Tinnitus (ringing in the ears)

Tinnitus is hearing a sound in one ear, both ears or in your head when there is no sound coming from outside. People describe it as ringing, buzzing, hissing, roaring, running water, chirping or clicking. It is a symptom rather than a disease in itself, and it is most often linked to changes in the hearing system, such as noise exposure or age-related hearing loss.

What tinnitus is, and what it is not

Tinnitus is not imagined, and for most people it is not a warning of something serious. Statistics Canada found that most Canadian adults who reported tinnitus did not find it bothersome, while roughly 7% found it bothersome enough to affect sleep, concentration or mood. A few patterns do need prompt assessment: tinnitus in one ear only, tinnitus that pulses in time with your heartbeat, and tinnitus arriving with sudden hearing loss or dizziness.

It is also not only a condition of later life. Past-year tinnitus was reported by 46% of Canadian adults aged 19 to 29, compared with 33% of those aged 30 to 49 and 35% of those aged 50 to 79. Hearing loss and tinnitus frequently come as a pair: 60% of Canadian adults had hearing loss, tinnitus, or both, with 15% reporting both together. Where the sound is disturbing sleep or low mood, those are treated as part of the picture rather than as separate complaints, and our pages on insomnia and depression cover them further.

Signs and symptoms

• Ringing, buzzing, hissing, humming or roaring that others cannot hear
• Sound in one ear, both ears, or seeming to come from inside your head
• Noise that is more noticeable in a quiet room or at night
• Trouble falling asleep or getting back to sleep because of the sound
• Difficulty concentrating, following conversation, or filtering background noise
• Frustration, low mood, anxiety or irritability related to the sound
• Hearing loss or sensitivity to loud sounds occurring alongside it

How much tinnitus intrudes varies enormously and does not track neatly with how loud the sound seems. It often fluctuates with tiredness, stress and how quiet your surroundings are.

What raises the risk

Some risk factors cannot be changed:

• Getting older, since age-related hearing changes are among the most common causes
• Existing hearing loss, which occurs together with tinnitus in about 15% of Canadian adults
• Head or neck injury, ear disorders and some inner ear conditions
• Certain medical conditions that occur more often alongside tinnitus, including high blood pressure and arthritis

Others can often be worked on, usually with support from a health care team:

• Loud noise exposure at work, at concerts, or from power tools and firearms, which is the leading preventable cause of noise-related inner ear damage
• Listening at high volume through headphones or earbuds for long periods
• Smoking and second-hand smoke exposure, and untreated stress, anxiety and poor sleep, which are associated with tinnitus being more bothersome

How tinnitus is assessed in Canada

Tinnitus is usually assessed by an audiologist, often after a referral from a family doctor or nurse practitioner. The Canadian Academy of Audiology describes a full audiological evaluation, including a medical history, a hearing test, questionnaires about how much the tinnitus affects daily life, and specific tinnitus measurement. Because tinnitus can occasionally point to an underlying ear or neurological problem, some people are also referred to an ear, nose and throat specialist, and imaging may be ordered if the sound is in one ear only, pulses in time with your heartbeat, or comes with dizziness or sudden hearing loss.

Treatment and day-to-day management

Clinical research for Tinnitus (ringing in the ears) is enrolling. See the current studies ↓

It is worth being clear about the goal. Nothing available today removes tinnitus, so care is aimed at reducing how much attention and distress the sound draws rather than at silencing it. Depending on your hearing and how much the sound intrudes, a health care team may discuss:

• Hearing assessment and hearing aids where hearing loss is present, sometimes with built-in tinnitus sound features
• Sound-based approaches, including sound generators, environmental sound and masking devices used to make the tinnitus less prominent
• Counselling and structured therapy, including cognitive behavioural therapy and tinnitus habituation or retraining programs delivered by audiologists and psychologists
• Care for related conditions such as insomnia, anxiety and depression, and management of contributing factors such as earwax, ear infections and medicines that can affect the ears
• Hearing protection and noise management at work and in daily life, plus support groups and self-management education

Which combination helps differs from person to person, and it often takes time to find. These are decisions for you, your audiologist and your own clinician rather than something this page can settle.

When to talk to a doctor

• Seek urgent medical care, the same day if possible, for sudden hearing loss in one or both ears, or for tinnitus that starts suddenly along with severe dizziness or vertigo, since sudden hearing loss is treated as an emergency.
• Call 911 or go to an emergency department if tinnitus comes with sudden weakness or numbness on one side, facial drooping, trouble speaking, a severe sudden headache, or a head injury.
• Book an appointment if tinnitus is in one ear only, pulses in time with your heartbeat, comes with ear pain or discharge, or is affecting your sleep, concentration or mood.

Why clinical research matters for tinnitus

Researchers still do not fully understand why the brain generates the sound, or why it becomes distressing for some people and barely registers for others. There is no treatment that removes it, and even measuring tinnitus severity consistently across studies remains an active problem. Trials under way include neuromodulation approaches such as bimodal stimulation that pairs sound with mild electrical stimulation, transcranial magnetic and electrical stimulation, drug candidates aimed at the inner ear and the central auditory pathways, digital and app-based cognitive behavioural therapy, and studies of hearing aid and sound therapy strategies.

Most tinnitus trials measure how much the sound bothers you using validated questionnaires, alongside hearing tests, before and after a period of treatment. Taking part is voluntary, you give informed consent before anything begins, and you can withdraw at any point without affecting your regular hearing care. No one can say in advance whether a study will help you personally.

Learn more from Canadian sources

• Canadian Academy of Audiology: tinnitus information for the public
• Canadian Academy of Audiology: tinnitus fact sheet
• Statistics Canada: tinnitus in Canada
• Canadian Sleep Society: sleep information and sleep centre map, for tinnitus that disturbs sleep