Tinnitus (ear ringing) – causes, types and treatment

This is one of the most common causes. The inner ear hair cells work less effectively due to noise exposure, aging, medication, or other damage. The brain then receives fewer normal sound signals and "turns up the gain." A byproduct of this can be whistling, ringing, or buzzing.

Typical examples: noisy workplace, machinery, concerts, headphones at too high volume, noisy sporting events. The ear is not "acting up" but signaling that it has been harmed.

Age-related hearing loss (presbyacusis): Neural hearing loss associated with aging often accompanies high-pitched ringing or whistling. Many patients notice the tinnitus before they recognize the hearing loss.

A wax blockage can be a simple but common cause. External ear infections, middle ear infections, eardrum problems, Eustachian tube dysfunction, fluid in the middle ear, or otosclerosis (stiffening of the stapes bone) can also cause tinnitus. These conditions often present with a feeling of fullness, blockage, hearing loss, or pressure.

Menière's disease: Characterized by episodic vertigo, tinnitus, a feeling of ear fullness, and fluctuating hearing loss. In this case the tinnitus is often deeper and more roaring rather than the classic high-pitched whistle.

If tinnitus appears together with sudden hearing loss, it is an urgent condition. Tinnitus associated with sudden hearing loss that developed within 3 days requires urgent specialist assessment within 24 hours.

This is not something to "sleep on." Time really matters here.

If the tinnitus pulses in time with your heartbeat, consider pulsatile tinnitus. Causes can include flow disturbances in neck or intracranial vessels, venous anomalies, arterial stenosis, vascular malformations, increased intracranial pressure, or less commonly a tumor.

This is a category where masking it with relaxation music is particularly not a good idea. Imaging diagnostics may be required.

Metabolic and circulatory factors: High blood pressure, cardiovascular disease, diabetes, and certain metabolic conditions can be associated with tinnitus. These are not always direct causes but can impair inner ear blood supply and neural function.

Tinnitus can be somatic/somatosensory in origin. In these cases, input from the jaw, masticatory muscles, neck muscles, or cervical spine affects auditory system function. It is suspicious when tinnitus changes with teeth clenching, chewing, head turning, neck strain, posture, or jaw movement.

Often this is not a "classic ear disease" but a disorder of ear–neck–jaw interaction. A systematic review suggests that treating TMD (bite splint, physiotherapy) can improve associated tinnitus symptoms.

Certain medications can cause tinnitus or hearing loss as side effects, especially at high doses or with prolonged use. These may include high-dose salicylates, some NSAIDs, aminoglycoside antibiotics, certain diuretics, chemotherapy agents, and quinine derivatives.

Important: Do not stop medication on your own for this reason. Consult your doctor first, because sudden withdrawal can sometimes cause more harm than the tinnitus itself.

Tinnitus can be associated with migraine, vestibular migraine, central nervous system disorders, multiple sclerosis, stroke, or less commonly an auditory nerve tumor (vestibular schwannoma). These are considered especially if tinnitus is unilateral, persistent, asymmetric hearing loss is present, or there are neurological signs or vertigo.

Stress is rarely the sole cause, but it often amplifies tinnitus. The objective noise may be the same, yet the brain perceives it as more threatening. Poor sleep, anxiety, fatigue, and sustained attentional focus can create a vicious circle: the ringing causes stress, and stress amplifies the ringing.

Therefore, assessing psychological burden and sleep quality is important in tinnitus care. I discuss this further in the treatment section.

Stress is one of the most common tinnitus-amplifying factors. The stress–tinnitus loop is vicious: the ringing causes stress, and stress intensifies the ringing. This loop must be broken.

What you can do: regular exercise (30 minutes’ walk daily can help), deep breathing exercises (4 seconds inhale, 7 hold, 8 exhale), progressive muscle relaxation (Jacobson method), and meditation (even 10 minutes daily). These methods divert the brain's attention networks away from the tinnitus sound.

Vitamin B12: Israeli studies suggest that B12 deficiency is common in patients with tinnitus. If confirmed by blood tests, supplementation may help.

Ginkgo biloba: A plant extract that may support circulation. Some reports suggest that 200 mg daily of a standardized extract may improve inner ear blood flow. Results are mixed — worth trying, but don't expect miracles.

Magnesium: Magnesium may have a protective effect against noise-induced hearing damage. Daily supplementation of 200–400 mg is generally safe and worth considering.

Avoid: Caffeine, alcohol, and excessive salt intake can worsen tinnitus for some people. Try eliminating them for 2–3 weeks and monitor any changes.

If you already have tinnitus, protecting your hearing is especially important. Further noise exposure can worsen the condition.

Use earplugs in noisy environments (concerts, DIY, mowing the lawn). Avoid loud headphone use — keep volume under 60%. If you work in a noisy environment, use active noise-cancelling hearing protection. Remember: prevention is much easier than treatment!

Tinnitus and sleep disturbance often go hand in hand. In silence tinnitus becomes more noticeable and is most disruptive when trying to fall asleep.

Tips: use a white noise generator or nature sounds next to the bed. Keep a regular bedtime. Avoid caffeine after 2 pm. Turn off screens one hour before bed. Good sleep reduces stress, which in turn lessens tinnitus perception — a positive cycle begins.