Ringing in Ears: 9 Causes of Tinnitus & What to Do

Ringing in the ears occurs after constant noise or sound at uncomfortable volumes. The ringing can be described as squeaking, whistling, buzzing, water-like, clicking or snapping. The ringing, also known as tinnitus, can be mild and heard only in silent environments, or they can be intense and persist throughout the day.

Tinnitus can occur in anybody, although it is more frequently noted in older adults. It is often caused by injuries within the inner ear from listening to loud music or hearing a loud noise, ear infections, head trauma, medication overdose or normal aging. 

If you experience tinnitus, you should monitor for other symptoms like dizziness, loss of balance and hearing loss. If these occur, you should see an ENT specialist for assessment and testing. Treatment will depend on the underlying cause, and may involve ear wax removal, antibiotics or surgery. 

Imagem ilustrativa número 1

The main causes of ringing in the ears are: 

1. Excessive ear wax

Built-up ear wax can block the ear canal and cause ringing in the ear, difficulty hearing, ear pain, itching or dizziness. 

Ear wax serves to protect the inner ear from moisture, infection, trauma or foreign bodies. Infections or even normal aging can cause increase ear wax production, or can cause ear wax to become harder, which can block the ear canal. 

What to do: You should see your doctor for ear syringing to remove ear wa. Excessive production can be treated with specific ear drops, while infections can be treated with antibiotics. You should never use a cotton swab to remove ear wax, as it can push the ear wax further inside and cause hearing loss.

2. Exposure to loud noise

Exposure to loud noise, like frequently listening to music through ear phones or going to a concert, can damage the cilia cells that line the inner ear. This can cause ringing in the ear, which generally improves within 48 hours. However, in some cases, ringing can persist for up to 1 to 2 weeks. 

What to do: You should see an ENT specialist for a hearing assessment if your ringing does not improve within 48 hours of initial exposure. Additionally, you should seek assessment if you have other symptoms like hearing loss or dizziness. 

3. Ear infection

An ear infection can occur due to bacteria, fungus or virus within the ear. It can increase ear pressure due to accumulation of fluid within the middle ear, which is behind the ear drum. Ear infections can cause ringing in the ear, pain, pressure within the ear and the formation of pus. 

Tinnitus that is caused by ear infections can also be accompanied by fever, redness or yellow or white discharge. 

What to do: You can apply a warm compress over the affected ear to relieve pain. You should see a ENT specialist to to initiate treatment, which is usually down with antibiotic ear drops applied in the ear. 

4. Labyrinthitis 

Labyrinthitis is an inflammation or infection that affected the labyrinth, located in the inner ear. Swelling can result in ringing in the ear, as well as dizziness, nausea, loss of balance or general malaise. This condition can be caused by viral infections, diabetes, high blood pressure or even emotional factors like stress, anxiety or depression. 

Generally, people who have had labyrinthitis in the past will often experience recurrences, with symptoms that appear suddently and intenseley. These symptoms often resolve in minutes or hours. 

What to do: You should rest as much as possible and follow your treatment as indicated by the ENT specialist. It may involve medications like betahistine, for example, which can improve blood circulation to the ear and reduce ringing. Labyrinthitis caused by infections may require prescription antibiotics, while emotional triggers can be treated with anxiolytic or antidepressants. 

5. Temperomandibular joint dysfunction 

Temperomandibular joint (TMJ) dysfunction can also cause ringing in the ear. This condition is characterized by an abnormality within the joint that connect the jaw to the skull, and can happen from teeth grinding when sleeping, direct trauma to the area, emotional distress or genetic factors. 

The TMJ is responsible for opening and closing the mouth, and injuries to this joint can cause tinnitus, headaches, jaw pain or facial pain, especially with chin movement. 

What to do: If you experience TMJ pain, you can apply a warm compresses to the ear and joint region to relieve discomfort. However, you should see a dentist for assessment and treatment, which may involve medications (like nati-inflammatories or analgesics), a mouth guard to prevent grinding, or even surgery. 

6. Chronic diseases 

Some chronic diseases, like diabetes, high blood pressure, rheumatoid arthritis, multiple sclerosis, lupus, stroke or thyroid problems can cause ringing in the ears. 

What to do: You should follow treatment for the specific disease as directed by your doctor, as adequate management can relieve the ear ringing. An anti-inflammatory diet with foods like broccoli, salmon or oranges can also help to relieve or prevent tinnitus.

7. Changes to structures in the ear

Ringing in the ears can also be caused by changes to the structures within the ear, like blood vessel malformations. This condition causes blood to flow with more force within the ear, causing ringing. 

Aging of the bones in the ear, also known as otosclerosis, or ear muscle spasms can also cause ringing in the ear or even hearing loss. 

What to do: You are advised to consult an ENT specialist, who can order tests like audiometer or impedance testing to confirm a diagnosis and start treatment. Treatment may include the use of a hearing aid or surgery. 

8. Using toxic medications in the ear  

Some medications can have a toxic effect in the ear, causing damage to the nerves that control hearing as well as ringing. 

The main medications that can be toxic include anti-inflammatories (like acetylsalicylic acid or ibuprogen), chemotherapy drugs (like cisplatin or vincristine), antibiotics (like ciprofloxacin or erythromycin), or diuretics (like furosemide or bumetanide).

What to do: You should see your prescriber if you notice ringing in the ears after starting a medication. The doctor will assess the side effect, and if necessary, consider an alternative medication.

9. Brain or ear tumors

The presence of a brain or ear tumor, like an acoustic neuroma (which is a benign tumor) can cause ringing that can affect one or both ears. It is generally accompanied by other symptoms like tingling or numbness in the ear or face, headache, dizziness or loss of balance. 

Nasopharyngeal cancer, which is a type of malignant cancer that is found behind the nose and in the mouth, can also cause ringing, infections or even hearing loss. 

Generally, in addition to ringing in the head, some signs of a brain or ear tumor include nausea, vomiting, vision changes or seizures. 

What to do: If you suspect you have a tumor, you should see an ENT specialist for testing with MRI, CT scan or biopsy , which can help to confirm a diagnosis and identify the type of tumor present. Once diagnosed, the ENT will likely refer you to an oncologist for treatment, which may involve surgery, radiation therapy and/or chemotherapy.