Tinnitus is the perception of sound when there is no external source of the sound. It’s usually described as a ringing in the ears, but it can also sound like buzzing, roaring, hissing, blowing, whistling, or humming. In some cases, tinnitus can even sound like voices or music.

It’s a common condition. In the U.S., over 50 million people—approximately 10% to 15% of adults—say they’ve experienced tinnitus. Thirty percent of people over 55 have the condition, which is common among older adults but can occur in people of any age, including children, in particular those with hearing loss.

Tinnitus is the sensation of hearing a sound when there is no source of that sound outside of the body. The sounds can be loud or soft, and they can be constant or intermittent. In a type of tinnitus known as pulsatile tinnitus, the sounds are rhythmic, coming and going with each heartbeat.

Often, tinnitus is more noticeable in quiet settings, for instance at bedtime. People with tinnitus may perceive sounds within one or both ears, within their head, or as coming from the surrounding environment.

When the condition lasts for six months or longer, it is called chronic tinnitus.

For many people, tinnitus doesn’t substantially affect their quality of life or their day-to-day activities. For others, however, the condition is bothersome and can lead to insomnia, depression, and anxiety, and can make it hard to concentrate and understand speech.

There are two types of tinnitus:

• Subjective tinnitus. In this form of tinnitus, the sounds are perceived only by the person with the condition. Subjective tinnitus makes up the vast majority of tinnitus cases.
  
• Objective tinnitus. In this rare type of tinnitus, sounds can be heard by the person with the condition as well as by a doctor during an examination. The sounds are produced within the body, usually somewhere near the ear. For instance, sounds can be generated by muscle spasms in the middle ear or turbulent blood flow through blood vessels.

Tinnitus is a symptom, not a disease in and of itself.

Subjective tinnitus can be caused by many disorders and diseases that affect the ear, including:

• Noise-induced hearing loss (caused by repeated exposure to loud sounds such as concerts, power tools, or gas-powered lawnmowers or by one-time exposure to very loud noises such as an explosion or firecracker)
• Age-related hearing loss
• Blockage of the ear canal by earwax or a foreign body
• Ear infection
• Cholesteatoma (a skin cyst that forms in the middle ear)
• Ototoxic drugs (drugs that can damage the ear)
• Central nervous system tumors
• Damage to the central nervous system caused by stroke or multiple sclerosis
• Ménière’s disease (an inner ear disorder that causes vertigo, hearing loss, and tinnitus)
• Barotrauma (damage to the eardrum caused by a change in pressure during activities such as scuba diving or flying)
• Otosclerosis (a condition in which there is abnormal bone growth in the middle ear)
• Temporomandibular joint (TMJ) disorder
• Diabetes
• Thyroid disease
• Dyslipidemia and hyperlipidemia
• Hormonal changes during pregnancy
• Traumatic brain injury (TBI)
• Eustachian tube dysfunction (a tube that connects the middle ear to the upper throat and back of the nose)

Objective tinnitus is most often due to conditions that disrupt the normal flow of blood through veins or arteries near the ears. The resulting abnormal blood flow can produce noises. It can also be caused by muscle spasms in the middle ear.

Some conditions that can cause objective tinnitus include:

• Anemia
• Abnormalities in a carotid artery (a blood vessel that carries blood to the head and brain) or jugular veins
• Muscle spasms in the palate (the roof of the mouth) or middle ear
• High blood pressure
• Tumors in the middle ear

If you are experiencing ringing, buzzing, roaring, or other sounds associated with tinnitus, you should see your doctor for an evaluation. To make a diagnosis, your doctor will review your medical history, perform a physical exam, and may order one or more tests.

As an initial step, your doctor will ask you about your symptoms, including what kind of sound or sounds you’re hearing, when they first started, how loud they are, and how bothersome they are. You may also be asked about past ear infections, head injuries, and hearing loss, as well as about whether you’ve used medications that can cause tinnitus.

Your doctor will also perform a physical exam to check for underlying conditions that could cause tinnitus. During the exam, your doctor will closely examine your ears, head, neck, and jaw.

Depending on your symptoms, your doctor may conduct a hearing exam, imaging studies, and/or blood tests to determine the cause of tinnitus. A hearing exam may include a number of separate tests to assess the function of the auditory (hearing) system. Imaging tests may include a computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan. Magnetic resonance angiography (MRA), CT angiography (CTA), and x-ray angiography allow doctors to determine if tinnitus may be caused by problems with the blood vessels.

If your tinnitus is caused by an underlying medical condition, treatment may be able to substantially or even completely relieve symptoms. These treatments vary depending on the underlying condition, but may include surgery, medications, or even the removal of earwax that is obstructing the ear canal.

In the majority of cases, however, tinnitus cannot be cured. When there is no treatable underlying cause, tinnitus treatment is aimed at reducing your symptoms and helping you learn to live with the condition and improve quality of life.

Treatment may include:

Lifestyle changes. You may be able to manage tinnitus symptoms by making certain lifestyle modifications. These may include:

• Learning and using relaxation and stress reduction techniques
• Limiting or avoiding caffeine, alcohol, and tobacco. These substances can worsen tinnitus symptoms.
• Practicing good sleep habits
• Preventing additional hearing damage by avoiding loud sounds and settings and wearing hearing protection around loud noises

Sound therapy. Sound therapy involves the use of or amplification of sounds to distract you from tinnitus sounds. Because sound therapy masks tinnitus, it is sometimes called “masking.” Sound therapy may involve the following devices:

• Hearing aids. Hearing aids work by amplifying sound. For those with hearing loss, hearing aids may mask the tinnitus, making it less noticeable.
• Sound generators. These devices generate sounds such as white noise, music, or other pleasant noises that can help you focus on sounds other than those caused by tinnitus. Sound generators include in-ear devices, headphones, speakers, pillow speakers, fans, radios, computers, smartphones, and other devices capable of producing sound.
• Cochlear implants. For people with severe to profound hearing loss as well as tinnitus, cochlear implants—electronic devices that allow people who have significant hearing loss to perceive and process sounds—may reduce tinnitus symptoms.

Medications: Because anxiety and depression can worsen tinnitus symptoms, treatment may involve antidepressants and antianxiety medications. Medications may also be used to improve your sleep.

Counseling: A counselor who is knowledgeable about tinnitus can help you learn about the condition and treat stress, depression, anxiety, and other mental health conditions that can worsen tinnitus symptoms. Other types of therapy for tinnitus include:

• Cognitive behavioral therapy (CBT). CBT can guide you in developing new ways to cope with tinnitus.
• Tinnitus retraining therapy (TRT). TRT combines CBT techniques with sound therapy to habituate the brain to tinnitus rendering it less bothersome.
• Biofeedback and stress reduction. In this type of therapy, you learn techniques to help you control your body’s reaction to distress caused by tinnitus.

The outlook for people with tinnitus varies based on the severity of the condition and whether it is caused by a treatable underlying medical condition. Those with more severe tinnitus may experience insomnia, depression, anxiety, or have difficulties concentrating or understanding speech. While the majority of tinnitus cases cannot be cured, treatments are available that can effectively manage symptoms in most cases. In some cases, tinnitus symptoms can spontaneously improve.

This article was medically reviewed by Moira Daley Bell, AuD (doctor of audiology), director of the Yale Medicine Hearing & Balance Program.