Tinnitus (Ringing in the Ears): Types, Symptoms, Causes, Risks, Complications, Diagnosis, Treatment and Prevention

old man with Tinnitus


The sense of hearing is sensitive because people can hear various sounds even the faintest ones. However, there are sounds that are not normally heard, since it comes from inside the ears. When you hear ringing, knocking, hissing or whistling sounds, it’s either an illness itself or a sign of an underlying health condition.

Tinnitus is the perception of noise in the head, not related to any psychiatric condition.
It’s often described as a ringing in the ear. Tinnitus is often a symptom of an underlying health condition like ear trauma, circulatory system disorder or age-related hearing loss.

As of the moment, there is no scientific cure for the condition, but there are ways to manage the symptoms. Also, treating the underlying condition may help eradicate the ringing sounds in the ear, which is an uncomfortable feeling.

2Types of Tinnitus

Many people hear varying sounds when it comes to tinnitus. Some may hear a continuous ringing sound in the head or one or both ears, while others may perceive the sounds like whistling, sizzling, knocking or buzzing.

Other people experience tinnitus as a thumping sound, like that of a heart beating, which is termed as pulsatile tinnitus.

Tinnitus: A Common Problem

According to the American Academy of Otolaryngology, more than 50 million people in the United States have experienced tinnitus or hearing noises in the head. This means that a person perceives hearing noises, without an external source.

About one in five people with tinnitus experience a great deal of discomfort. The condition may negatively impact their quality of life, and this condition can last for prolonged periods, especially if the underlying cause has not been identified.

Aside from the type of sounds heard, there are two other types of tinnitus.

Subjective tinnitus

This is the sounds you can hear inside your head or ears. This is the most common type of tinnitus. Sometimes, this type of tinnitus is caused by problems with the auditory nerves or how the brain interprets nerve signals as sounds.

Objective tinnitus

Objective tinnitus is when the doctor or audiologist can hear when an ear examination is performed. This is a rare type of tinnitus and usually caused by a problem with a blood vessel in the ear or the head, muscle contractions or middle ear bone problem.


Tinnitus is considered non-auditory and an internal sound that can be continuous or intermittent. It can be heard in one or both ears, in either high-pitch or low-pitch level.

If you have tinnitus, you may hear varying sounds including those of:

  • Ringing
  • Roaring
  • Buzzing
  • Hissing
  • Whistling
  • Clicking
  • Thumping
  • Chirping
  • Screeching
  • Static
  • Whooshing
  • Musical

When to see your doctor:

As soon as the tinnitus is bothering your or has been affecting your daily activities, you should see your doctor. Moreover, you should see your doctor if you continually hear sounds in your ears.

The doctor will examine your ears and see if the problem is caused by an underlying health condition or the presence of easy-to-treat ear conditions such as an earwax buildup or an infection. The doctor can also see if you are suffering from hearing loss.

Why is Tinnitus Worse at Night?

During the day, the activities and sounds around you make the tinnitus less noticeable. However, at night, when the surrounding is quiet, the tinnitus seem louder and more pronounced. As a result, stress, insomnia, and fatigue are complications of tinnitus.


There are many possible causes of tinnitus. However, their exact etiology of the condition or the exact cause has not been found yet. Here are some of the common causes of tinnitus:

Ear Cell Damage

One of the most common causes of tinnitus is ear cell damage. Inside the ear, there are tiny and delicate hairs that move in relation to the pressure of sound waves. As a result, they release an electrical signal via the auditory nerve to the brain for interpretation. Sometimes, the hairs are broken and produce random electrical impulses to the brain, causing subjective sounds.

Age-related Hearing Loss

In most cases, the hearing may become impaired with age. This usually happens beyond the age of 60. When there is a problem with hearing, this may lead to tinnitus.

Prolonged Exposure to Loud Noises

Being exposed to loud noises for a long time may cause inner ear damage. Loud noises, like those from heavy machinery, firearms and chain saws may take a toll on the ears.
This may lead to a noise-related hearing loss. In some cases, even those who listen to loud music through portable music devices may lead to this hearing loss.

Impacted Cerumen

Also called earwax blockage or earwax build-up, this condition happens when too much earwax accumulates inside the ear canal. As a result, it causes hearing loss and sometimes, ear irritation.

