What causes tinnitus? How does it start? We shed some light on the most commonly asked questions about what causes the condition in this comprehensive guide.
Fatema Dawoodbhoy

Fatema Dawoodbhoy

Medically Reviewed by
Dr Jameel Muzaffar
Content Writer | Medical Student
October 23, 2020

What Causes Tinnitus? The Science Made Simple

Ringing or buzzing in the ears is incredibly common and affects millions of people all over the world. But what causes tinnitus? How does it start? Is it preventable? We're going to shed some light on the most commonly asked questions about the condition.

What can cause ringing in the ears?

Did you know 1 in 8 people in the UK have tinnitus?

That’s over 10% of the population battling this silent condition. It can be seriously debilitating, not only affecting hearing but also having a big effect on sleep, stress and mental health.

Tinnitus is a term to describe hearing sounds from inside the body rather than externally. Essentially, you can hear a sound, or sounds, when that sound does not exist in the world outside you.

It is important to clarify that it is not a disease in itself, and often can be a symptom of an underlying cause.

It normally indicates an issue in the auditory system, which consists of:

  • the external ear (the ear canal and ear drum)
  • the internal ear (where sound gets converted to an electrical signal)
  • the auditory nerve (connecting the inner ear to the brain)
  • the parts of the brain that process sound

Diagram of the ear. Source: Wikimedia Commons

A common phrase people with tinnitus might use to describe tinnitus is a “ringing in the ears” but the sounds heard also include buzzing, humming, grinding, hissing and whistling.

We'll split the causes of tinnitus into three broad categories:

  1. Common causes of tinnitus
  2. Rarer medical conditions that can cause tinnitus
  3. Medications that cause tinnitus

What causes tinnitus: common conditions

Let's start by going over the commonest causes of tinnitus:

  • Ear wax
  • Ear bone changes
  • Noise exposure
  • Age related hearing loss

There are many common causes of tinnitus, which are often nothing to worry about!
There are many common causes of tinnitus

Ear wax

Something as simple as earwax causing an occlusion to the ear canal can cause tinnitus. What's important to know about earwax and tinnitus

Earwax is something we regard as unpleasant but in reality, it has a lot of protective features for our ear.

It coats our ear canal, trapping dirt and impeding the growth of bacteria inside the ear.

However, a good balance is always needed. When the earwax accumulates and hardens, it becomes difficult to wash away naturally and hence can result in hearing loss or eardrum irritation leading to tinnitus.

Ear bone changes

Otosclerosis is a condition which results in the abnormal growth of bones inside the ear.

Inside the ear, there are three tiny bones present which vibrate when sound waves enter. They are responsible for transmitting sound waves to the inner each where the sound waves are converted into signals later sent to the brain.

When otosclerosis is present, one of the three bones (the stapes) fuse its surrounding bones and eventually becomes rigid and immoveable. As a result, this means that sound waves are not efficiently transmitted to the inner ear.

This cause of tinnitus tends to run in families.

Noise exposure is a common cause of tinnitus
Noise exposure is a common cause of tinnitus

Noise exposure

Approximately 70% of tinnitus is caused by loud noises.

Loud noises are all around us, from fire alarms to concerts. We can’t avoid them all, but we can try to protect against them.

If the loud noise exposure was for a short period of time, the tinnitus tends to resolve and go away but short or long-term exposure can also cause permanent damage leading to lifelong tinnitus.

Tips on protecting against loud noises:

  • Plan ahead - if you know you’re going to a loud event (eg. concerts or sports games), bring some earbuds
  • Music - I’m sure we’re all guilty of turning up the music too loud to drown out the background noises, but this can be detrimental to your hearing
  • Hearing test - if you are worried about your hearing health, it can be a good idea to get your hearing tested


Old age is linked to many conditions, such as worsening eyesight and hearing. People around the age of 60 tend to gradually start experiencing a worsening in their hearing. This hearing loss can also cause tinnitus.

The medical term for this specific type of hearing loss is presbycusis.

Often age related hearing loss is a common cause of tinnitus
Age related hearing loss is a really common cause of tinnitus.

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Rarer Medical Problems Causing Tinnitus

There are other medical problems that can cause tinnitus, and in some cases your doctor will send you for further tests to rule these out. Some of these conditions include:

  • Meniere's disease
  • Acoustic neuroma
  • Head or neck injury
  • Eustachian tube dysfunction
  • Turbulent blood flow

Meniere’s disease

Meniere’s disease is a condition affecting the inner ear resulting in the following symptoms:

  • Tinnitus
  • A feeling of pressure in the ear
  • Hearing loss
  • Vertigo

Meniere’s disease is thought to be linked to the inappropriate amount of fluid found in the inner ear, but the exact cause is uncertain.

Tinnitus is considered an early indicator of this disease and can aid in the diagnosis.  

Acoustic neuroma

Acoustic neuroma (or vestibular schwannoma as they are sometimes called) is the medical word for a non-cancerous tumour in one of the nerves that runs from the brain to the inner ear.

This nerve is responsible for balance and hearing, and when the tumour places pressure on the nerve both of these things are affected.

This will result in tinnitus in one ear.

A diagram of an acoustic neuroma - a rarer cause of tinnitus. Source: Wikimedia Commons

Head or neck Injury

It is difficult to prevent any injury to the head or neck as no one deliberately tries to get injured.

