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When Should I Be Concerned About Ringing in My Ears?

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Tinnitus refers to the perception of sound when no external sound is present. Tinnitus is often described as a ringing in the ears, but it can also be heard as a buzzing, hissing, or roaring sound. Tinnitus affects people of all ages and can occur in one or both ears.

The most common cause of tinnitus is exposure to loud noise, such as music or machinery. Other causes of tinnitus include ear infections, damage to the ear from injury or illness, and certain medications. Tinnitus can also be a symptom of an underlying health condition, such as high blood pressure, thyroid problems, or a tumor.

Although some cases of tinnitus may resolve on their own, it is important to seek medical attention if you experience tinnitus for an extended period of time. Tinnitus can be a symptom of a more serious underlying condition, and early detection and treatment can prevent further damage to the ear and improve outcomes.

Treatments for tinnitus vary depending on the underlying cause. For example, if tinnitus is caused by medication, reducing or discontinuing the medication may alleviate symptoms. If tinnitus is caused by a health condition such as high blood pressure, managing the underlying condition may help to reduce symptoms.

It is important to protect your hearing and reduce your risk for developing tinnitus. This can be achieved by wearing earplugs or earmuffs in noisy environments and avoiding exposure to loud noise whenever possible. Additionally, adopting a healthy lifestyle, such as maintaining a healthy weight, limiting alcohol consumption, and managing stress, can support overall ear health and reduce the risk for tinnitus.

Symptoms and Signs

Tinnitus can manifest as intermittent or constant ringing, buzzing, or hissing in one or both ears. Some people describe their tinnitus as a pulsing or warbling sound, while others describe it as a high-pitched or low-pitched noise. Patients with tinnitus may experience different sounds at different times or in different environments.

Associated Symptoms and Signs

Tinnitus is sometimes accompanied by other symptoms that may indicate an underlying condition. Patients may experience dizziness, vertigo, or a feeling of pressure or fullness in the ears. Some may experience difficulty concentrating or trouble sleeping due to the constant or intermittent nature of the sound. Others may experience hyperacusis or phonophobia, which is a heightened sensitivity to sound or anxiety related to sound exposure, respectively. People with severe tinnitus may also experience depression or anxiety related to their condition.

Impact on Daily Life

Tinnitus can have a significant impact on a person's daily life. Patients with tinnitus may have difficulty concentrating on tasks, communicating with others, or sleeping. The sound can be distracting and make it difficult to focus on work, school, or other activities. Patients may also experience social isolation or difficulty in group settings due to the noise. Additionally, the constant or intermittent sound can cause stress or anxiety, leading to poor mental health outcomes.

When Tinnitus is Normal

Though tinnitus can be an alarming symptom, there are times when it may be a normal occurrence and not a cause for concern. Here are some situations where tinnitus may be considered normal or temporary:

Temporary Tinnitus Causes

During and after a cold, sinus infection, or other respiratory illness, the Eustachian tubes that connect the inner ear to the back of the throat may become blocked, causing a sensation of fullness or pressure. Fluid buildup and inflammation can also cause temporary tinnitus. In most cases, the ringing or buzzing will resolve once the underlying cause clears up.

Tinnitus After Exposure to Loud Noises

After exposure to loud noises, such as attending a concert or working in a noisy environment, ringing in the ears may occur temporarily. This condition is called temporary threshold shift, which occurs when the hair cells in the inner ear become overloaded with stimulation from sound waves. The ringing will usually subside within a few hours or days. However, repeated exposure to loud noises over time can lead to permanent tinnitus.

Tinnitus After a Head Injury

Tinnitus can also occur after a blow to the head or a neck injury. This type of tinnitus usually disappears on its own or with treatment of the underlying condition.

When to See a Doctor

There are times when tinnitus might require medical attention, particularly if it is persistent or accompanied by other symptoms. Here are some scenarios where it is advisable to seek medical attention for tinnitus:

Persistent or Chronic Tinnitus

Persistent tinnitus refers to tinnitus that lasts for longer than three months. Chronic tinnitus is when it lasts for more than six months. In most cases, persistent or chronic tinnitus progresses slowly, but it can become more severe over time. Individuals with persistent tinnitus should seek medical evaluation to help identify potential underlying causes and determine appropriate treatment.

Sudden Onset of Tinnitus without an Apparent Cause

If you experience sudden tinnitus without an apparent cause, it is recommended to seek immediate medical attention. This can help rule out more serious underlying conditions such as head or neck injuries, or the rare possibility of a tumor. Early diagnosis and treatment is critical to prevent more serious complications.

Associated Symptoms, Such as Dizziness or Headaches

If you experience tinnitus accompanied by other symptoms such as dizziness or headaches, this may be a sign of an underlying condition that needs medical attention. For example, Meniere's disease, a disorder of the inner ear, can cause tinnitus, vertigo, and hearing loss. Seeking medical evaluation can help diagnose the underlying cause and develop appropriate treatment.

Diagnostic and Treatment Options

When you visit a doctor about tinnitus, they will typically begin by asking about your symptoms, medical history, and lifestyle habits such as exposure to loud noises. A physical exam of the ears, head, and neck may also be conducted. If necessary, the doctor may order hearing tests, including pure-tone audiometry and speech audiometry, to evaluate the extent of your hearing loss and determine if there are any associated issues.

Potential Underlying Causes of Tinnitus

Tinnitus is often associated with age-related hearing loss or exposure to loud noises. However, it can also result from underlying medical conditions such as otosclerosis, a build-up of earwax, or high blood pressure. Certain medications such as chemotherapy drugs and antibiotics can also cause tinnitus. In rarer cases, tinnitus may be a symptom of a more serious underlying condition such as acoustic neuroma or Meniere's disease.

Treatment Options, including Medication and Therapy

There is currently no cure for tinnitus, but there are several treatment options that can help manage the symptoms. Medications such as antianxiety drugs and antidepressants can help alleviate symptoms by addressing associated psychological conditions such as stress and anxiety. Sound therapy, including techniques such as white noise and tinnitus retraining therapy (TRT), can also help desensitize the brain to the tinnitus sound, reducing its perceived severity. Other potential treatments may include cognitive-behavioral therapy (CBT), acupuncture, and dietary adjustments. In severe cases, a cochlear implant may be recommended to replace damaged inner ear hair cells that contribute to hearing loss and tinnitus. Ultimately, the treatment recommended by your doctor will depend on the underlying cause and severity of your symptoms.

Prevention and Lifestyle Changes

Tinnitus is a condition that can drastically impact one's quality of life. While there is no complete cure for tinnitus, there are several ways to manage and prevent the symptoms. Lifestyle changes and preventative measures can make a significant difference in reducing tinnitus's severity.

Reducing Exposure to Loud Noises

Exposure to loud sounds is one of the most common causes of tinnitus. Repeated exposure to loud noises can cause permanent damage to the inner ear and contribute to hearing loss and tinnitus. To reduce exposure to loud noises, it's essential to use protective devices such as earplugs or noise-canceling headphones. It's also important to maintain a safe distance from loudspeakers, fireworks, firearms, and other noisy sources. Taking breaks from loud environments or limiting the duration of exposure can also be essential in preventing tinnitus.

Maintaining A Healthy Lifestyle

A healthy body is less likely to develop tinnitus, and taking care of one's body can reduce the condition's severity. Regular exercise, proper nutrition, and adequate sleep can all contribute to reducing stress and improving overall health. Reducing alcohol consumption and quitting smoking can also improve tinnitus symptoms.

Stress Management Techniques

Stress is known to worsen tinnitus symptoms. Learning stress management techniques can help reduce stress levels and alleviate tinnitus. Yoga, meditation, and mindfulness techniques can help relax the body and mind, reducing stress levels and improving overall well-being. Additionally, making time for hobbies and practicing enjoyable activities can provide a sense of relaxation and reduce stress levels.


In summary, tinnitus is a prevalent condition that affects millions of people worldwide. Understanding the underlying causes and taking preventative measures can help reduce the severity of symptoms. In this article, we have covered the following main points:

  • Tinnitus is a condition marked by the sensation of hearing ringing, buzzing, or hissing sensations in one or both ears.
  • Common causes of tinnitus include exposure to loud noises, hearing loss, and ear infections, among others.
  • While tinnitus can be normal in certain cases, persistence or sudden onset requires medical attention.
  • Diagnosis and treatment usually involve a medical exam, hearing tests, and consideration of potential underlying conditions.
  • Lifestyle changes, such as reducing exposure to loud noises, maintaining a healthy lifestyle, and managing stress levels, can significantly reduce the severity of tinnitus symptoms.

It's crucial to encourage seeking medical attention if experiencing persistent or worsening tinnitus symptoms. While there is no complete cure for tinnitus, there are several treatments and lifestyle changes that can manage and reduce symptoms. Additionally, taking steps towards protecting hearing health, such as using hearing protection in noisy environments, can help prevent tinnitus and potential hearing loss. By following these preventative measures and seeking appropriate medical attention, individuals can effectively manage tinnitus and improve their quality of life.

William H. McDaniel, MD

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School.

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