Tinnitus (ringing in the ears)
Investigating and treating tinnitus: ear examination, audiometry, ruling out treatable causes, and habituation and sound therapies.
What tinnitus is
It's the perception of a sound — ringing, buzzing, hissing — that doesn't come from outside. It's very common and almost never a sign of anything serious, but it can seriously affect sleep, concentration and mood, especially at first and at night, when there's no background noise to mask it.
What's behind it
- Hearing loss, from age or noise exposure: the most common cause, even if hearing worse isn't noticeable.
- Earwax build-up or an ear infection: simple, reversible causes worth ruling out first.
- Acoustic trauma after a concert or an explosion.
- Ménière's disease and other inner ear conditions.
- Problems with the jaw joint and neck muscles.
- Certain medications, stress and lack of sleep, which make it worse.
When to see us without delay
If the tinnitus appears suddenly in one ear only, if it comes with sudden hearing loss or vertigo, or if it's pulsatile — beating in time with your heart. These cases need urgent assessment because some only respond to treatment if it's started quickly.
What can be done
First, investigate: an ear examination, audiometry and whatever tests the case needs. Then, treat what can be treated. When there's no correctable cause, the goal is habituation: getting the brain to stop prioritising that sound. Sound therapy and enriching your environment work, as do hearing aids when there's hearing loss, psychological work on the associated insomnia and anxiety, and looking after the neck and jaw if they're contributing. What doesn't work is resigning yourself to it without having it investigated.
Frequently asked questions
Can tinnitus be cured?
When there is a treatable cause —earwax, an ear infection, a jaw or neck problem— it resolves once that is treated. When there is none, the aim is habituation: for the brain to stop giving that sound priority. Sound therapy works, as do hearing aids if there is hearing loss and work on insomnia and anxiety.
When do I need to seek urgent care?
If the tinnitus appears suddenly in a single ear, if it comes with sudden hearing loss or vertigo, or if it is pulsatile and beats in time with your heart. Some of those cases only have an effective treatment if you act quickly.
Why is it louder at night?
Because there is no background noise to mask it and all your attention goes to it. That is why one of the most useful measures is to enrich the sound environment at bedtime, along with looking after sleep and stress, which amplify the perception.
What causes tinnitus?
The most common cause is hearing loss, whether from age or from noise exposure, even when you don't notice that your hearing has worsened. Other causes include earwax build-up, an ear infection, acoustic trauma, Ménière's disease, jaw or neck problems and certain medicines. Finding the cause is the first step.
What makes tinnitus worse?
Complete silence, lack of sleep, stress, too much caffeine and exposure to loud noise. Also the habit of focusing on the ringing: the more attention it gets, the more present it becomes. That is why treatment works on both the surrounding sound and the emotional response.
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Content reviewed by Dr Irene Mayorga Chamorro