Short answer: Tinnitus — medically known as tinnitus — is caused in most cases by damage to the hair cells in the inner ear, which causes the brain to generate its own sound signal in the absence of external stimulation.
Tinnitus Subjective or Objective: Not All Tinnitus Is the Same
Before realising what causes the ringing in the ears, it is worth noting that there are two basic types — and that this distinction changes the course of the diagnosis.
O subjective tinnitus is the most common, accounting for more than 90% in some cases: the sound that only those who suffer can hear.
O objective tinnitus It is rare, and corresponds to a real sound produced inside the body — usually by vascular changes — and can be felt from the outside. It often beats in time with the heartbeat.
The Most Common Causes of Tinnitus
Tinnitus It is a symptom, not a disease. There is always an underlying cause — although identifying it sometimes requires careful investigation.
Damage to Hair Cells and Exposure to Noise
The hair cells in the inner ear convert the sound as an electrical signal to the brain. Prolonged exposure to loud noise causes progressive damage to them and, often, permanent. When this happens, the brain “misses” the signal it was expecting to receive and starts to generate its own — which is experienced as tinnitus.
Age-related hearing loss
It is the most common cause in adults over the age of 60 — around 2 out of 5 In this age group, some people have hearing loss, and tinnitus often accompanies many of these cases as a result of progressive sensory deprivation.
Medicines that can cause tinnitus
A factor that is often overlooked: there are more than 200 drugs with potential ototoxic — capable of damaging the structures of the inner ear. The main groups include:
- aminoglycoside antibiotics (gentamicin, streptomycin),
- loop diuretics (furosemide),
- high-dose anti-inflammatory drugs,
- chemotherapy drugs such as cisplatin.
If the ringing came about or worsened after starting a new medication, mention it to the doctor.
Vascular and Metabolic Causes
A high blood pressure uncontrolled and the diabetes damage the blood vessels that supply the inner ear — and by treating these conditions, tinnitus can improve significantly.
When Tinnitus Originates in the Neck or Jaw
One of the most underdiagnosed causes is musculoskeletal in origin.
O cervicogenic tinnitus is the result of changes in cervical spine or at the temporomandibular joint (TMJ), which have direct connections to the auditory pathways in the brainstem.
Bruxism (teeth grinding), chronic neck tension, prolonged poor posture whilst using a screen, and neck injuries are among the conditions most commonly associated with to this type of tinnitus.
What Happens in the Brain When You Have Tinnitus
Whatever the cause, chronic tinnitus is, to a large extent, a brain phenomenon — which explains why there’s a buzzing sound persists even when “My ear is fine”.
When the inner ear stops sending the usual signal, the brain does not fall silent: is worth it, increasing spontaneous activity in the auditory cortex and generating a signal that is interpreted as sound.
It is a adaptation mechanism which, in this context, becomes counterproductive. The chronic stress and anxiety exacerbate this process — the limbic system (the body’s emotional centre) is anatomically linked to the auditory pathways, and in prolonged states of alert, that connection amplifies the perception of tinnitus, creating a self-perpetuating cycle.
Why Does Tinnitus Get Worse in Silence and at Night?
During the day, the sounds of the surrounding environment compete help manage tinnitus symptoms and reduce their impact. When the silence falls, the contrast increases sharply — and the brain’s attention system focuses on that signal with much greater intensity.
Is There a Treatment for Tinnitus? Where to Start
It depends on the cause — and that is precisely why the correct identification It is the most important step.
O tinnitus pharmacological can be resolved with medication.
O cervical tinnitus physiotherapy is the answer.
O vascular tinnitus improvements in the management of high blood pressure or diabetes.
For those chronic conditions of central origin (neurological), the most effective approaches target patterns of brain activity.
To find out more about Which doctor should I see for tinnitus, and what treatments are available?, Click on the link to read an article on this topic.
🧠 Key Points to Retain
- Tinnitus is classified as subjective (more than 90% of cases) and objective (rare, usually vascular and pulsatile).
- The most common causes include damage to hair cells, age-related hearing loss, ototoxic medications, high blood pressure and diabetes.
- More than 200 drugs have ototoxic potential — aminoglycoside antibiotics, loop diuretics and anti-inflammatory drugs at high doses are among the main ones.
- Cervicogenic tinnitus — originating in the neck or jaw — is often underdiagnosed and responds to specialist physiotherapy.
- In chronic tinnitus, the auditory cortex generates its own sound signal — the problem is no longer confined to the ear.
- Tinnitus gets worse in silence because the environmental sounds that mask the tinnitus during the day are no longer present.
FAQs — Frequently Asked Questions
Does tinnitus in just one ear mean something different?
Yes. Unilateral tinnitus may indicate localised causes such as a wax plug, otitis, or, more rarely, an acoustic neuroma. It should be assessed as a matter of some urgency, especially if it has come on suddenly.
Can stress cause tinnitus?
Not directly, but it can trigger it in susceptible individuals and significantly exacerbates existing cases. A state of chronic alertness amplifies the perception of internal auditory signals — it is common for tinnitus to worsen during periods of heightened psychological stress.
Could the medicines I’ve taken have caused my tinnitus?
It is a real possibility. If the tinnitus started after you began taking a new medication, mention it to your doctor — never stop taking it on your own. In many cases, adjusting or changing the medication will resolve the problem.
Can tinnitus go away on its own?
Acute tinnitus can resolve within hours or days. When it persists for more than three months, it is considered chronic and rarely goes away without treatment — but “chronic” does not mean “permanent”: with the right approach, it is possible to significantly reduce its intensity.
