What Causes Ringing in the Ears? Tinnitus Explained
You hear a ringing. Or a buzz. Or a hiss. No one else can hear it. You want to know why. This article explains exactly what causes that sound, how each trigger works inside your ear and brain, and what to do about it.
- How tinnitus starts: what happens inside the ear
- Loud noise: the biggest preventable cause
- Age-related hearing loss
- Earwax blockage
- Ear infections and fluid
- Medications that cause tinnitus
- Blood pressure and circulation
- Head and neck injuries
- Jaw problems: TMJ
- Meniere's disease
- Other causes worth knowing
- All causes at a glance
- When to see a doctor right away
- What to do next
- People also ask
Ringing in the ears - called tinnitus - is almost always caused by damage or changes somewhere in the hearing system. The most common cause is damage to the tiny hair cells inside the cochlea, the part of the inner ear that converts sound into nerve signals. When hair cells are damaged, they can send random signals to the brain. The brain hears those signals as ringing, buzzing, hissing, or humming. The most common triggers are loud noise and aging. Other causes include earwax, ear infections, certain medications, high blood pressure, head injuries, jaw problems, and Meniere's disease. For a complete overview of tinnitus - including treatments and how to live well with it - see: Tinnitus: Causes, Relief & Living Well with Ringing in the Ears (2026 Guide).
How Tinnitus Starts: What Happens Inside the Ear
Sound travels through your outer ear and down the ear canal. It hits your eardrum and makes it vibrate. Those vibrations pass through three tiny bones in the middle ear. Then they reach the cochlea in the inner ear.
The cochlea is a snail-shaped, fluid-filled chamber. Inside it are thousands of tiny hair cells. They sit on a surface called the basilar membrane. When the fluid in the cochlea moves, the hair cells bend. That bending creates electrical signals. Those signals travel up the auditory nerve to the brain. Your brain reads those signals as sound.
This system works beautifully when everything is healthy. But it is fragile. Damage to any part of the pathway can disrupt how signals reach the brain.
When hair cells are damaged or destroyed, they stop sending the right signals. In some cases, they start sending wrong signals. Random. Constant. Uninvited. The brain interprets those signals as sound. That is tinnitus.
Research funded by the NIH published in 2023 found that people with chronic tinnitus were much more likely to show reduced responses in their cochlear nerve - the nerve that carries signals from the hair cells to the brain. This gives scientists an important new lead on why some people develop persistent tinnitus after inner ear damage.
Healthy hair cells send clear sound signals to the brain. Damaged hair cells send random electrical signals. The brain has no way to tell the difference. It interprets those random signals as sound - the ringing you hear. This is why most tinnitus happens alongside hearing loss. They share the same root cause: damaged hair cells.
Loud Noise: The Biggest Preventable Cause
Loud noise is the most common preventable cause of tinnitus. It is also the most common cause overall.
Sound above 85 decibels (dB) can damage hair cells in the cochlea. The damage depends on how loud the sound is and how long you are exposed. Repeated exposure at 85 dB over years causes gradual, cumulative damage. A single very loud event - a gunshot, explosion, or burst of industrial noise right next to the ear - can cause immediate and permanent damage.
Here is what happens. Extremely loud sound causes the fluid in the cochlea to move so violently that it physically damages the hair cells. The stereocilia - the tiny projections on top of the hair cells - get bent, broken, or sheared off. Once destroyed, they do not grow back. The body has no mechanism to regenerate cochlear hair cells in humans.
Damaged hair cells may start firing randomly. Or they may stop firing at all, leaving a gap in the signal that the brain tries to fill. Either way, the result can be tinnitus.
Who is most at risk from noise
- Construction and manufacturing workers exposed to machinery, power tools, and heavy equipment day after day
- Military veterans and active service members exposed to gunfire, explosions, and jet engines - tinnitus is the most common service-related disability among US veterans
- Musicians and live event workers exposed to amplified music for hours at a time over many years
- Concertgoers and nightclub attendees who regularly spend hours in venues with sound levels above 100 dB
- Frequent headphone users who listen at high volumes for long periods
- Hunters and sport shooters exposed to gunshots without ear protection
Related reading: For safe sound levels, exposure limits, and exactly what counts as "too loud," see: How loud is too loud? Safe decibel levels explained. For noise protection strategies at every age, see: Noise-induced hearing loss: prevention and protection.
