Tinnitus (Ringing in the Ears): What Causes It, How It's Treated, and When to See a Doctor

Written by Dr. Kathryn Kline, MD, Board-Certified Family Medicine Physician | Medically reviewed by Dr. Casey Dean, DO | Trinity Family Medicine

Last medically reviewed: October 2026

About the author: Dr. Kline is a board-certified family medicine physician (ABFM) who evaluates hearing-related complaints, reviews medications, and screens for serious red flags for patients across Texas through primary care and telehealth.

That high-pitched ringing, buzzing, hissing, or humming you hear when the room is quiet has a name: tinnitus, the medical term for the perception of sound when there is no external source making it. It is one of the most common symptoms in all of medicine. According to the 2026 American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) tinnitus guideline, tinnitus affects an estimated 10% to 15% of adults, and more than 50 million Americans have reported experiencing it. If you have had ringing in the ears that won't go away, you are far from alone — and there is a clear, evidence-based path forward. This guide explains what causes tinnitus, which treatments actually have evidence behind them, and the specific warning signs that mean you should be seen promptly.

Quick Summary: Key Facts at a Glance

Key takeaway: Tinnitus usually cannot be "cured," but for most people it can be substantially reduced and made far less distressing with the right combination of hearing care, sound strategies, and counseling.

Emergency warning: Tinnitus that pulses in time with your heartbeat, comes on suddenly in one ear with new hearing loss, or arrives with face drooping, severe headache, weakness, or slurred speech needs urgent medical evaluation — call 911 for stroke-like symptoms.

What Is Tinnitus?

Tinnitus is the perception of sound without an outside source, and about one in ten to one in seven adults experiences it. The sound is real to you but inaudible to anyone else, because it is generated inside the hearing system rather than by the air around you. Most people describe ringing, but buzzing, hissing, roaring, clicking, whooshing, and humming are all common. Doctors sort tinnitus a few important ways. Primary tinnitus has no identifiable cause and is usually tied to hearing loss, while secondary tinnitus is linked to a specific problem such as earwax, a medication, or a blood-vessel issue. Nearly all tinnitus is subjective (only you can hear it); rarely, a clinician can actually detect an objective sound. The most important split is bothersome versus non-bothersome — the AAO-HNS notes only about 20% of people with tinnitus are bothered enough to seek care. Tinnitus is also called persistent once it lasts six months or longer.

What this means in plain English: tinnitus is a symptom, not a diagnosis — the goal of a visit is to find out why you hear it and how much it is affecting your life.

What Causes Ringing in the Ears?

The most common cause of tinnitus is hearing loss — from aging (presbycusis) or from a lifetime of loud-noise exposure — which is why tinnitus and difficulty hearing so often show up together. Researchers believe the ringing is the brain's response to missing input: when the inner ear stops sending certain sound frequencies, the brain's hearing pathways turn up their own internal "gain," and you perceive that activity as noise. Tinnitus is almost never a sign that you are losing your mind or your hearing overnight.

Common and treatable contributors include:

A single symptom is a clue, not a diagnosis. Many conditions overlap here. Age-related hearing loss, earwax, Ménière's disease, an acoustic neuroma (a benign nerve tumor), and medication effects can all produce similar ringing, so the pattern and accompanying symptoms matter more than the sound itself. Ringing in both ears that comes and goes usually reflects ordinary hearing changes, while ringing in one ear only, or a whooshing that beats with your pulse, points toward a specific cause worth investigating.

Is Tinnitus Permanent? How Long Does It Last?

It depends on the cause. Tinnitus from a temporary trigger — a loud concert, an ear infection, a wax plug, or a new medication — often fades within days to a few weeks once the trigger is resolved. Tinnitus tied to long-standing hearing loss tends to persist, but "persistent" does not mean "untreatable." Over months, the brain often habituates, meaning the sound fades into the background even when it is technically still there. The 2026 AAO-HNS guideline focuses specifically on tinnitus that has lasted six months or longer and is bothersome, because that is the group most likely to benefit from active treatment.

How Is Tinnitus Treated?

There is no pill that cures tinnitus, but several approaches have real evidence for making it quieter and far less intrusive. The 2026 AAO-HNS guideline, which replaced the 2014 version and includes 16 research-based recommendations, emphasizes a personalized plan built around hearing care, sound, and counseling rather than a one-size-fits-all fix.

What the guideline supports for persistent, bothersome tinnitus:

What the guideline recommends against routinely using as a primary tinnitus treatment: antidepressants, anticonvulsants, anti-anxiety drugs, and in-the-ear (intratympanic) injections; dietary supplements such as ginkgo biloba, melatonin, and zinc; and repetitive transcranial magnetic stimulation (rTMS). Medications aimed directly at the ringing carry side effects — drowsiness, dependency risk, or heart-rhythm concerns depending on the class — without reliable benefit, which is why they are not first-line. A clinician may still treat co-existing anxiety, depression, or insomnia on their own merits, which can indirectly help.