Sometimes, life just deals us a bad hand. However, some people are at an increased risk of such injuries depending on their profession. Sports professionals such as football or rugby players or manual workers like builders might injure their head and neck at some point in their career.

These traumas may lead to tinnitus. They can also injure the inner ear and any injury to the inner ear can affect one or more of the anatomy linked to hearing.

Depending on the extent of the injury to the inner ear, it will correlate to the severity of the tinnitus.

Eustachian tube dysfunction

The eustachian tube is a small pipe that connects the middle ear to the upper part of the throat.

This tube is in charge of regulating the pressure within the middle ear, equalising the pressure inside and outside the ear. When a person has Eustachian tube dysfunction, this tube remains expanded all the time resulting in full sensation in the ear.

One of the symptoms of the condition can be tinnitus and problems with hearing.

Blood vessel disorders

These blood vessel-related causes of tinnitus are much rarer.

They usually result in a specific type of tinnitus called pulsatile tinnitus. Pulsatile tinnitus occurs as a  result of turbulent blood flow in or near your ears.

Instead of hearing a steady ringing or buzzing, you would tend to hear a rhythmic sound that follows the same rate of the heart.

Various medications can cause tinnitus
Various medications can cause tinnitus

What medications cause tinnitus?

There are known medications that have been linked to the cause or worsening of tinnitus.

It is generally thought that in higher doses, the higher the risk of tinnitus. But when the medications are stopped, it tends to subside and usually will stop. The medications include:

  • Antibiotics: polymyxin B, erythromycin, vancomycin and neomycin
  • Cancer medications: methotrexate and cisplatin
  • Diuretics (water medications): bumetanide, ethacrynic acid or furosemide
  • Quinine medications used in the treatment of malaria or other conditions
  • Certain antidepressants
  • High doses of aspirin.

If you happen to be taking any of these, your doctor will have probably advised you to look out for any symptoms.

If you do think your tinnitus is linked to one of these medications, make an appointment with your GP to discuss it further.

Does stress cause tinnitus?

It is unlikely that stress would be a direct cause of tinnitus.

However, the tinnitus and stress are closely linked and we do know that increased stress can make tinnitus worse. Stress can also trigger a tinnitus flare up in those that have habituated to the condition.

In many people hearing the sound of their tinnitus will activate the fight or flight response. This may in turn make the tinnitus feel more intrusive.

Learn more about how to interrupt the cycle of tinnitus and stress.

Finding the Cause

How can you find out which one of these conditions is causing your tinnitus?

After some tests, your doctor should be able to tell you which condition is causing your tinnitus. Although it is worth noting that this is not always possible.

In rarer cases, sometimes the cause is never found.

If you live in the UK, there is a specific pathway for tinnitus diagnosis and treatment in the NHS.

You can read more about which tinnitus treatments may be more appropriate for you in our next article.

Join Oto

The Oto app offers a comprehensive tinnitus solution all in the palm of your hand:

  • CBT techniques
  • Pleasant and relaxing sounds and audio landscapes
  • Sleep support including sleep stories, mindfulness for sleep, and sleep preparation
  • Meditation, visualisation, anchoring, and breathing exercises
  • Stretching exercises for the neck, shoulders, arms, jaw, and back

Check out Oto's Tinnitus Support Group, a supportive community for individuals with tinnitus or related conditions to receive regular tips and tricks from the expert team at Oto!‍


What is tinnitus?

Tinnitus is a condition where individuals hear an internal sound in one or both of their ears, such as ringing or buzzing, when no external sound is present.

How prevalent is tinnitus?

Approximately 1 in 8 people in the UK, over 10% of the population, have tinnitus.

Is tinnitus a disease?

No, tinnitus is not a disease in itself. It is often a symptom of an underlying cause related to the auditory system. However in some cases no cause for tinnitus may be identified.

What are the common causes of tinnitus?

Common causes include ear wax accumulation, noise exposure, hearing loss or certain medical conditions such as meniere's disease or acoustic neuroma.

Can medications cause or worsen tinnitus?

Yes, certain medications, especially in higher doses, can cause or exacerbate tinnitus. These include some certain antibiotics, diuretics, quinine medications, some antidepressants, and high doses of aspirin to name a few.

How is tinnitus linked to stress?

While stress might not directly cause tinnitus, it can exacerbate the condition. Increased stress can trigger a tinnitus flare-up, even in those who have habituated to the condition.

What are some rarer medical conditions that can cause tinnitus?

Rarer conditions include Meniere's disease, acoustic neuroma, head or neck injuries, Eustachian tube dysfunction, and certain blood vessel disorders.

How is pulsatile tinnitus different?

Pulsatile tinnitus is a type where individuals hear a rhythmic sound that follows the same rate as the heart. This can be due to turbulent blood flow near the ears which can be caused by a number of conditions. If you suffer from pulsatile tinnitus you should consult with a medical professional.

How can one determine the cause of their tinnitus?

Doctors can conduct tests to identify the cause of tinnitus. However, in some cases, the exact cause might remain unidentified.

Are there treatments available for tinnitus?

Yes, treatments include Cognitive Behavioral Therapy (CBT), sound therapy alongside addressing any identified underlying cause.

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Discover how to tune out tinnitus with our free webinar

Register for our 20 minute webinar and learn why you don't just have to live with tinnitus.
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