Tinnitus in one ear is a ringing, buzzing, hissing or other sound that has no outside source and that you hear on one side. Merck Manual says most tinnitus comes from causes that are not dangerous, but tinnitus in one ear is a finding doctors take seriously, especially with hearing loss, dizziness or balance trouble. Start with your primary care doctor, then a hearing test, and let them sort the common causes from the rare ones.
What causes tinnitus in one ear?
The NIDCD (National Institute on Deafness and Other Communication Disorders) links tinnitus to noise exposure, hearing loss, certain medications, earwax or an ear infection, and head or neck injuries. Merck Manual adds that many ear-related disorders include tinnitus as a symptom, and that people with hearing loss, regardless of cause, often develop it.
Temporary tinnitus often has a simple trigger. Cleveland Clinic says too much earwax can cause temporary hearing loss, and it lists tinnitus among the symptoms of a clogged ear. The NIDCD says that when tinnitus has a physical cause such as earwax or jaw joint problems, addressing that cause can eliminate or greatly reduce symptoms.
If you developed tinnitus for no obvious reason, you are not alone in that. The NIDCD says some people develop it for no known reason, and Merck Manual says that in many cases the cause is unknown.
Why does one-sided tinnitus need context?
Ringing in one ear is different from ringing in both ears because it can point to a problem on one side. Merck Manual lists tinnitus in only one ear, particularly when it comes with hearing loss, dizziness or balance difficulty, among the findings of concern. CommonSpirit Health says tinnitus affecting one ear may be a sign of a specific ear-related problem, and that a doctor’s evaluation is advisable.
Harvard Health notes that in rare cases the noise can come from a tumor or cyst pinching the auditory nerve, a buildup of earwax, or blood vessel damage. That is why one-ear tinnitus with no clear trigger deserves a proper check.
Some patterns change how fast you should act. The Merck Manual lists any neurologic symptoms other than hearing loss among these findings of concern, particularly difficulty with balance or walking, but also vertigo or difficulty seeing, speaking, swallowing, and/or talking. Merck advises that people with warning signs see a doctor right away.
Woke up with tinnitus in one ear, or it has been constant?
If tinnitus recently began, Merck Manual says people without warning signs should call their doctor. Most people with tinnitus and no warning signs have had it for a long time, and Merck says they should see their doctor about it if they have not already done so. Constant tinnitus is still worth raising at a visit, because it gives your clinician a clear starting point.
Does hearing asymmetry matter?
Yes, a difference between your ears is one of the things a clinician looks at. Merck Manual says most people with tinnitus should have a formal hearing test, including an audiogram. Merck also says people with tinnitus in one ear and hearing loss should have gadolinium-enhanced MRI, a scan that uses contrast dye.
Cleveland Clinic asks people to have a hearing test within six months before a tinnitus appointment, because understanding how hearing loss may be contributing to the tinnitus helps decide next steps. The Harvard Health article on hidden hearing loss explains that for people with measurable hearing loss, hearing aids sometimes reduce the perception of tinnitus.
Is pulsing in one ear serious, or is it a sound that changes when I lie down?
Pulsing tinnitus is different. The NIDCD says that in rare cases the sound pulses rhythmically, often in time with your heartbeat. A doctor may hear it with a stethoscope, and it is considered objective tinnitus. The NIDCD says these cases often have an identifiable cause and are treatable.
Merck Manual says people with pulsatile tinnitus should call their doctor. A New Jersey neurosurgery practice’s pulsatile tinnitus page says that noticing your heartbeat when lying on one side is not uncommon, but that persistent pulsing, especially if you hear it clearly at rest or on one side, should be evaluated by a healthcare professional. If the sound only comes when you lie down, tell your clinician exactly when it happens.
What questions might a clinician ask?
Merck Manual says doctors start with the nature of the tinnitus, including whether it is in one or both ears and whether it is constant or pulsatile. They also ask about neurologic symptoms, loud noise exposure and medications that can affect the ears. The physical exam focuses on the ears, including hearing, and the neurologic system.
The NIDCD describes the usual path. A primary care doctor checks for earwax or fluid from an ear infection and asks about medical history and medications. An ear, nose and throat doctor, called an otolaryngologist, then asks you to describe the sounds and when they started. An audiologist may measure your hearing, and imaging such as MRI, CT or ultrasound may be ordered, especially if the tinnitus pulses.
If your clinician mentions vestibular testing, ask what it will check. Merck Manual lists vestibular testing among tests for Ménière disease, and the NIDCD says Ménière’s disease can cause tinnitus along with balance problems and hearing loss.
Can tinnitus go away, and what helps?
The NIDCD says tinnitus may improve or even go away over time, but for some people it worsens. Merck Manual says tinnitus rarely can be stopped, but certain techniques help people manage their symptoms.
Sound helps many people. Merck says background sound can mask tinnitus and help you fall asleep, and that some people use a tinnitus masker, a device worn like a hearing aid. The NIDCD says sound therapy may help by masking the sounds, helping you grow accustomed to them, or distracting you. Cleveland Clinic recommends white noise such as a fan or low-level television sounds as one way to focus away from tinnitus.
Caffeine is a known trigger for some people. Merck says caffeine and other stimulants can worsen tinnitus, so people should try to avoid them.
The NIDCD says there are currently no medications approved by the U.S. Food and Drug Administration for treating tinnitus. It also says vitamins, herbal extracts and dietary supplements commonly advertised for tinnitus have not been proven effective. If you suspect a vitamin deficiency, ask your clinician whether a test makes sense. If you are considering heat or another home treatment, ask your clinician first.
What the research shows and where it stops
A 2023 study published in Scientific Reports, described by Harvard Health, is one of the largest looks at this question. Researchers at Massachusetts Eye and Ear recruited almost 300 people aged 18 to 72 who had normal hearing tests. Some had chronic tinnitus, some had none and some had intermittent tinnitus. 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 increased brain activity. That is an association, not proof of the cause. Harvard Health adds that tests for this kind of hidden hearing loss are available only in research labs, and that the researcher says it is unclear when or if the nerve fibers can be regenerated in people.
The NIDCD also says preliminary trials of repetitive transcranial magnetic stimulation have yielded mixed results. Its page was last updated May 1, 2023, so check it for newer guidance.
Where can I get practical help?
The NIDCD Information Clearinghouse answers questions about hearing and tinnitus. You can call (800) 241-1044 toll-free, use the TTY line at (800) 241-1055, or email nidcdinfo@nidcd.nih.gov.
If you are also dealing with ear pain or discharge, read ear infection signs and what can be mistaken for an ear infection to compare symptoms before your visit. For how a remote ear image can be reviewed with a clinician, see remote ear assessment.
What is the next step?
Call your primary care doctor and describe the tinnitus: which ear, constant or pulsing, when it started and whether it changes when you lie down. Ask about a hearing test, and ask whether you should see an ear, nose and throat doctor. If you have any neurologic symptoms, such as trouble with balance or walking, vertigo, or trouble seeing, speaking or swallowing, Merck advises that you see a doctor right away.
Before you go to your appointment
- Which ear is affected, and did it start suddenly?
- Is the sound constant, intermittent or pulsing with your heartbeat?
- Does it change when you lie down, move your head or jaw?
- Have you had recent loud noise, new medications or ear fullness or discharge?
- Do you need a hearing test or an MRI, and what will each check?
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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