Changes in the Ear Bones

When the tiny bones in the middle ear become stiff, they may affect your hearing and cause tinnitus. One of the conditions related to this is otosclerosis, which is a hereditary abnormal bone growth in the middle ear.

Medicines Linked To Tinnitus

  • Antibiotics
  • Cancer medications
  • Diuretics
  • Antidepressants
  • Aspirin
  • Quinine medications

Blood Vessel Disorders That Cause Tinnitus

  • Atherosclerosis
  • High blood pressure or hypertension
  • Head and neck tumors
  • Turbulent blood flow
  • Capillary malformation

Other Possible Causes of Tinnitus:

5Risk Factors

Tinnitus is a common problem among people especially those who are older and those who are suffering from underlying health conditions. There are people who are at a higher risk of experiencing tinnitus. The risk factors include:

  • Exposure to loud noise – prolonged exposure to loud noises may cause damage to the tiny sensory hair cells in your ear that are responsible for transmitting sounds to the brain.
  • Age – Older people are prone to having tinnitus, especially those who have hearing loss
  • Gender – Men are at a higher risk of developing tinnitus
  • Smoking – People who are smoking, have a higher risk of developing tinnitus.
  • Hearing Loss – People with hearing impairment are susceptible to experiencing tinnitus.
  • Cardiovascular Problems – Conditions that affect the blood flow to the head and brain like high blood pressure and atherosclerosis can increase the risk of having tinnitus.


Tinnitus can adversely affect the quality of life. Though its effects vary from one person to another, people with tinnitus may suffer from the following complications:

  • Hearing loss
  • Fatigue
  • Sleep problems or insomnia
  • Stress
  • Problems with concentration
  • Memory problems
  • Depression
  • Anxiety
  • Feeling of loss of control over one’s life
  • Poor work performance


To diagnose tinnitus, the doctor will conduct a complete interview of the medical history of the patient along with a physical assessment. The doctor will ask about the symptoms, including the following questions:

  • Is the sound continuous or intermittent?
  • Is the problem having an impact in daily life?
  • Does the problem affect one ear or both ears?
  • Are there other symptoms that accompany the sounds like hearing loss or a spinning sensation?

After a complete medical history, the doctor will perform various examination procedures on the ears, head, and neck.

Hearing Tests – These tests will determine if there is hearing loss. They can also help identify possible causes of tinnitus, as the damage to the ear cells.

Imaging Tests – Imaging tests such as CT scan and MRI can help determine the cause of tinnitus.

Physical Examination – The doctor will examine the ears to see obvious problems like the build-up of earwax inside the ears and possible ear infections.

Ear Sounds Can Signal Possible Tinnitus Causes:

Rushing Sound – This means that the problem is with the blood vessels. The sounds may worsen when doing exercise or changing positions, like from lying down to standing up.

Clicking – When you hear a clicking sound, it means that the muscles are contracting.

Heart Beat Sounds – Hearing the heart beating or pumping may mean blood vessel problems. This may indicate an aneurysm, tumor, blockage of the ear canal, blocked Eustachian tube and high blood pressure.

High-Pitched Ringing – This sound may indicate an exposure to a loud sound or blast that has affected the ear. This can also be caused by prolonged exposure to loud sounds and age-related hearing loss.

Low-Pitched Ringing – This sound means that there are conditions present such as Meniere’s disease or vertigo.


The treatment of tinnitus is based on the underlying cause. If these are managed effectively, the tinnitus will resolve on its own.

Treatment of the Underlying Health Condition

As mentioned earlier, there are various health conditions that could cause


The best way to reduce the risk of developing tinnitus is through prevention. However, in some cases, tinnitus can’t be prevented, but there are precautions that can be done:

  • Reduce your volume – Prolonged exposure to loud sounds or music with no ear protection may cause hearing loss and tinnitus.
  • Hearing protection – Protect your ears with headphones or ear plugs when using heavy and loud machinery like chain saws. Moreover, when you work entails listening to loud music like being a musician or a DJ, protect your ears too.
  • Live a healthy lifestyle – Protect your cardiovascular health through living a healthy lifestyle such as eating a well-balanced diet and engaging in the regular physical activity.