Dr. Kline's clinical perspective: "The questions I focus on first are not 'how do we silence the sound?' but 'is there a reversible cause here — wax, a medication, untreated hearing loss — and how much is this affecting your sleep and mood?' Answering those two questions resolves or dramatically improves a large share of cases before anyone reaches for anything exotic."

Which Tinnitus Option Fits Your Situation?

Do You Need a Scan or Other Tests?

Usually not — most tinnitus needs a hearing test, not a brain scan. The AAO-HNS and the American Academy of Family Physicians (AAFP) agree that a hearing evaluation is the core workup, and that imaging (such as an MRI or CT angiography) is reserved for people with specific concerning features. According to the AAFP's 2021 review, imaging is warranted when tinnitus is pulsatile, one-sided or asymmetric, accompanied by asymmetric hearing loss, or paired with focal neurologic findings. Those patterns can signal a treatable blood-vessel problem or, rarely, an acoustic neuroma. Routine blood tests are not needed for everyone, but your clinician may check for contributors such as thyroid problems or anemia when the history suggests them.

When Is Tinnitus a Warning Sign?

Most tinnitus is benign, but certain features change the urgency. See a clinician promptly — or seek emergency care for stroke-like symptoms — if any of these apply.

These red flags are not all equally urgent. Sudden hearing loss in one ear is the most time-sensitive — it should be checked within a day or two rather than "watched," because prompt treatment can improve the chance of recovering hearing. Pulsatile tinnitus and new one-sided ringing need timely evaluation, with the urgency rising if other symptoms come with them.

Pulsatile tinnitus deserves special mention: because it can reflect turbulent blood flow, the AAFP notes it should prompt evaluation for an underlying vascular or cardiovascular cause. And the 2026 guideline makes a point of urging clinicians to ask directly about emotional distress and self-harm, because up to one-third of people with tinnitus have clinically significant depressive symptoms. If the ringing is pushing you toward hopelessness, that is a medical reason to reach out today, not something to tough out alone.

When to See Your Doctor — and How Telehealth Can Help

As a general guide, see a clinician for tinnitus that lasts more than a week or two, affects only one ear, or comes with dizziness or ear pain — and seek same-day care for sudden hearing loss, which should not wait. A visit lets a clinician take a focused history, look for reversible causes such as earwax or a problem medication, screen for the red flags above, and arrange a hearing test. These are the steps that resolve or substantially improve many cases and that keep a rare serious cause from being missed. Testing or an in-person ear exam is sometimes the safer path, and tinnitus with stroke-like symptoms always needs emergency care rather than a remote visit.

A telehealth visit is a practical front door for exactly this. A Trinity Family Medicine clinician can assess whether your symptoms sound like ordinary, benign tinnitus or something needing urgent in-person evaluation, review your medications for ones that cause ringing, treat contributors like high blood pressure or insomnia, and coordinate a hearing test or ENT referral when warranted. Trinity Family Medicine offers physician-led telehealth across Texas starting at $49.99, with the same doctor each visit; book at trinitymedtx.com or call 817-932-4022. If your ringing comes with dizziness or a spinning sensation from an inner-ear problem, or with the loud snoring and daytime exhaustion of sleep apnea, those are worth raising at the same visit — see our guides to vertigo and the Epley maneuver and obstructive sleep apnea.

Can You Treat Tinnitus During Pregnancy?

Yes — the safest, best-supported tinnitus strategies are non-drug ones appropriate in pregnancy: sound enrichment, CBT, and hearing care. Pregnancy itself can bring on or amplify pulsatile tinnitus because blood volume and flow increase; this is usually benign but should be mentioned to your clinician, especially alongside new high blood pressure or headaches. Since the 2026 guideline advises against medications and supplements for tinnitus anyway, there is little to "avoid." Still, high-dose aspirin and some other drugs that can cause ringing are already limited in pregnancy, so review any medication or supplement with your clinician first.

Frequently Asked Questions

The Bottom Line

Tinnitus is extremely common, affecting roughly 10% to 15% of adults, and it is almost always a symptom of something else — most often ordinary hearing loss — rather than a disease on its own. While it usually cannot be cured outright, the 2026 AAO-HNS guideline shows that a personalized plan built around a hearing evaluation, hearing aids, sound enrichment, and cognitive behavioral therapy can substantially reduce the ringing and the distress it causes for most people. If your tinnitus is persistent, one-sided, pulsatile, or affecting your sleep and mood, see a clinician — the right evaluation can uncover a reversible cause, rule out the rare serious ones, and get you on an effective plan.

References