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A whistling, ringing, rushing or pounding in the ear – without anyone producing this sound. Almost everyone experiences ringing in the ears (medically tinnitus aurium) briefly at some point in life, usually after a loud concert or during stress. In most people it goes away again. If it persists, it can become a significant burden. Here you'll learn which causes are typical, when it is an emergency (sudden sensorineural hearing loss!), and what really helps – as well as which remedies are not recommended in the guidelines.
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Sudden one-sided hearing loss with ringing in the ear or pulsatile tinnitus? Seek prompt ENT assessment!
Tinnitus (tinnitus aurium) is sound that is perceived in the ear or head without an external sound source. It can take the form of whistling, ringing, rushing, humming, hissing or pulsatile pounding. Practically everyone experiences brief tinnitus at some point in life – usually it is harmless and temporary.
If tinnitus persists, it can lead to significant distress: sleep problems, difficulty concentrating, low mood. Around ten to 15 percent of adults are affected at some point in their life, with some experiencing it permanently. A detailed account of chronic tinnitus with all treatment options can be found on the tinnitus page.
Noise exposure: Concerts, loud workplaces, shooting ranges, headphones at high volume – the most common preventable cause.
Hearing loss: Age-related hearing loss (presbyacusis), noise-induced hearing loss – almost always associated with tinnitus.
Sudden sensorineural hearing loss: Sudden, usually one-sided hearing loss, often with tinnitus and sometimes vertigo.
Earwax plug, acute otitis media, eustachian tube dysfunction: Common, easily treatable causes.
Stress, lack of sleep, psychological strain: Can trigger or intensify acute tinnitus.
Temporomandibular disorders (TMD), neck problems: Can promote tinnitus.
Acoustic neuroma: A benign tumour of the auditory and balance nerve, typically one-sided – which is why an MRI is recommended for one-sided tinnitus.
Ménière's disease: Triad of vertigo, hearing loss and tinnitus.
Otosclerosis: A condition of the ossicles with hearing loss and tinnitus.
Pulsatile tinnitus: Vascular anomalies, carotid stenosis, high blood pressure, hyperthyroidism or anaemia can cause pulsatile tinnitus.
The duration of tinnitus is an important distinguishing feature – it determines which investigations and which treatments are sensible.
| Feature | Acute tinnitus | Chronic tinnitus |
|---|---|---|
| Duration | Up to 3 months (subacute up to 12 months) | Longer than 3 months |
| Common triggers | Noise, stress, cold, sudden hearing loss, earwax | Hearing loss, noise damage, persistent after acute event |
| Course | Often subsides on its own | Persists – treatment goal: better coping |
| Treatment focus | Glucocorticoids if appropriate for sudden hearing loss, treat the cause | Counselling, CBT, hearing aids if there is hearing loss |
Also important: compensated vs. decompensated. Some people can largely tune out the tinnitus (compensated), while others suffer significantly with sleep problems, anxiety and depression (decompensated) – the comorbidity substantially influences the course and should be specifically treated.
Acute tinnitus / sudden sensorineural hearing loss: Usually a trial of glucocorticoids (systemic or intratympanic). The recommendation is given individually in the ENT guidelines – the practice decides on a case-by-case basis.
Earwax plug, otitis media: Treat the underlying cause – tinnitus often resolves with it.
Chronic tinnitus: Counselling (structured information and advice), cognitive behavioural therapy (CBT), hearing aids if there is accompanying hearing loss, tinnitus self-help groups. CBT does not reduce the sound itself but the distress it causes.
Treat comorbid conditions: Sleep disorders, depression and anxiety disorders significantly worsen the burden of tinnitus.
The most important prevention is hearing protection: wear ear protectors during loud work, at concerts and when doing DIY; keep headphone volume moderate. Don't seek absolute silence – it intensifies tinnitus. Background sounds (soft music, nature sounds, white noise) help many people fall asleep more easily. Sufficient sleep, exercise and relaxation techniques reduce the perception of tinnitus. Self-help groups and structured tinnitus apps support living with the sound.
Some medications are ototoxic and can trigger or worsen tinnitus or hearing loss. Important to know: there are scarcely any established drug therapies for tinnitus itself – ginkgo, betahistine and the like are not recommended (see above). The focus is therefore on the causative agents:
| Medication | Effect on tinnitus / hearing |
|---|---|
| Aminoglycosides (gentamicin, tobramycin) | Ototoxic – tinnitus and hearing loss, often irreversible. Strict indication required |
| Loop diuretics at high doses (furosemide) | Tinnitus and hearing loss, usually reversible with dose reduction |
| Cisplatin (chemotherapy) | Strongly ototoxic – audiometry checks during treatment |
| NSAIDs and high-dose aspirin | Tinnitus reversible after stopping – classic salicylate phenomenon |
Some antibiotics (e.g. erythromycin at high doses) and antimalarials (quinine) can also trigger tinnitus. If you suspect a medication-related cause, never stop on your own – speak to your practice.
Digital medication plan: Record all medicines – ENT, GP, neurology and oncology can immediately see which agents may be ototoxic. → Create a medication plan
Interaction checker: Which medications can intensify tinnitus? → Start the interaction checker
Medication reminder: Take corticosteroids for sudden hearing loss, antidepressants for comorbidity or other medications on time. → Set up reminder
Sign up for free nowMore on this: Preparing for your doctor's appointment.
brite helps you organise your treatment and medication reliably – so that ototoxic agents are recognised in time and treatments such as corticosteroids or accompanying medication for CBT are taken consistently.
