What Causes Tinnitus? The Ear-Brain Explanation in Plain English

By Glen MercerEditor, Audifort ReviewUpdated October 21, 20264 min read

About one in ten American adults heard ringing, buzzing or hissing in their ears in the past year. For most of them the sound has no outside source and no single cause. The best current explanation starts in the inner ear and ends in the brain.

How common it is

The largest US survey on the subject, a 2016 analysis of the National Health Interview Survey, estimated that 21 million adults, about 9.6%, had tinnitus in the previous 12 months. More than a third heard it almost constantly, and 27% had lived with it for more than 15 years. People with steady noise at work were about three times as likely to have it.

Most people describe it as mild. About 7% called it a big or very big problem, which still adds up to well over a million people. Only half had ever talked to a doctor about it.

It starts with hearing damage

The inner ear holds thousands of tiny hair cells that turn sound into nerve signals. Loud noise, age, some medications and other causes damage those cells, usually starting with the ones tuned to high pitches. The NIDCD explains tinnitus as a symptom of something going on in the hearing system, most often this kind of hearing loss, rather than a disease of its own.

Many people with tinnitus don't know they have hearing loss. The damage is often limited to high frequencies that ordinary conversation doesn't depend on, so it only shows up on a hearing test.

Then the brain turns up the volume

When part of the cochlea goes quiet, the auditory parts of the brain receive less input from those frequencies. The brain responds the way a listener turns up a radio with a weak signal: it raises its own sensitivity. Nerve cells that used to wait for real sound start firing on their own, and the brain hears the result as a tone or hiss.

Part of that turning up is a loss of inhibition, the brakes that normally keep neural activity in check. A 2015 brain imaging study found people with tinnitus had less GABA, the brain's main inhibitory messenger, in the auditory cortex. Researchers at Georgetown famously described tinnitus as the brain trying, but failing, to repair itself.

This model explains a lot. It is why tinnitus often matches the pitch of a person's hearing loss, why it can get louder in quiet rooms, and why stress and poor sleep make it feel worse: they weaken the brain's ability to filter out an unimportant signal.

Common triggers and causes

• Noise exposure: concerts, firearms, power tools, loud workplaces, headphones at high volume.
• Age-related hearing loss, which builds slowly from the 50s on.
• Earwax buildup pressing on the eardrum, which is easy to fix.
• Medications that can affect hearing, including high doses of aspirin, some antibiotics, some chemotherapy drugs and loop diuretics.
• Jaw and neck problems, such as TMJ disorders.
• Ear conditions like Meniere's disease or otosclerosis.
• Blood vessel problems, which cause a pulsing, whooshing type that keeps time with the heartbeat.

When to see a doctor

See a doctor soon if the ringing is in one ear only, pulses with your heartbeat, comes with dizziness or hearing loss, or started after a head injury. Sudden hearing loss with new tinnitus is an emergency; treatment works best in the first days. For everyone else, a hearing test with an audiologist is a good first step. The American Speech-Language-Hearing Association has a guide to what that evaluation involves.

What helps

There is no cure that works for everyone, but a lot can make tinnitus quieter or less bothersome:

• Hearing aids, if you have hearing loss. Restoring the missing input often turns the tinnitus down.
• Sound therapy: a fan, a white noise machine or a sound app at night.
• Cognitive behavioral therapy, which has the strongest evidence of any tinnitus treatment. A Cochrane review found it reduces how much tinnitus affects quality of life.
• Protecting your ears from further noise damage.
• Sleep, stress and blood pressure: managing these doesn't remove the sound, but it changes how loud it feels.

Supplements sit in the "may help some people" category. Formulas like Audifort combine antioxidants for the inner ear with calming ingredients such as GABA and L-tryptophan that target the brain and sleep side of the problem. If you want to try one, read our Audifort review for the full ingredient breakdown, the price and how the 90-day refund works, and see what research says about ginseng for tinnitus.

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