If you hear ringing, buzzing or hissing with no outside source, that sound is tinnitus, and Johns Hopkins Medicine says there is currently no known cure for it. Some causes can be treated, and when none is found, the research points to ways to make the sound easier to live with. Your practical next step is a hearing test and a visit with a clinician who can look for a cause.
The CDC’s ear infection basics lists hearing loss and fluid or pus coming from the ear among reasons to see a healthcare provider. Cleveland Clinic’s earwax guide advises medical evaluation if home remedies do not work, your ear hurts or you have trouble hearing. This page cannot tell you how urgent your own case is, so ask a clinician about any new or concerning symptoms.
What is tinnitus?
Tinnitus is the sound of ringing in the ears. Johns Hopkins Medicine also describes roaring, buzzing, hissing or clicking inside the head. The sound can be soft or loud, high or low pitched, and it can be in one ear or both. It may come and go, or it may be ongoing. Its effect ranges from a mild distraction to a disabling condition.
Cleveland Clinic describes two types. Somatosensory tinnitus is a sound your brain perceives when you move the muscles of your jaw or neck. Subjective tinnitus is a sound only you can hear.
What causes tinnitus?
Tinnitus has many possible causes. The table sets out the causes listed by Johns Hopkins Medicine and by MedlinePlus, the consumer health site of the National Library of Medicine.
| Possible cause | Johns Hopkins | MedlinePlus |
|---|---|---|
| Hearing loss | Yes (various types) | Yes (in older people) |
| Exposure to loud noise | Yes | Yes |
| Ear and sinus infections | Yes | Yes |
| Blood pressure, heart or blood vessel problems | Yes (high or low blood pressure) | Yes (heart or blood vessel problems) |
| Tumor | Yes | Yes (brain tumors) |
| Diabetes | Yes | Not listed |
| Thyroid problems | Yes | Yes |
| Head or neck injury | Yes | Not listed |
| Reaction to certain medicines | Yes | Yes (certain medicines) |
| Wax buildup | Yes | Not listed |
| Jaw misalignment | Yes | Not listed |
| Meniere’s disease | Not listed | Yes |
| Hormonal changes in women | Not listed | Yes |
A 2013 review in The Lancet, indexed by PubMed, lists hearing loss, ototoxic medication (medicines that can harm hearing), head injury and depression as risk factors. Its authors say the possibility of ear disease, anxiety and depression should be considered at the first visit.
Some causes are less common and need a check. The 2021 American Family Physician review says vascular tumors and vestibular schwannoma, a tumor on the nerve that runs from the ear to the brain, should be ruled out. If ringing comes with dizziness, read our guide to tinnitus and dizziness. If the ringing is in one ear only, see our guide to tinnitus in one ear.
Does tinnitus always mean hearing loss?
No. Tinnitus is strongly linked to hearing loss, but it does not always come with it. The 2021 American Family Physician review says most cases are benign and idiopathic, meaning the cause is unknown, and that most cases are strongly associated with sensorineural hearing loss, which is hearing loss from the inner ear or its nerve.
A standard hearing test does not catch everything. Harvard Health reports that some people with normal hearing tests still have tinnitus. It describes a study published November 30, 2023, in Scientific Reports. Researchers at Massachusetts Eye and Ear, a Harvard-affiliated center, recruited almost 300 adults aged 18 to 72 with normal hearing tests. Some had chronic tinnitus, some had intermittent tinnitus and some had none. They measured auditory nerve responses and brainstem activity. Compared with people without tinnitus, chronic tinnitus was associated with a loss of auditory nerve fibers and with increased brain activity. Harvard Health calls this “hidden hearing loss,” damage to the auditory nerve that conventional tests do not pick up. The study found an association. It does not prove that nerve loss causes the sound.
Harvard Health also notes that hearing aids are not recommended for people with normal hearing test results, even when hidden hearing loss is suspected, because tests for it exist only in research labs.
Is there a cure for tinnitus, and can it be permanent?
There is no known cure for tinnitus, according to Johns Hopkins Medicine. The 2013 Lancet review reports that no effective drug treatments are available, though much research is underway into mechanisms and possible treatments.
What can be treated is often the cause. Cleveland Clinic says that when tinnitus has an underlying medical cause, a specialist typically treats that condition first. Harvard Health says that in rare cases the noise comes from a tumor or cyst pressing on the auditory nerve, earwax buildup or blood vessel damage, and that treating these can sometimes reduce or even eliminate it. More often, it says, people learn to live with tinnitus or reduce it.
On whether it is permanent, Johns Hopkins Medicine says the sounds may come and go, or they may be ongoing. The Lancet review notes that tinnitus can persist even after surgery treats an ear problem linked to it. For a sense of what is likely in your case, ask your clinician.
What helps tinnitus feel quieter?