Age-Related Hearing Loss
As we get older, the hair cells in the cochlea naturally wear out. This is called presbycusis, or age-related hearing loss. It happens slowly, usually starting around the age of 50 to 60. Most people do not notice it until it has been going on for years.
The process is gradual. Hair cells at one end of the cochlea - the ones that process high-frequency sounds - tend to go first. That is why older adults often struggle to hear high-pitched sounds like speech consonants and bird calls before they notice any other change.
As more hair cells stop working, the random signal problem gets worse. Tinnitus becomes more common. NIDCD data shows that tinnitus rates rise sharply after age 40 and peak between ages 65 and 79.
Age-related hearing loss and tinnitus almost always go together. Addressing the hearing loss - through hearing aids or personal listening devices - can reduce the isolation and silence that makes tinnitus feel louder.
Related reading: For the strong connection between hearing loss and tinnitus, see: Tinnitus and hearing loss: how they are connected.
Earwax Blockage
Earwax is normal and healthy. It protects the ear canal. But sometimes it builds up too much. When it does, it can press against the eardrum and block incoming sound.
That blockage changes the pressure inside the ear. It muffles external sounds. With less outside sound coming in, internal sounds like tinnitus feel louder by contrast. The blockage can also put physical pressure on structures inside the ear that affect how signals are sent to the brain.
Earwax-related tinnitus is one of the most common and most treatable causes. A doctor or audiologist can safely remove the blockage. The tinnitus often improves or disappears soon after.
- Do not use cotton swabs inside the ear canal
- Cotton swabs push wax deeper, not out
- Deep compacted wax is harder and riskier to remove
- Do not use ear candles - no evidence they work
- Do not attempt to dig out wax with any object
- Do see a doctor or audiologist for safe removal
- Some over-the-counter drops can soften wax safely
- Ask your audiologist what approach is right for you
Ear Infections and Fluid
Infections of the outer or middle ear often cause tinnitus. They do this in a few ways.
An outer ear infection (otitis externa) causes inflammation and swelling. This can partially block the ear canal and change how sound reaches the eardrum. A middle ear infection (otitis media) causes fluid to build up behind the eardrum. That fluid dampens the movement of the eardrum and the tiny bones of the middle ear. Sound does not travel through the system cleanly. The disruption in normal sound input can cause tinnitus.
The good news: tinnitus caused by ear infections usually gets better once the infection is treated. It is a temporary symptom of a temporary problem. If tinnitus lingers after an infection clears, see your doctor. It may point to lingering fluid or another underlying issue.
Medications That Cause Tinnitus
Some medications are ototoxic. That means they can damage the ears as a side effect. Tinnitus is one of the most common signs of ototoxicity.
According to the American Speech-Language-Hearing Association (ASHA), over 200 medications and chemicals are known to be ototoxic. Not everyone who takes these drugs will develop tinnitus. Risk depends on the dose, how long you take the drug, and whether you take other ototoxic drugs at the same time.
The most common ototoxic drug groups
| Drug Category | Examples | Notes |
|---|---|---|
| Salicylates (high dose) | Aspirin at around 2 grams daily or more | Tinnitus is usually reversible when the dose is reduced or stopped |
| NSAIDs | Ibuprofen (Advil, Motrin), naproxen (Aleve), diclofenac | Risk rises with frequent use or high doses; usually reversible on stopping |
| Aminoglycoside antibiotics | Gentamicin, streptomycin, neomycin, tobramycin, amikacin | Can cause permanent inner ear damage; typically given IV in hospital settings only |
| Loop diuretics | Furosemide (Lasix), ethacrynic acid (Edecrin) | Risk higher at large IV doses; usually reversible |
| Chemotherapy agents | Cisplatin, carboplatin, vincristine | Cisplatin in particular is strongly ototoxic; damage often permanent |
| Antimalarials | Quinine, hydroxychloroquine, chloroquine | IV quinine causes tinnitus in 1 to 7 days; usually reversible on stopping |
Important: Never stop a prescribed medication without speaking to your doctor first. If tinnitus starts shortly after you begin a new drug, tell your prescribing physician. They may be able to lower your dose, switch to an alternative, or monitor your hearing more closely.
Blood Pressure and Circulation
Your ears are very close to major blood vessels. Any change in how blood flows near those vessels can produce sound that reaches the inner ear.
This type of tinnitus is called pulsatile tinnitus. It is different from the constant ringing of most tinnitus. It pulses. It matches your heartbeat. You might notice it as a whooshing, throbbing, or rhythmic sound.
