Tinnitus is the perception of abnormal ear or head noises without any external sound. Noises may be high pitched, ringing, clicking, or buzzing. Pulsatile tinnitus is caused by the flow of blood that accompanies each heartbeat.
Anatomy of the Ear
Copyright © Nucleus Medical Media, Inc.
Tinnitus is caused by: Cochlear damage from noise exposureHearing lossDamage to the auditory system
Occasional episodes of tinnitus lasting at most a few minutes are quite common in normal people, especially after exposure to loud noises.
Factors that may increase your chance of tinnitus may include: Occupations or activities that expose you to loud noisesWax or a foreign body in the ear canalStressFatigueCertain medications, such as aspirin, antibiotics, or diureticsToxins, such as heavy metals, carbon monoxide, or alcohol
Certain health conditions, such as:
Ear infectionMeniere's diseaseAllergiesHigh
or low blood pressure
DiabetesDepressionAnxietyTumorsThyroid problemsTemporomandibular joint disorder
Blood vessel disorders, such as an aneurysm, fistula, or hardening of the arteries are associated with pulsatile tinnitusFluid in the earRuptured membrane in the earInjury to the head or neck
Center for Communication and Hearing
maintains an updated list of medications that are associated with tinnitus.
The sensations of tinnitus may have the following characteristics: Ringing, roaring, buzzing, whistling, or hissing soundsIntermittent, continuous, or pulsatile qualitySame or varying intensitySingle or multiple tonesMore annoying symptoms at night or when there are fewer distractionsSensation of normal internal events, such as blood pulsing or muscles contracting
Sometimes tinnitus is accompanied by hearing loss and
vertigo, a sensation of spinning while standing still.
Call your doctor if you have tinnitus, especially if it: Is associated with hearing loss, vertigo, change in personality, speech, or weakness in any body areaStarts after head or neck injuryIs associated with new medicationIs pulsatileIs associated with pain in the ear, fever, nausea, or vomiting
The doctor will ask about your symptoms and medical history. A physical exam will be done. Special attention will be paid to your head, neck, and ears.
You will be asked questions about: The sensations that you haveThe factors that may increase or decrease the sensationThe medications that you takeHistory of trauma
The doctor will look at your ear canal and eardrum using an instrument with a light that is held at the external opening of the ear. A tuning fork can help evaluate hearing. You should receive a complete hearing test. Imaging tests, such as a
MRI, may be ordered to rule out serious conditions.
A hearing test includes: TympanogramAuditory brain responseElectrocochleoraphy—to test for Meniere's disease
Tinnitus treatment depends on what is causing the symptoms. This may mean: Wearing a specially made splint to help manage
temporomandibular joint disorderTaking antibiotics for a sinus or ear infectionHaving the wax removed from your ear canalStopping or changing medications to see if tinnitus goes away
Therapy aims to eliminate or reduce bothersome sensations. Treatment may include:
No medication has been shown to be very effective in treating tinnitus. Your doctor may still try to use some medications to ease your symptoms. These may include antidepressants and sedatives.
If you have Meniere's disease, your doctor may prescribe medication to treat that condition.
Devices include: Hearing aid—sometimes relieves tinnitus and improves hearing in some people with hearing loss
Tinnitus masker—a device that emits a low level of white noise to help cover up the internal sensations and block out external noises
Measures to discuss with your doctor if no cure or specific treatment is available include: Stress management
and relaxation techniques
BiofeedbackRepetitive transcranial magnetic stimulationCognitive behavioral therapy
Avoid anything that makes tinnitus sensations worse, such as:
Loud noisesAlcoholSmokingSaltCaffeineExercise regularly
to improve circulation
Make time to relax and
get enough sleepPlaying a radio or a white-noise machine for about 30 minutes at bedtime may help relieve the ringing sensations at night
Surgery may help relieve certain causes of tinnitus. These include: Tinnitus caused by a tumor frequently subsides after the growth is removedAbnormalities in blood vessels that lead to tinnitus can sometimes be corrected with surgerySurgery may also be an option for people with Meniere's disease, but it is usually done only for disabling vertigo
To help reduce your chance of tinnitus, take these steps: Avoid exposure to excessive noise.Wear earplugs in noisy situations.Wear earmuffs when mowing the grass.Learn and practice stress management and relaxation techniques.Limit use of medications that damage hearing.
American Tinnitus Association website. Available at:
http://www.ata.org/for-patients/about-tinnitus. Accessed September 26, 2014.
Acute otitis media. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed. Updated July 2, 2014. Accessed September 26, 2014.
Conn HF, Rakel.
Conn’s Current Therapy.
54th ed. Philadelphia, PA: WB Saunders Company; 2002.
Goroll A, Mulley A.
Primary Care Medicine.
4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2000.
Tinnitus. American Academy of Otolaryngology—Head and Neck Surgery website. Available at:
http://www.entnet.org/content/tinnitus. Updated December 2010. Accessed September 26, 2014.
Tinnitus. American Speech-Language-Hearing Association website. Available at:
http://www.asha.org/public/hearing/Tinnitus. Accessed September 26, 2014.
Tinnitus. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed. Updated February 26, 2014. Accessed September 26, 2014.
10/16/2009 DynaMed's Systematic Literature Surveillance
http://www.ebscohost.com/dynamed: Baldo P, Doree C, Lazzarini R, Molin P, McFerran D. Antidepressants for patients with tinnitus.
Cochrane Database Syst Rev.
Last reviewed August 2014 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © EBSCO Publishing. All rights reserved.