing loss, dizziness or weakness in the face. If tinnitus is affecting your daily life, a tinnitus assessment can help find likely causes and suitable ways to manage it.

What is tinnitus?

Tinnitus is the perception of sound without an external source. People describe it in many ways: a high-pitched ring, a low hum, a hiss like steam, buzzing, clicking or a sound like rushing water. It may be heard in one ear, both ears or "inside the head". It can be constant or come and go, and it may seem louder in quiet places or at night.

Tinnitus is a symptom rather than a diagnosis. It usually reflects a change somewhere in the hearing system, most often in the inner ear, and the way the brain responds to that change.

What causes ringing in the ears?

Tinnitus often has more than one contributing factor. Common causes and triggers include:

Hearing loss. Tinnitus very often goes hand in hand with hearing loss, including age-related hearing loss. When the brain receives less sound from the ear, it may "fill the gap" with its own activity, which is heard as tinnitus.
Loud noise. Exposure to loud music, machinery or events can cause temporary ringing, and repeated exposure can lead to lasting tinnitus and hearing damage. See Headphones and Earbuds: How to Listen Safely for practical prevention.
Ear wax build-up or other blockages in the ear canal.
Ear infections and fluid in the middle ear.
Certain medicines can cause or worsen tinnitus in some people. Do not stop any prescribed medicine on your own; discuss it with your doctor.
Head or neck injury.
Jaw joint problems and muscle tension in the jaw or neck.
Stress, anxiety and tiredness, which do not usually cause tinnitus on their own but can make it more noticeable and harder to cope with.
Other health conditions affecting blood flow or the inner ear, which is one reason why certain types of tinnitus should be checked by a doctor.

Sometimes no clear cause is found, which can be frustrating, but management can still help.

Is tinnitus serious?

In most people, tinnitus is not caused by a serious illness. However, it can have a real impact on sleep, concentration, mood and quality of life, and that impact deserves attention in its own right.

When to seek medical attention promptly

See a doctor promptly if you have:

Tinnitus in one ear only, especially if it is new or persistent
Pulsatile tinnitus, a rhythmic sound that beats in time with your heartbeat
Tinnitus with sudden hearing loss, which may be a medical emergency; read Sudden Hearing Loss in One Ear: Why It Needs Urgent Medical Attention
Tinnitus with dizziness or a spinning sensation
Tinnitus after a head injury
Tinnitus with weakness, drooping or numbness in the face, or other new neurological symptoms
Tinnitus with ear pain and discharge

Seek help as well if tinnitus is causing significant distress, anxiety or low mood. You do not have to manage this alone.

How is tinnitus assessed?

A tinnitus assessment aims to understand your tinnitus, find possible causes and identify what will help you. It usually includes:

A detailed history. What the tinnitus sounds like, which ear, when it started, whether it is constant or comes and goes, whether it pulses, what makes it better or worse, and how it affects sleep, work and mood.
An ear examination to check for wax, infection or eardrum problems.
A full hearing test. Because tinnitus is so often linked to hearing loss, a hearing test is a core part of the assessment. It may include pure-tone audiometry, speech tests and middle-ear tests. For more on these, read Hearing Loss: Types, Causes, Signs and What to Do Next.
Questionnaires that measure how much tinnitus is affecting your daily life, which also help track progress.
Tinnitus matching, in some cases, where the audiologist plays sounds to estimate the pitch and loudness of your tinnitus.
Referral to a doctor if any findings suggest a medical cause needs to be ruled out.

At the end, your audiologist will explain what the results show and discuss options with you.

How is tinnitus managed?

There is no single treatment that works for everyone, and claims of a guaranteed cure should be treated with caution. However, many people find that their tinnitus becomes less noticeable and less bothersome over time, especially with the right support. Options may include:

Treating any underlying cause, such as wax or an ear infection, with medical help.
Hearing aids, if you have hearing loss. Amplifying everyday sounds can make tinnitus less noticeable for many people, and some hearing aids include sound features designed for tinnitus. Hearing Aids: A Complete Guide to How They Work and Getting Started explains the basics.
Sound therapy, using gentle background sound such as soft music, nature sounds or a fan to reduce the contrast between tinnitus and silence.
Counselling and education, which help reduce worry about tinnitus and change how the brain responds to it.
Cognitive behavioural therapy (CBT) and related approaches, delivered by trained professionals, which can help reduce the distress tinnitus causes.
Healthy routines: managing stress, regular exercise, good sleep habits and protecting your ears from loud noise.

Living with tinnitus day to day

Avoid complete silence; a low level of background sound often helps.
Protect your ears from loud noise to avoid making tinnitus or hearing loss worse.
Notice what makes your tinnitus worse, such as stress or lack of sleep, and adjust where you can.
Try relaxation techniques that suit you, such as breathing exercises.
If tinnitus disturbs your sleep, read Tinnitus at Night: Practical Ways to Sleep Better.

When to see a specialist

Book a tinnitus or hearing assessment if:

Tinnitus has lasted for some time or keeps coming back
It affects your sleep, concentration or mood
You also notice difficulty hearing, especially in noise
It started after exposure to loud noise

See a doctor promptly for tinnitus in one ear only, pulsing tinnitus, tinnitus with sudden hearing loss or dizziness, after a head injury, or with facial weakness.

Our tinnitus assessment and hearing test services are available at our centre in Bousher, Muscat, without a referral. You can book online.

Frequently asked questions

Can tinnitus go away on its own?

Sometimes. Tinnitus after a loud event, a cold or a wax build-up often settles once the cause passes or is treated. Long-standing tinnitus may not disappear completely, but many people find it becomes less noticeable and less bothersome over time, especially with support.

Is tinnitus in one ear a concern?

Tinnitus in one ear only should be checked by a doctor, especially if it is new, persistent, pulsing, or comes with hearing loss or dizziness. Most cases turn out not to be serious, but it is important to rule out conditions that need medical care. A hearing test is usually part of the assessment.

Can hearing aids help with tinnitus?

If you have hearing loss as well as tinnitus, hearing aids may help by making everyday sounds easier to hear and tinnitus less noticeable. Some devices also offer sound features designed for tinnitus. An audiologist can assess whether hearing aids are likely to help in your case.

Sources

This article is general information and does not replace advice from a qualified professional.

Tinnitus Assessment & Follow-up Ashfeera Ashraf