Circulation-related causes of pulsatile tinnitus
- High blood pressure (hypertension): Elevated pressure makes blood flow more turbulently through vessels near the ear. The turbulence creates sound
- Atherosclerosis: Hardened, narrowed arteries near the ear cause blood to flow unevenly. That irregular flow creates noise
- Abnormal blood vessel connections (AVM): Rare tangles of arteries and veins near the ear can generate audible turbulence
- Anemia: Low red blood cell count causes the heart to pump faster and harder. The increased blood flow can be audible near the ear
- Idiopathic intracranial hypertension: Elevated pressure of cerebrospinal fluid around the brain can cause pulsatile tinnitus, often in one ear
Pulsatile tinnitus always warrants a doctor visit. It can point to a vascular condition that has its own treatment. Finding and addressing the underlying cause often reduces or resolves the tinnitus.
Head and Neck Injuries
The auditory system does not exist in isolation. Nerves, blood vessels, and muscles around the head and neck all connect to it in ways that can affect hearing.
A head injury - a concussion, a blow to the skull, or whiplash - can shake the delicate structures of the inner ear. It can injure the auditory nerve. It can affect blood flow to the cochlea. Any of these can trigger tinnitus.
Tinnitus from a head or neck injury sometimes appears immediately after the event. Sometimes it takes days or weeks to show up. It may appear alongside headaches, dizziness, or memory problems.
This type of tinnitus should always be assessed by a doctor as part of the overall injury evaluation. Do not dismiss new tinnitus that follows any kind of head trauma.
Jaw Problems: TMJ
The temporomandibular joint - the hinge joint that connects your jaw to your skull - sits directly in front of the ear. Problems with this joint can affect hearing.
TMJ disorders cause pain, clicking, or stiffness in the jaw. They can also cause tinnitus. The exact reason is not fully understood. The leading explanations involve shared nerve pathways between the jaw and the auditory system, and the joint's physical proximity to ear structures.
TMJ-related tinnitus often changes with jaw movement. If your tinnitus shifts when you open your mouth wide, move your jaw from side to side, or press on the muscles around your jaw, TMJ may be a factor. A dentist or oral surgeon who specializes in TMJ can evaluate and treat the underlying joint problem.
Meniere's Disease
Meniere's disease is a disorder of the inner ear. It involves abnormal fluid pressure inside the cochlea and vestibular system - the part of the inner ear that controls balance.
It causes four main symptoms. These are episodes of vertigo (severe spinning dizziness), fluctuating hearing loss, a feeling of fullness or pressure in the ear, and tinnitus. The tinnitus in Meniere's disease often gets louder or changes character just before a vertigo episode. It may affect only one ear at first.
The cause of Meniere's is not fully understood. But the abnormal fluid buildup disrupts both the hearing and balance functions of the inner ear. Treatment focuses on reducing the frequency and severity of episodes through dietary changes, medication, and in some cases procedures to reduce fluid pressure.
Other Causes Worth Knowing
Acoustic neuroma
This is a rare, slow-growing, non-cancerous tumor on the vestibular nerve that connects the inner ear to the brain. It usually causes tinnitus in one ear only, along with gradual hearing loss on that side. It requires imaging to diagnose. Treatment depends on the size and growth rate of the tumor.
Thyroid disorders
Both underactive (hypothyroidism) and overactive (hyperthyroidism) thyroid glands have been associated with tinnitus in some patients. The mechanism is not fully established. Treating the thyroid condition sometimes improves the tinnitus.
Anemia and nutritional deficiencies
Low iron causes the heart to work harder. That can increase blood flow near the ear and trigger pulsatile tinnitus. Vitamin B12 deficiency has also been associated with tinnitus in some research, though the evidence is not strong enough for clear recommendations.
Stress and anxiety
Stress does not directly cause tinnitus in the way that noise damage does. But it can make existing tinnitus much worse. High stress sensitizes the auditory nervous system. The same tinnitus signal feels louder and more intrusive when you are under strain. Tinnitus and anxiety often feed each other in a cycle: tinnitus causes anxiety, anxiety makes tinnitus feel worse.
Caffeine and alcohol
Some people notice that caffeine or alcohol makes their tinnitus spike. The evidence linking either substance directly to tinnitus onset is not strong. But as individual triggers, they are worth tracking. If you consistently notice your tinnitus spikes after coffee or alcohol, reducing intake is a low-risk experiment.
