At a glance

  • The sounds that people with tinnitus hear include whistling, buzzing, humming, hissing, clicking or knocking.
  • People often get tinnitus from loud sounds, but frequently doctors can’t find a specific cause.
  • It usually goes away on its own.
  • The tinnitus is considered to be chronic if it lasts longer than three months.
  • The treatment will depend on the cause of the tinnitus.


Photo of a woman frowning and holding her head

Many people experience ringing in their ears after hearing loud sounds, like a rock concert, a sports event, a very loud machine or an explosion. It usually goes away on its own. This ringing in your ear (tinnitus) can be caused by many different things. It is only very rarely a sign of a serious medical condition. Sometimes people develop tinnitus for no known reason – but then it usually doesn't last for more than a minute.

In some people, though, the sound continues over a longer period of time. If tinnitus lasts longer than three months, it is considered to be chronic. It is usually quite mild: Although it is annoying, people can learn to live with it. Yet sometimes it’s so bad that their everyday lives and quality of life are severely affected. The sounds can lead to constant stress and make it hard to concentrate and sleep properly.


The word “tinnitus” comes from the Latin word for “ringing.” But the sounds that people with tinnitus hear also include whistling, buzzing, humming, hissing, clicking or knocking. They may be heard in one or both ears. Some people say it feels like the sound is coming from inside their head, whereas others say it sounds like it is coming from outside. Tinnitus may be constant or it may come and go. It is sometimes very quiet and then really loud again.

It can be, but isn't necessarily, associated with hearing loss. Most people with tinnitus have normal hearing otherwise.


Tinnitus is very often caused by loud sounds that damage the of the cochlea in the inner ear. Most of those affected have spent a lot of time in loud places. Being briefly exposed to an extremely loud noise, such as an explosion or nearby gunshots, can also cause tinnitus.

It is not exactly clear how and why hearing damage caused by loud sounds can lead to tinnitus. This also makes it harder to find an effective treatment. According to one of several theories, the damaged or irritated in the cochlea can no longer send signals to the brain. As a reaction to the lack of real signals, the nerve cells in the brain’s center of hearing become more active and produce "phantom sounds" anyway. This is similar to how phantom pain develops following amputation.

Other possible causes of tinnitus include the following:

If the noise in your ear pulses to the rhythm of your heartbeat, it is called pulsatile tinnitus. This type of tinnitus can be caused by various things, for instance high blood pressure.

In rare cases, tinnitus is a side effect of medication such as certain kinds of , cancer drugs or anti-malarials.

For many people, though, no cause of tinnitus can be found. Doctors call this type of tinnitus “primary” or “idiopathic” tinnitus.

It is debatable whether tinnitus can be caused by stress. But there isn’t a clear link: So far, relaxation techniques haven’t been shown to have a direct impact on tinnitus.


Tinnitus is quite common: Between 5% and 15% of all adults experience a longer-lasting episode of tinnitus at some point in their lives. In about 10% to 20% of people who have tinnitus, the symptoms are so bad that they have a considerable impact on quality of life, and treatment is needed.

Tinnitus is most common in people over the age of 50 years, and is rare in children.


Nobody can predict the exact course of tinnitus. If the cause is known and treatable, it may go away again. If it isn’t clear what is causing the tinnitus, it may continue and become chronic. Some people’s hearing becomes more sensitive too, which can be unpleasant in loud places (hyperacusis).

Chronic tinnitus can affect quality of life and lead to problems with sleep and concentration. If it gets very bad, some people may withdraw socially and go out less. This can sometimes even lead to depression or contribute to its development.

The problems and trouble caused by chronic tinnitus may also improve over the years.


The doctor first asks about the symptoms: what sounds you hear exactly, in what situations you hear them, and whether there are other symptoms such as earache or a feeling of pressure in the ear. They will also ask about any medicine you are taking and the dose, because some medications can cause ringing in your ear if you take too much of them – for example, very high doses of acetylsalicylic acid (the drug in medicines like Aspirin).

In primary (idiopathic) tinnitus, both ears are usually affected. If the sounds are only heard in one ear and are accompanied by other symptoms such as earache, the tinnitus is likely to have a specific cause which is usually treatable.

The talk with the doctor is usually followed by an ear examination and a hearing test. The doctor will also listen to the blood vessels in your neck and recommend further tests if necessary. It may be a good idea to have a dental examination to rule out any problems with your jaw.

