Health Library Ringing in the Ears (Tinnitus)From Healthwise

Many people experience an occasional ringing (or roaring, hissing, buzzing, or tinkling) in their ears. The sound usually lasts only a few minutes. Ringing in the ears that does not get better or go away is called tinnitus. You may hear a sound, such as a ringing or roaring, that does not come from your surroundings (nobody else can hear it). The sound may keep time with your heartbeat, it may keep pace with your breathing, it may be constant, or it may come and go. Tinnitus is most common in people older than age 40. Men have problems with tinnitus more often than women.

See a picture of the ear.

There are two main types of tinnitus.

• Pulsatile (like a heartbeat) tinnitus is often caused by sounds created by muscle movements near the ear, changes in the ear canal, or blood flow (vascular) problems in the face or neck. You may hear sounds such as your own pulse or the contractions of your muscles.
• Nonpulsatile tinnitus is caused by problems in the nerves involved with hearing. You may hear sounds in one or both ears. Sometimes this type of tinnitus is described as coming from inside the head.

The most common cause of tinnitus is hearing loss that occurs with aging (presbycusis), but it can also be caused by living or working around loud noises ( acoustic trauma). Tinnitus can occur with all types of hearing loss and may be a symptom of almost any ear disorder. Other possible causes of tinnitus include:

• A buildup of earwax.
• Medicines, especially antibiotics or large amounts of aspirin.
• Drinking an excessive amount of alcohol or caffeinated beverages.
• Ear infections or eardrum rupture.
• Dental or other problems affecting the mouth, such as temporomandibular (TM) problems.
• Injuries, such as whiplash or a direct blow to the ear or head.
• Injury to the inner ear following surgery or radiation therapy to the head or neck.
• A rapid change in environmental pressure (barotrauma).
• Severe weight loss from malnutrition or excessive dieting.
• Repeated exercise with the neck in a hyperextended position, such as when bicycle riding.
• Blood flow (vascular) problems, such as carotid atherosclerosis, AV malformations, and high blood pressure (hypertension).
• Nerve problems (neurologic disorders), such as multiple sclerosis or migraine headache.
• Other diseases. These may include:
  • Acoustic neuroma.
  • Anemia.
  • Labyrinthitis.
  • Ménière's disease.
  • Otosclerosis.
  • Thyroid disease.

Most tinnitus that comes and goes does not require medical treatment. You may need to see your doctor if tinnitus occurs with other symptoms, does not get better or go away, or is in only one ear. There may not be a cure for tinnitus, but your doctor can help you learn how to live with the problem and make sure a more serious problem is not causing your symptoms.

Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a doctor.

Tinnitus and:

• Severe headache
• Vision changes
• Loss of coordination or vertigo that prevents standing or walking
• Severe vomiting
• Signs of a stroke

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

If you have any of the following symptoms, evaluate those symptoms first.

• Tinnitus that occurs following a head injury: Go to the topic Head Injury, Age 4 and Older.
• Tinnitus that occurs with ear pain, drainage, or a fever: Go to the topic Ear Problems, Age 12 and Older.

	Yes	Do you have any symptoms of nerve damage?
When to See a Doctor See significance of symptoms of nerve damage if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you have new numbness or weakness on one side of the face or the body? Call your health professional today if you answer "Yes" to the following question. Yes Did tinnitus came on suddenly and is in only one ear, but you do not have other symptoms? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Do you have tinnitus along with chronic, ongoing changes in the nervous system? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have new tinnitus with other symptoms?
When to See a Doctor See significance of new tinnitus if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have vertigo? Yes Do you feel like you have lost your balance? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have hearing loss? Yes Do you have nausea or vomiting? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Have you been in a car crash that set off the air bag within the last 2 weeks? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Have you had new tinnitus without other symptoms for longer than 2 weeks? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Have you had an injury to your ear?
When to See a Doctor See significance of an ear injury if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: Head injuries that cause hearing loss or ongoing tinnitus are more serious than localized ear injuries with similar symptoms. If your symptoms are the result of a head injury, go to the topic Head Injury, Age 4 and Older. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have drainage or bleeding from the ear? Yes Are you having trouble hearing or understanding sounds? Yes Do you have vertigo? Yes Do you have a severe earache? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Have you had tinnitus that is slowly getting worse for longer than 24 hours after an injury to the ear, but you do not have other symptoms? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Have you had tinnitus for longer than 2 weeks that has not gotten better? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you think your tinnitus may be caused by a medicine?
When to See a Doctor See significance of a medicine causing tinnitus if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to any of the following questions. Yes Did tinnitus begin after you started taking a new medicine? Yes Did tinnitus begin after you increased a dose of a medicine you were already taking? Note: If you answered Yes to either of the above questions: Call the doctor who prescribed the medicine to determine whether you should stop taking the medicine or take a different one. An appointment may not be necessary. If you are taking a nonprescription medicine, stop taking it. Call your doctor if you feel you need to continue taking the medicine. If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Have you had tinnitus for longer than 2 weeks?
When to See a Doctor See significance of persistent tinnitus if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Have you had tinnitus for longer than 2 weeks? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.