All Causes at a Glance
| Cause | How it causes tinnitus | Is it reversible? | What helps |
|---|---|---|---|
| Loud noise (acute or chronic) | Destroys cochlear hair cells; damaged cells send random signals | Usually not - hair cells do not regrow | Hearing protection; tinnitus management strategies |
| Age-related hearing loss | Gradual hair cell loss over time disrupts auditory signals | No - natural degeneration is permanent | Hearing aids; sound therapy; amplification |
| Earwax blockage | Blocks canal; changes pressure; reduces external sound input | Yes - often resolves after safe removal | Professional earwax removal by a doctor or audiologist |
| Ear infection | Fluid and inflammation disrupt normal sound transmission | Usually yes - once infection clears | Appropriate antibiotic or antifungal treatment |
| Ototoxic medications | Drug accumulates in inner ear; damages hair cells or nerve | Often yes for NSAIDs and aspirin; often not for aminoglycosides or cisplatin | Dose reduction or drug change (with doctor guidance only) |
| High blood pressure / circulation | Turbulent blood flow near ear creates pulsatile sound | Often yes - treating the vascular cause helps | Medical management of blood pressure or vascular issue |
| Head or neck injury | Trauma damages inner ear structures, nerve, or blood supply | Variable - depends on severity | Medical evaluation; audiological assessment |
| TMJ disorder | Jaw joint dysfunction affects nearby auditory structures | Often yes - treating TMJ can reduce tinnitus | Dental or oral surgery evaluation; TMJ treatment |
| Meniere's disease | Abnormal inner ear fluid pressure affects cochlea and nerve | Partial - episodes can be managed but not cured | Low-sodium diet; medication; specialist management |
| Acoustic neuroma | Tumor presses on vestibular nerve affecting auditory signals | Depends on treatment approach | Imaging, monitoring, surgery, or radiation depending on size |
When to See a Doctor Right Away
Most tinnitus does not need emergency care. But some presentations do. Do not wait with any of these.
- Tinnitus that started suddenly with no clear cause
- Tinnitus in one ear only
- Tinnitus that pulses with your heartbeat
- Tinnitus alongside sudden hearing loss in one ear
- Tinnitus alongside dizziness or vertigo
- Tinnitus with ear pain or discharge
- Tinnitus that is rapidly getting louder
- Tinnitus following a head injury
Sudden sensorineural hearing loss is a medical emergency. It must be treated within 24 to 72 hours for the best chance of recovery. Tinnitus alongside sudden hearing loss in one ear should be treated as urgent. Do not assume it will resolve on its own.
For a complete guide to the warning signs that mean you should book an audiologist appointment now, see: When to see an audiologist: warning signs to watch.
What to Do Next
You now know what is likely causing your tinnitus. The next step is getting the right evaluation and putting the right strategies in place.
What to do when you have ringing in the ears
Start with step one. Work through these in order.
- See a doctor if tinnitus is sudden, one-sided, or pulsing
- Get your hearing tested by a licensed audiologist
- Check whether a new medication may be the cause
- Have a doctor check for earwax blockage and clear it safely
- Tell your doctor about any recent head or neck injury
- Ask about jaw problems if tinnitus changes with jaw movement
- Have your blood pressure checked if tinnitus pulses with your heart
- Avoid further loud noise exposure from today onward
- Use ear protection in any environment above 85 decibels
- Keep headphone volume at or below 60% of maximum
- Use background sound at home to reduce contrast with tinnitus
- Read the full guide to tinnitus relief and living well
Struggling to hear clearly alongside your tinnitus?
More sound around you means less silence for tinnitus to fill. Bellman personal listening devices help you hear speech and everyday sounds more clearly.
People Also Ask
What causes ringing in the ears?
The most common cause is damage to the tiny hair cells inside the cochlea - the inner ear structure that converts sound waves into nerve signals. When these cells are damaged by noise, aging, or medications, they can send random electrical signals to the brain. The brain interprets those signals as ringing, buzzing, or hissing. Other causes include earwax blockage, ear infections, high blood pressure, head injuries, jaw problems, and Meniere's disease.
Can loud noise cause ringing in the ears?
Yes. Loud noise is the most common preventable cause of tinnitus. Sound above 85 decibels can damage cochlear hair cells. A single extremely loud event - a gunshot or explosion close to the ear - can cause immediate permanent damage. Repeated exposure at lower levels causes gradual damage over years. Once cochlear hair cells are destroyed, they do not grow back in humans.