Based on the outcomes of the doctor’s examination, he or she will determine which type of tinnitus you have. Doctors distinguish between the following types of tinnitus:

  • Subjective and objective tinnitus: Subjective tinnitus can only be heard or perceived by the person who has it. Possible causes include problems with the auditory (hearing) system or the nerves that belong to it. In objective tinnitus, which is very rare, the doctor can hear the sounds too or detect the nerve signals causing the sounds. This is the case with tinnitus that is caused by blood-vessel-related problems, for instance. Here the doctor can hear a pulsing noise in the carotid artery in the neck with the help of a stethoscope.
  • Primary and secondary tinnitus: If no clear cause can be found, it is referred to as primary tinnitus or idiopathic tinnitus. If there is an identifiable cause, it is known as secondary tinnitus. Possible causes include a perforated eardrum or a vascular (blood vessel) disease.
  • Acute and chronic tinnitus: If the sounds last longer than three months, it is considered to be chronic tinnitus.
  • Various levels of severity: Tinnitus can be mild and hardly affect your everyday life, or only occur from time to time. Sounds that are constantly and clearly heard are more serious: They can have a big impact on your daily life and work, for instance because it is hard to sleep and concentrate properly.


It is generally always a good idea to protect yourself from sounds that are too loud. One easy way to do this is to avoid places with a lot of loud noise or to wear earplugs, for instance. This lowers the risk of developing tinnitus in the first place, or of existing tinnitus becoming chronic.


The treatment options for tinnitus will depend on the cause. The underlying condition is then treated – for instance with medication to lower blood pressure. If treatment is possible, the tinnitus will usually go away.

It is harder to treat tinnitus if the cause is unknown, though. The main aim of treatment is then to reduce the symptoms and find ways to cope well in everyday life despite having tinnitus. If the tinnitus is associated with hearing loss, a hearing aid might be considered.

A wide variety of products are available for the treatment of tinnitus, including herbal products, dietary supplements and various medications such as steroids or carbamazepine. None of these treatments have been proven to help. And some may have side effects.

The best-studied treatment is cognitive behavioral therapy (CBT), which involves learning how to cope better with chronic tinnitus. Although this doesn’t make the sounds go away, it can lead to an improvement in quality of life.

If tinnitus arises suddenly, doctors often suggest immediate treatment with an infusion (a drip), for instance with a saline (salt) solution – particularly if the tinnitus is associated with sudden hearing loss. Sometimes people are given an infusion with hydroxyethyl starch (HES) instead. But no studies have shown that infusions with this drug help. On the contrary, HES can trigger severe allergic reactions, with itching all over the body.

Further information

When people are ill or need medical advice, they usually go to see their family doctor first. In our topic "Health care in Germany" you can read about how to find the right doctor – and our list of questions can help you to prepare for your appointment.

There are many sources of support for people living with tinnitus, including support groups and information centers. But there are often regional differences in how these services are organized, and they aren't always easy to find. You can use our list to help you find and make use of local services in Germany.

Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie (DGHNO-KHC). Chronischer Tinnitus (S3-Leitlinie). AWMF-Registernr.: 017-064. 2021.

Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie (DGHNO-KHC). Hörsturz (Akuter idiopathischer sensorineuraler Hörverlust) (S1-Leitlinie, in Überarbeitung). AWMF-Registernr.: 017-010. 2015.

Fuller T, Cima R, Langguth B et al. Cognitive behavioural therapy for tinnitus. Cochrane Database Syst Rev 2020; (1): CD012614.

Kreuzer PM, Vielsmeier V, Langguth B. Chronic tinnitus: an interdisciplinary challenge. Dtsch Arztebl Int 2013; 110(16): 278-284.

Person OC, Puga ME, da Silva EM et al. Zinc supplementation for tinnitus. Cochrane Database Syst Rev 2016; (11): CD009832.

Phillips JS, McFerran DJ, Hall DA et al. The natural history of subjective tinnitus in adults: A systematic review and meta-analysis of no-intervention periods in controlled trials. Laryngoscope 2018; 128(1): 217-227.

Robert Koch-Institut (RKI). Hörstörungen und Tinnitus. 2020.

Savage J, Waddell A. Tinnitus. BMJ Clin Evid 2014: pii: 0506.

Yew KS. Diagnostic approach to patients with tinnitus. Am Fam Physician 2014; 89(2): 106-113.

Zenner HP, Delb W, Kröner-Herwig B et al. Zur interdisziplinären S3-Leitlinie für die Therapie des chronischen-idiopathischen Tinnitus [On the interdisciplinary S3 guidelines for the treatment of chronic idiopathic tinnitus]. HNO 2015; 63(6): 419-427.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?

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Updated on December 14, 2022

Next planned update: 2025


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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