Other Symptoms to Watch For

Do you have the following symptom?

• Earwax: Go to the topic Earwax.
• An object in the ear: Go to the topic Objects in the Ear.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

The following tips may help you reduce symptoms of tinnitus.

• Cut back on or stop drinking alcohol and beverages containing caffeine.
• Stop smoking and stop using smokeless tobacco products. Nicotine use makes tinnitus worse by reducing blood flow to the structures of the ear.
• Limit your use of aspirin, products containing aspirin, and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen.
• Exercise regularly. Exercise improves blood flow to the structures of the ear. However, avoid extended periods of exercise, such as bicycle riding, that keep your neck in a hyperextended position. For more information, see the topic Fitness.

While waiting to see whether tinnitus goes away, or if your doctor has advised you that your tinnitus will be present for a long time, try these methods to cope with the constant noise:

• Limit or avoid exposure to the noises you suspect are causing your tinnitus. If you cannot avoid loud noises, wear protective earplugs or earmuffs.
• Try to ignore the sound by directing your attention to other things.
• Practice relaxation techniques, such as biofeedback, meditation, or yoga. Stress and fatigue seem to make tinnitus worse.
• Quiet rooms can cause tinnitus to seem more distracting. Background noise may reduce the amount of noise you hear. Play music or white noise when you are trying to fall asleep or anytime you find yourself in a quiet place. Try using a fan, a humidifier, or a machine that makes soothing sounds such as ocean waves.
• Try the herbal supplement ginkgo biloba. Some studies suggest that it may help relieve tinnitus, but other studies do not show a benefit. Further studies are needed to determine the best dosage.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment:

• Symptoms develop that are related to nerve damage, such as loss of coordination or numbness or weakness on one side of the face or one side of the body.
• Other symptoms develop, such as significant hearing loss, vertigo, loss of balance, nausea or vomiting.
• Tinnitus localizes to one ear.
• Hearing loss becomes worse within 24 hours after an ear injury, or tinnitus or hearing loss does not improve within 1 week of an ear injury.
• Tinnitus continues for 2 weeks, despite the use of home treatment.
• Your symptoms become more severe or more frequent.

You may be able to prevent ringing in the ears if you:

• Limit or avoid exposure to loud noises, such as music, power tools, gunshots, and industrial machinery.
  • Wear protective earplugs or earmuffs if you cannot avoid loud noises. Do not use wadded-up tissue or cotton balls. These do not protect adequately against loud noises, especially the more dangerous high frequencies, and they may become lodged in the ear canal.
  • Be careful when using stereo headphones. If music is so loud that others can hear it clearly or you can't hear other sounds around you, the volume is too high.
• Cut back on or stop drinking alcohol and beverages containing caffeine.
• Do not smoke or use smokeless tobacco products. Nicotine use may cause tinnitus by reducing blood flow to the structures of the ear. For more information, see the topic Quitting Tobacco Use.
• Exercise regularly. Exercise may prevent tinnitus because it improves blood flow to the structures of the ear. For more information, see the topic Fitness.
• Maintain a healthy weight. Tinnitus occurs more frequently in obese adults. For more information, see the topic Healthy Weight.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

• When did your tinnitus start?
• Have you ever had tinnitus before? How old were you when you first had problems with tinnitus?
• Is the tinnitus in one or both ears? Do you feel like the noise is inside your head?
• How would you describe your tinnitus?
  • Is it high-pitched or low-pitched?
  • Is it constant, or does it come and go?
  • Is it steady, or does it pulsate? If it pulsates, is it in time with your heartbeat or is it irregular with no steady rhythm?
  • Do you hear roaring, clicking, or blowing noises?
  • Does it change when you swallow or yawn?
• Have you noticed any hearing loss?
• Have you had a recent injury to the ear?
• Have you recently been involved in a motor vehicle accident that set off the air bag?
• Do you have any other symptoms of a nervous system problem, such as numbness, weakness, or loss of coordination?
• Do you have frequent headaches or temporomandibular (TM) pain?
• Do you have any symptoms of vertigo?
• Have you recently lost 20 lb (9 kg) or more?
• What prescription and nonprescription medicines are you currently taking?
  • How long have you taken these medicines?
  • Have you recently started taking any new medicines?
  • Have you increased your dose of any medicines?
  • Did you ever use streptomycin, gentamicin, or other ear medicines in the past?
• Do you have any health risks?

Organization

• Benign Paroxysmal Positional Vertigo (BPPV)
• Ear Infections
• Ear Problems and Injuries, Age 12 and Older
• Earwax
• Head Injury, Age 4 and Older
• Labyrinthitis
• Ménière's Disease
• Quitting Tobacco Use
• Temporomandibular (TM) Disorders
• Vestibular Neuritis

Author:	Jan Nissl, RN, BS	Last Updated: February 13, 2008
Medical Review:	William M. Green, MD - Emergency Medicine Donald R. Mintz, MD - Otolaryngology
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