Tinnitus (ringing in the ears): causes, symptoms, and treatment

Tinnitus (pronounced tih-NITE-us or TIN-uh-tus) is the perception of a sound that has no external source, so other people cannot hear it; it is commonly described as ringing in the ears. According to the U.S. clinical practice guideline on tinnitus (AAO-HNSF, updated in 2026), more than 50 million Americans have reported it, an estimated 10% to 15% of adults.

Tinnitus is not a disease but a symptom. In most cases, it develops in three steps:

• Less input. Each point of the cochlea, in the inner ear, responds to a different frequency. A small loss of sensory cells in certain parts of the cochlea means the brain receives less input at those frequencies.
• More gain. When the input decreases, the brain tries to keep the level up and raises the gain in the neurons that process those frequencies. With more gain, they become too excitable.
• A sensation of sound. These neurons start firing on their own, without any external sound, and the brain turns that activity into a sensation of sound.

This is how tinnitus arises in about 90% to 95% of cases (see what tinnitus is, step by step). Researchers call this compensation central gain. One leading theory described by the NIDCD points the same way: although tinnitus seems to come from the ear, the sound is generated by the brain.

Tinnitus is most often linked to hearing loss, from aging or from loud noise, but it has many possible triggers. According to the NIDCD, most people with tinnitus have some degree of hearing loss, although some people with hearing loss never develop it. Common triggers include:

• Loud noise, at work, at concerts, or from other sources.
• Earwax, or fluid from an ear infection, blocking the ear canal.
• Some medicines, especially at high doses, such as aspirin, ibuprofen, and other anti-inflammatory drugs, or certain antibiotics.
• Head or neck injuries.

Less common causes include Ménière’s disease, an inner ear disorder that can also cause balance problems and hearing loss; jaw joint (TMJ) problems; blood vessel problems, such as high blood pressure; a benign tumor called an acoustic neuroma; and chronic conditions such as diabetes, migraines, thyroid disorders, and anemia. Some people develop tinnitus for no known reason.

That is why the U.S. guideline asks clinicians to start with a targeted history and physical exam: some conditions, if promptly identified and managed, may relieve the tinnitus.

Tinnitus most often sounds like ringing, but it can also buzz, roar, whistle, hum, click, hiss, or squeal, according to the NIDCD. You may hear it in one ear, in both ears, or in your head. It can be soft or loud, low or high pitched, and it may come and go or be there all the time. Some distinctions help describe it:

• Subjective tinnitus: only you can hear it. This is the most common form.
• Somatosensory tinnitus: moving your head, neck, or eyes, or touching certain parts of your body, brings on the sound or briefly changes it.
• Pulsatile tinnitus: in rare cases, the sound pulses rhythmically, often in time with your heartbeat. If a doctor can hear it with a stethoscope, it is called objective tinnitus, and it often has an identifiable cause that can be treated. Pulsatile tinnitus should be checked by a doctor: NICE recommends imaging tests for it.
• Chronic tinnitus: tinnitus that lasts three months or longer is considered chronic.
• Bothersome or not: many people notice tinnitus without being troubled by it. The U.S. guideline asks clinicians to tell these situations apart, because the approach differs.

Tinnitus often seems louder at night because your surroundings are quieter: as MedlinePlus notes, it is often more noticeable when you go to bed. Everyday background sounds cover part of it; in a silent bedroom, little competes with it.

When it comes to tinnitus and sleep, the NIDCD notes that some people find it affects their ability to sleep, and NICE asks clinicians to check for sleep problems in people with tinnitus. What may help at night:

• A sound generator or a smartphone app near your bed with pleasant sounds, such as rain or waves, or a household fan. If your tinnitus is mild, this may be all you need to fall asleep (NIDCD).
• Low, steady background sound, such as a white noise machine or a humidifier, so the room is not completely silent.
• A relaxing routine before bed, since stress can make tinnitus worse.
• Telling your doctor or hearing professional if tinnitus keeps you awake.

Levo uses that time for treatment: with acoustic stimulation during sleep, Levo Gen 2 plays a sound matched to your tinnitus each night while you sleep.

Yes. Stress can make tinnitus worse, according to NICE, although MedlinePlus notes that it is not known whether stress causes it. It also works the other way: in severe cases, tinnitus can lead to anxiety or depression, as the NIDCD notes.

In the brain, the areas that process sound communicate with areas that control attention and emotion. Focusing on tinnitus can make it more noticeable, and the stress it can cause makes it harder to tune out, feeding a vicious cycle. Knowing that tinnitus is rarely linked to a serious condition can itself reduce anxiety.

Psychological approaches target that cycle. The U.S. guideline recommends cognitive behavioral therapy (CBT) for persistent, bothersome tinnitus: it helps you identify thoughts that cause distress and change how you respond to them. For distress that persists, NICE suggests digital CBT first, then group programs such as mindfulness-based cognitive therapy or acceptance and commitment therapy, then individual CBT.

