What tinnitus is, and how common it is
Tinnitus is hearing a sound that is not coming from outside your ear. Most people call it ringing, but buzzing, hissing, humming, whooshing, clicking and roaring are all common. It can be in one ear, in both, or feel like it sits in the middle of your head. It can be steady, or it can come and go.
Tinnitus is a symptom, not a disease. Most of the time it is a sign that something has changed in the hearing system, and the brain is generating sound to fill in what the ear no longer sends. That is why the first question is always “what is going on with the hearing,” not “how do we silence the ringing.”
It is very common. The National Institute on Deafness and Other Communication Disorders (NIDCD) cites surveys estimating that 10 to 25 percent of adults have tinnitus. The American Tinnitus Association says more than 50 million American adults experience it, roughly 5 million struggle with burdensome chronic tinnitus, and about 2 million find it debilitating. Most people with tinnitus are not in those last two groups. They notice it mainly in quiet rooms and at night.
Common causes of ringing or buzzing in the ears
Tinnitus rarely has a single cause you can point to, but a few things come up again and again.
- Hearing loss. Hearing loss from aging or from noise is the most common companion of tinnitus. When the inner ear sends less sound to the brain, the hearing centers appear to turn up their own gain, and that added activity is heard as ringing. Most people who come to us with tinnitus have some measurable hearing loss, even when they have not noticed it.
- Noise exposure. Concerts, power tools, firearms, lawn equipment, factory floors and military service all count. A single loud night can cause ringing for a day. Repeated exposure can make it permanent.
- Earwax. A canal packed with wax can cause ringing, muffled hearing and a plugged feeling. This is one of the few causes that can be cleared quickly.
- Medications. NIDCD lists non-steroidal anti-inflammatory drugs such as ibuprofen, naproxen and aspirin, usually at high doses, among the medications linked to tinnitus. Some antibiotics, chemotherapy drugs and diuretics are also on the list. Never stop a medication on your own. Ask the doctor who prescribed it.
- Jaw and neck. Problems with the jaw joint, neck injuries and muscle tension can produce or change tinnitus. A clue is tinnitus that changes when you clench your jaw, turn your head or press on your neck.
- Other conditions. Ear infections, Meniere’s disease, head injury, high blood pressure, diabetes and thyroid problems can all play a part. Your doctor manages these. We manage the hearing side.
Ringing in one ear only
Tinnitus in one ear deserves more attention than tinnitus in both. The common reasons are ordinary: wax in that ear, an infection, or hearing loss that is worse on one side because of a job or hobby that puts noise on one side (shooting is the classic example). Less often, one-sided tinnitus comes from a problem along the hearing nerve, which is why a doctor may order an MRI.
The 2026 tinnitus guideline from the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) calls for a hearing evaluation, preferably within four weeks, when tinnitus is in one ear, has lasted six months or more, or comes with hearing problems. If your one-sided tinnitus started recently, see a doctor or ENT promptly. We can do the hearing test and ear check the same week and send the results along.
Pulsatile tinnitus and other red flags
Pulsatile tinnitus is a thumping or whooshing that keeps time with your heartbeat. NIDCD describes it as rare, and notes that a doctor may be able to hear it with a stethoscope. It usually relates to blood flow in vessels near the ear rather than to the ear itself, so it needs a medical evaluation rather than a hearing-aid conversation. The doctor may order imaging to find the source.
See a doctor or ENT promptly, before booking with us, if you have any of these:
- Hearing that dropped suddenly, in one ear or both.
- Tinnitus in one ear that started recently.
- Tinnitus that pulses in time with your heartbeat.
- Ear pain with drainage or bleeding.
- Dizziness or balance trouble along with a change in your hearing.
We are a hearing clinic, not a medical office. When something we see or hear in an evaluation points to one of these, we say so, and we help you get to the right doctor first.
What a tinnitus evaluation at Piccolo involves
A tinnitus evaluation is a hearing test with extra steps. Plan on more time than a standard test. Here is what happens, in order.
A conversation and a short questionnaire. We ask what the sound is like, when it started, whether it is in one ear or both, and how it affects sleep, concentration and mood. The questionnaire gives a score for how much the tinnitus is bothering you. That score is your baseline, and we repeat it later to see whether things are moving in the right direction.
An ear check. Our licensed hearing instrument specialist looks in both ears with an otoscope for wax, irritation or anything that needs a doctor. In Houston, wax can be removed on site for $100 after the ear check, see earwax removal in Houston. In Duluth we refer you for removal.
A full hearing test. The hearing test is free and is not billed to Medicare or any plan. It maps how well each ear hears across the pitches of speech. This is the most important part of the visit, because the tinnitus is usually loudest at the pitches where the hearing loss is worst.
Pitch and loudness matching. We play tones until you find the one that sounds most like your tinnitus, then measure how loud it seems next to that tone. This does not change the tinnitus. It gives us a description we can use to set up sound therapy and to compare with on later visits. Many people are surprised at how quiet their matched tinnitus is on paper, even when it feels loud.
Results in plain words. You see your hearing test, hear what it means, and go over your options. For most people the options are some combination of hearing aids, sound therapy and the self-care habits further down this page. Our tinnitus management page describes the program itself.