Several options are used, and the research behind them varies. The table shows what each source reports.
| Option | What the research or source says |
|---|---|
| White noise, fan or nature sounds | Harvard Health says these may make tinnitus seem quieter. Cleveland Clinic recommends white noise such as a fan or low-level television sound. |
| Cognitive behavioral therapy (CBT) | The 2021 American Family Physician review calls it the only treatment shown to improve quality of life in people with tinnitus. |
| Sound therapy combined with CBT-based counseling | The 2013 Lancet review says the evidence base is strongest for this combination. |
| Hearing aids | Johns Hopkins Medicine says they may help some people who have hearing loss, because they make sounds easier to hear and may reduce the tinnitus. |
| Sound therapy alone and tinnitus retraining therapy | The 2021 American Family Physician review says the evidence for these is inconclusive. |
| Medicines | Johns Hopkins Medicine says some medicines may ease tinnitus by addressing a linked problem, and may improve mood or sleep. The 2021 review says melatonin and antidepressants may help with sleep and mood problems. The 2013 Lancet review says no effective drug treatments are available. |
Harvard Health’s first suggestion is sound. It says listening to white noise or nature sounds might make tinnitus seem quieter, and suggests a white noise machine, sleep headphones, earbuds or a wearable sound-masking device.
Stress can make it harder. Harvard Health says stress may increase both your perception of tinnitus and your reaction to it, and suggests yoga or tai chi. Cleveland Clinic says tinnitus can cause and result from anxiety and stress, and its program includes cognitive behavioral therapy and mindfulness training.
What makes tinnitus worse, and can you prevent it?
Loud noise is one factor the research names. Johns Hopkins Medicine notes that loud noise can damage hearing, whether it is a loud burst or years of prolonged exposure. The 2021 American Family Physician review says avoiding noise exposure may help keep tinnitus from developing or getting worse. Stress is another factor, as described above. Some medicines are also listed as a cause by MedlinePlus.
Harvard Health lists good sleep habits, daily exercise and limiting alcohol intake, and says each of these can help reduce how often tinnitus occurs and how intense it is. The drink Harvard Health names is alcohol, and its advice is to limit it. For foods, ask your clinician whether any change to your diet makes sense for you.
Ask your clinician about any supplement you take. Cleveland Clinic’s specialists review medications and supplements to see whether tinnitus may be a side effect of them.
What information helps at an appointment?
Johns Hopkins Medicine advises writing down your questions before the visit, bringing someone to help you ask them and remember the answers, and asking whether your condition can be treated in other ways. Diagnosis includes a complete health history and physical exam, and your provider may request an audiological evaluation. The 2021 Medical Clinics of North America chapter on hearing loss and tinnitus names a focused history, an otoscopic and tuning fork exam, and formal hearing testing as the diagnostic pillars.
These notes help your clinician narrow things down:
| What to note | Why it helps |
|---|---|
| Which ear, or both | The 2021 American Family Physician review recommends a comprehensive audiologic evaluation for one-sided tinnitus. |
| How long it has lasted | The same review recommends that evaluation for tinnitus present six months or longer. |
| Any hearing problems you notice | The same review recommends the evaluation when tinnitus comes with hearing problems. |
| Whether it pulses, or is uneven between ears | The review says brain imaging is not part of the standard workup unless tinnitus is asymmetric or one-sided, pulsatile, linked to focal neurologic abnormalities, or linked to asymmetric hearing loss. |
| A recent hearing test | Cleveland Clinic asks for a hearing test in the six months before its tinnitus appointment. |
| An ear, nose and throat (ENT) visit | Cleveland Clinic asks you to see an ENT doctor first, so conditions that need medical or surgical treatment are ruled out. |
| Medicines and supplements you take | Cleveland Clinic’s neurology experts review them to see whether tinnitus may be a side effect. |
What the research cannot tell you yet
- Whether a future treatment may help support tinnitus. Johns Hopkins Medicine says there is currently no known cure.
- How long your own tinnitus will last.
- Whether hidden hearing loss causes tinnitus in everyone who has it. The 2023 study found an association.
- Whether nerve regeneration could help people. Harvard Health reports that nerve fibers have been regenerated in animal models, and says it is unclear when or if that will be possible in humans.
- Which treatment works best for a given person. The 2013 Lancet review says clinical trials are constrained by how varied tinnitus patients are.
Where can you find support now?
Harvard Health suggests looking for tinnitus groups on Facebook or through the American Tinnitus Association, which has a support section. It says you may pick up tips that work for other people. MedlinePlus lists directories for finding an audiologist and an ENT specialist, plus a support group directory.
Your next step
Ask about a hearing test and an ENT visit if you have not had them, and bring the notes from the table above. Write down which ear is affected, how long it has lasted, and any medicines or supplements you take. Ask whether a treatable cause could explain your ringing, and ask about combining sound therapy with counseling, the approach the 2013 Lancet review says has the strongest evidence base. If your ringing is new or concerning, ask a clinician about it now, since this page cannot tell you how urgent your case is.
By the Connected Diagnostics Evidence Team
This article is for general information purposes only and does not constitute medical advice. Consult your doctor or qualified healthcare provider before making changes to your health routine.
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