At any time, step by step, the Continuous Learning Platform (CLP) in Levo Gen 2 offers short lessons and exercises to help you understand tinnitus and manage distress, with tools inspired by evidence-based approaches such as CBT and mindfulness. If distress becomes severe or you have thoughts of harming yourself, call or text 988 now.

Today there is no treatment that eliminates tinnitus in every case, but that does not mean nothing can be done. As the NIDCD puts it, there is currently no cure for tinnitus, “but there are ways to reduce symptoms.” Researchers are working to match treatments to different tinnitus profiles.

• A treatable cause can resolve it. When tinnitus has a physical cause, such as earwax or a jaw joint problem, treating the cause can eliminate or greatly reduce the symptoms. If a medicine may be involved, your doctor can review it.
• It can improve over time. Tinnitus may improve or even go away, although for many people it lasts months or even years, and in some it worsens. NICE tells clinicians to reassure patients that it may resolve by itself.
• It can stop being a problem. Management strategies help many people live well with tinnitus (NICE), and some therapies help you get used to the sound so you notice it less (NIDCD). This is called habituation: the sound moves from foreground to background.
• Treatment aims at intensity and impact. A realistic goal is for tinnitus to bother you less: to be noticed less often and, when noticed, to cause less distress.

Be cautious with any product sold as a cure, and remember that results vary from person to person.

Tinnitus treatment depends on the cause, your hearing, and how much tinnitus bothers you. Approaches in the guidelines include:

• Treating the cause, such as removing earwax.
• Hearing aids, if you have trouble hearing: the U.S. guideline recommends a hearing aid evaluation when persistent, bothersome tinnitus comes with hearing difficulties.
• CBT, recommended by the U.S. guideline and by NICE.
• Sound therapy, such as sound generators, alone or with counseling, as in tinnitus retraining therapy. The U.S. guideline lists sound enrichment as an option; NICE made no recommendation and called for more research.
• Medicines. None is specific for tinnitus (NIDCD), and the U.S. guideline advises against routinely using antidepressants, anticonvulsants, anti-anxiety drugs, or ear injections primarily to treat persistent, bothersome tinnitus.

Levo Gen 2 is FDA-cleared for the temporary relief of tinnitus symptoms in adults. Prescribed and set up by a hearing professional, it combines acoustic stimulation during sleep with the Continuous Learning Platform. Your hearing professional designs a personalized acoustic prescription, and each night Levo Gen 2 plays it while you sleep. That sound is designed to give back the input that was reduced at the affected frequencies, which can help the neurons involved become less excitable. As the gain comes down, tinnitus can lose intensity. Treatment takes about one year. See tinnitus treatment with Levo and the research behind Levo, done with earlier versions of the system.

See a doctor if tinnitus persists or bothers you, and sooner if certain signs appear. Start with your primary care doctor, who may refer you to an ear, nose, and throat doctor (ENT) and to an audiologist for a hearing test (NIDCD). This is guidance, not a diagnosis:

• Get emergency care right away if tinnitus comes with sudden facial weakness or other sudden neurological symptoms, severe vertigo, or signs of a stroke (NICE).
• See a doctor immediately if you lose hearing suddenly. Sudden hearing loss is a medical emergency, and timely treatment greatly increases the chance of recovering at least some hearing (NIDCD).
• Make a prompt appointment if tinnitus is in one ear only and lasts several weeks, pulses with your heartbeat, started after a head injury, or comes with dizziness, loss of balance, nausea, or vomiting (MedlinePlus).

Tinnitus is only rarely linked to a serious medical problem. If it causes severe distress or you have thoughts of harming yourself, call or text 988 to reach the 988 Suicide & Crisis Lifeline, which is free, confidential, and available 24/7. If you are in immediate danger, call 911.

To find out whether Levo Gen 2 is right for you, start with an initial evaluation by a hearing professional.

A few steps can make tinnitus easier to live with while you wait for an evaluation or alongside treatment:

• Protect your hearing. Avoid loud places and sounds, and use hearing protection, such as earplugs, when noise is unavoidable. Loud noise can make tinnitus worse (NICE).
• Avoid total silence. Low background sound, such as a fan, a radio at low volume, or a white noise machine, can make tinnitus less noticeable.
• Manage stress. Relaxation and self-help strategies can help you cope.
• Watch caffeine, alcohol, and smoking. They may worsen tinnitus in people who already have it (MedlinePlus).
• Get a hearing test. It can reveal a hearing loss you have not noticed; if you have one, hearing aids may help.
• Review your medicines with your doctor. Some can cause tinnitus, but do not stop a prescribed medicine on your own.
• Skip supplements sold as remedies. None has been proven to work, and the U.S. guideline recommends against dietary supplements for persistent, bothersome tinnitus.

If tinnitus persists or bothers you, a hearing professional can assess it and talk with you about options. If you are a clinician, learn about the Levo Clinical Network.