How hearing aids with sound therapy help
NIDCD calls hearing aids one of the main treatment options for people with tinnitus who have hearing loss, and the AAO-HNSF guideline recommends a hearing aid evaluation for anyone with hearing loss and persistent, bothersome tinnitus. Hearing aids help in two ways.
The first is simple amplification. When hearing loss takes away the soft everyday sounds, the refrigerator hum, leaves, footsteps in the hall, the ringing has no competition and the brain strains to hear. Restoring those sounds gives the brain something else to listen to, and the tinnitus tends to move toward the background. This is the main reason most people with tinnitus and hearing loss do better with hearing aids.
The second is built-in sound therapy. Most current hearing aids from the brands we fit include a relief-sound feature that the clinic sets up and you adjust from your phone. These are examples, not promises:
- Phonak’s Tinnitus Balance adds a gentle broadband noise behind your hearing program.
- Oticon’s Tinnitus SoundSupport offers a set of relief sounds, including ocean-style sounds.
- Signia’s Notch Therapy filters the narrow band around your matched tinnitus pitch.
- Widex’s Zen plays soft, non-repeating chime-like tones.
- Starkey and ReSound models carry their own tinnitus sound programs and apps.
We set these features using your pitch and loudness match, and we can fit and program most major brands. Which sound suits you is personal, and no feature works for everyone. Hearing aids bought from us come with a 45-day trial, so you can wear them through real days and nights before deciding. Ask us for the trial terms in writing.
Sound therapy and habituation, in plain words
Habituation is the brain learning to file a sound as unimportant. You already do it with the refrigerator, traffic outside and your own breathing. The goal of tinnitus management is for the ringing to join that list. It does not disappear. It stops demanding attention.
Sound therapy helps habituation along by adding soft, neutral sound to your day. Think of a candle in a dark room versus the same candle in daylight. The candle is the same, but in daylight you hardly notice it. The sound can come from your hearing aids, a tabletop sound machine, a phone app, or a fan. Keep it just below the level of the tinnitus, so both are audible. Drowning the tinnitus out tends to make the brain hunt for it harder when the noise stops.
The AAO-HNSF guideline says clinicians may recommend sound therapy for persistent, bothersome tinnitus, and is clear that no single approach works for everyone. Expect weeks to months, not days. Most people notice first that they are checking for the tinnitus less often, and only later that it seems quieter.
What tinnitus retraining therapy is
Tinnitus retraining therapy, or TRT, is a structured program that NIDCD describes as using counseling and sound therapy to retrain the brain, both emotionally and physiologically. In practice it means a series of counseling sessions that explain what tinnitus is and why it is not dangerous, paired with wearable sound generators or hearing aids worn most of the waking day, followed over many months. Programs commonly run a year or longer.
Piccolo offers tinnitus management with sound therapy and hearing aids. We do not deliver TRT. When someone needs a formal TRT program, cognitive behavioral therapy for tinnitus, or medical treatment, we refer them to providers who do that work and share our test results with them. We would rather send you to the right place than stretch what we do to fit.
One more point from the 2026 guideline: it recommends against routinely using medications, dietary supplements or repetitive transcranial magnetic stimulation for tinnitus. Be cautious with anything sold as a tinnitus cure.
Self-care that helps
None of this replaces an evaluation, but all of it is within your control.
- Sleep. Tinnitus is loudest in a silent bedroom. A fan, a sound machine or a phone app set low gives your brain something else to settle on. Keep a regular bedtime. Poor sleep makes tinnitus feel louder the next day, and loud tinnitus makes sleep harder, so breaking that loop matters.
- Sound enrichment during the day. Avoid long stretches of silence. Soft background sound at your desk or in the car is enough.
- Hearing protection. A loud event can spike tinnitus for days. Wear earplugs or earmuffs around power tools, concerts, firearms and lawn equipment. Custom hearing protection made from an impression of your ear is more comfortable for long wear and easier to keep using.
- Caffeine, alcohol, salt and nicotine. Some people notice their tinnitus more after these, and others notice no change. The research is mixed. A two-week log is the fairest test for you.
- Stress. Stress and tinnitus feed each other. Whatever already calms you, a walk, prayer, breathing exercises, time with people, counts as tinnitus care.
- Do not go looking for it. Checking whether the ringing is still there, in a quiet room, teaches the brain that the sound is important. It is a hard habit to break and worth breaking.
Living with tinnitus, and when to come in
Most people with tinnitus reach a point where it is part of the background, the way a ticking clock becomes part of a room. Getting there is faster with a clear explanation, hearing that works as well as it can, and sound to fill the quiet. That is what a tinnitus evaluation is for.
Come in when the ringing has lasted more than a few weeks, when it is affecting your sleep or concentration, when you suspect your hearing has changed, or when you simply want to know your options. Come in sooner, after seeing a doctor, if any of the red flags above apply. Our Duluth and Houston clinics both do tinnitus evaluations in English, Korean, Vietnamese and Chinese, see hearing aids for tinnitus in Duluth and hearing aids for tinnitus in Houston.
On cost: the hearing test is free. If hearing aids turn out to be part of your plan, coverage varies by plan. Original Medicare does not cover hearing aids, and many Medicare Advantage plans include a hearing aid benefit through their networks. We verify your benefit before any purchase. Our insurance and Medicare and hearing aids pages explain how that works.