Can medications cause ringing in the ears?
Yes. Many medications are ototoxic - they can damage the inner ear as a side effect. According to ASHA, over 200 medications and chemicals are known to be ototoxic. Common examples include high-dose aspirin and NSAIDs, aminoglycoside antibiotics, cisplatin chemotherapy, loop diuretics, and antimalarial drugs like quinine. If tinnitus starts after a new medication, speak with your doctor before stopping or changing the drug.
Why does ringing in the ears get worse at night?
It feels worse at night because the room is quiet. During the day, background sound competes with the tinnitus for your attention. At night, there is nothing competing with it. The contrast makes the ringing feel louder and more intrusive. Using a fan, sound machine, or sleep app provides low-level background noise. This gives the brain something else to process and makes the tinnitus feel less prominent.
Does earwax cause ringing in the ears?
Yes. A buildup of earwax can block the ear canal, press on the eardrum, and change the pressure inside the ear. This can cause or worsen tinnitus. Earwax-related tinnitus is one of the most treatable causes. Once a doctor or audiologist removes the blockage safely, the tinnitus usually improves or clears. Never try to remove earwax with cotton swabs - this pushes wax deeper and can cause more damage.
When should I see a doctor about ringing in the ears?
See a doctor promptly if your tinnitus started suddenly, affects only one ear, pulses with your heartbeat, or comes with hearing loss, dizziness, or ear pain. Sudden hearing loss alongside tinnitus is a medical emergency that needs treatment within 24 to 72 hours for the best chance of recovery. Any tinnitus that is new, rapidly changing, or severely affecting your sleep and daily life also warrants prompt medical evaluation.
Sources used in this article:
- National Institute on Deafness and Other Communication Disorders (NIDCD) - What Is Tinnitus? Causes and Treatment - nidcd.nih.gov/health/tinnitus
- National Institute on Deafness and Other Communication Disorders (NIDCD) - Noise-Induced Hearing Loss - nidcd.nih.gov/health/noise-induced-hearing-loss
- NIH Research Matters - Cochlear Nerve Damage Associated with Tinnitus (2026) - nih.gov/news-events/nih-research-matters/cochlear-nerve-damage-associated-tinnitus
- American Speech-Language-Hearing Association (ASHA) - Ototoxic Medications - asha.org/public/hearing/ototoxic-medications
- Merck Manual Professional Edition - Drug-Induced Ototoxicity (Updated 2025) - merckmanuals.com/professional/ear-nose-and-throat-disorders
- Medical News Today - What Types of Medications Can Cause Tinnitus? (Updated Nov 2024) - medicalnewstoday.com/articles/what-medications-cause-tinnitus
- NIDCD - Meniere's Disease (Updated Aug 2024) - nidcd.nih.gov/health/menieres-disease
- NIDCD - Prevalence of Chronic Tinnitus Statistics - nidcd.nih.gov/health/statistics/prevalence-chronic-tinnitus-chart
This article is for informational purposes only. It does not constitute medical advice. If you have tinnitus - especially sudden, one-sided, or pulsing tinnitus - please consult a licensed audiologist or physician promptly.
Read Next in This Series
Tinnitus: Causes, Relief & Living Well (2026 Guide)
The full pillar guide - treatments, sound therapy, sleep strategies, and daily coping in one place.
Tinnitus and Hearing Loss: How They Are Connected
Why tinnitus and hearing loss share the same root cause and what that means for managing both.
Noise-Induced Hearing Loss: Prevention & Protection
How to protect your ears from the most common preventable cause of tinnitus and hearing damage.
How Loud Is Too Loud? Safe Decibel Levels Explained
Everyday sounds, safe exposure times, and exactly when sound becomes a risk to your cochlea.
Tinnitus Masking & Sound Therapy: What Actually Works
White noise, pink noise, notched music, and other approaches for reducing how loud tinnitus feels.
How to Sleep with Tinnitus: Sound & Vibration Strategies
Practical steps for falling asleep when tinnitus feels loudest in a quiet bedroom.
When to See an Audiologist: Warning Signs to Watch
The tinnitus and hearing symptoms that mean you should not wait to book an appointment.
Can Hearing Amplifiers or Aids Help with Tinnitus?
What personal listening devices can and cannot do for people who have tinnitus alongside hearing difficulty.
