Ringing in the Ear: Possible Causes and What Different Sounds Mean

Ringing, squeaking, or humming in the ear when everything around is quiet is familiar to many. Let us explain what this phenomenon is, where it comes from, and when a doctor is needed.

What ringing in the ear is and how it manifests

Ringing in the ear is the perception of a sound that has no external source: only the person themselves hears the noise. The scientific name is tinnitus. The sound may be in one ear, in both, or "in the head," and it may come and go or be constant. Usually it is not a sign of anything serious and often goes away on its own.

Up to 35–45% of adults hear noise from time to time, 8% — constantly, and in 1% it noticeably reduces quality of life.

Ringing, squeaking, humming, and buzzing: how the sounds differ

People describe the sensations differently: ringing, squeaking, whistling, humming, buzzing, hissing, clicking, the sound of falling water. The sound may be quiet or loud, high or low. You will be asked about it at the appointment.

Pulsatile ringing that coincides with the heartbeat is singled out separately: it calls for an urgent consultation with a doctor.

• how long the noise lasts: up to three months — acute, from three months to a year — moderate, more than a year — chronic;
• in which ear it is heard: left, right, both sides, or "in the head";
• whether the sound coincides with the pulse;
• what it disrupts: sleep, work, concentration, mood.

Ringing in the left or right ear: does the side matter

It is useful for the doctor to know whether the noise is heard in one ear, in both, or in the center of the head, and whether the side changes over time. If a headache and ringing in the left ear appeared together, this is mentioned at the appointment.

Possible causes of ringing in the ear

There are many causes, and they are not always obvious. Among them: hearing loss, including age-related, and regular loud noise; earwax impaction and ear inflammation; Meniere's disease; heart and vascular problems; diabetes, thyroid disease, multiple sclerosis; anxiety and depression; side effects of medications — certain chemotherapy drugs, antibiotics, high-dose aspirin, diuretics. Tinnitus has also been described as a symptom of post-COVID.

What happens inside. Tinnitus is considered a compensatory reaction of the central parts of the auditory system to hearing loss: the balance of excitatory and inhibitory neurotransmitters changes. It almost always accompanies hearing loss, although most people with reduced hearing do not hear noise.

When ringing is accompanied by ear pain, headache, or dizziness

If ringing is accompanied by ear pain, the doctor examines the ear to check for inflammation or earwax impaction. A routine appointment is not awaited in cases of sudden hearing loss, facial muscle weakness, a sensation of spinning (dizziness), or if the ringing appeared after a head injury. Pulsatile ringing in time with the heartbeat is also a reason to get a consultation quickly. If a headache is added to the noise, it is reported at the appointment.

Ringing in the ear by itself is not a reason to call an ambulance. 103/112 — if the ringing appeared after a head injury or comes together with sudden hearing loss, facial muscle weakness, or a sensation of spinning (dizziness).

How the doctor determines the cause and when to see a doctor

At the appointment, the doctor examines the ears, checks hearing, and, if necessary, refers to a specialist for further examinations. Tests include audiometry — a relatively objective indicator of hearing status, especially in high-frequency hearing loss.

A distinction is made between compensated noise, which the person copes with, and decompensated noise — with anxiety, insomnia, and depression.

When to make an appointment with a doctor: if the noise is regular or constant, if it intensifies, if it interferes with sleep and concentration, causes anxiety or low mood. With pulsatile noise, an urgent consultation is requested.

All of this is reference information, not a substitute for a doctor's consultation: ears are not a case where a diagnosis is made from an article.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer