Tinnitus is most often described as ringing, but it can also roar, click, hiss or buzz; sudden hearing loss or vertigo that will not settle needs urgent attention, and pulsing or one-sided tinnitus needs a doctor's assessment. This article sets out the range of what people hear, the patterns that change what a doctor does next, and the guideline timings for getting seen. For the mechanism — why the brain produces a sound that is not there — see what tinnitus is.
What tinnitus sounds like
The clinical definition is short. The US clinical practice guideline on tinnitus, from the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS), defines it as the perception of sound without an external source. What that sound is like varies a great deal. The US National Institute on Deafness and Other Communication Disorders (NIDCD) describes it as commonly a ringing, but also roaring, clicking, hissing or buzzing; soft or loud, high-pitched or low-pitched, and in one ear or both.
The words people use fall into a handful of groups:
- Ringing or whining — a steady, tonal sound, often high-pitched
- Buzzing or humming — lower-pitched, sometimes described as electrical
- Hissing or static — closer to white noise or an untuned radio
- Clicking — brief, repeated, sometimes rhythmic sounds, occasionally linked to muscle spasms near the middle ear (middle ear myoclonus); intermittent bursts like Morse code in one ear are a separate, rare pattern, typewriter tinnitus
- Roaring, rushing or whooshing — often described in pulsatile tinnitus, sometimes compared to the ocean or to blood rushing
- Chirping or crickets — a higher-pitched, sometimes intermittent quality some people describe as insect-like
- Music or voices — fragments of a tune or a radio in another room, rather than a tone or a hiss. People rarely volunteer this one, but it is a recognised perceptual phenomenon, musical ear syndrome, not a psychiatric symptom
None of these is more or less "real" than the others. The sound quality does not map neatly onto a single cause, and the same person can hear it differently at different times.
Tinnitus, and tinnitus disorder
The field has long lacked an agreed definition that separates the sound from the suffering. The World Health Organization's ICD-11 lists tinnitus only as a non-specific symptom of a hearing disorder, and the American Psychiatric Association's DSM-5 does not mention it at all.
A 2021 proposal from an international, multidisciplinary group of 57 authors set out two terms. Tinnitus is the conscious awareness of a tonal or composite noise with no identifiable external source. It becomes tinnitus disorder when it comes with emotional distress, cognitive dysfunction or autonomic arousal (the body's stress response) that lead to changes in behaviour and in how well you function day to day. The same paper argues that acute tinnitus may be a symptom of an injury or illness, while chronic tinnitus may be a disorder in its own right.
The US guideline draws a parallel line in practice. One of its two strong recommendations is that clinicians distinguish bothersome from non-bothersome tinnitus, and it separates tinnitus of recent onset from tinnitus that has persisted for 6 months or longer. So your symptoms, as a clinician sees them, include two things: what you hear, and what it is doing to your sleep, concentration and mood.
Constant or intermittent, steady or fluctuating, one ear or both
Beyond the sound quality, the pattern is diagnostically relevant:
- Constant vs. intermittent — tinnitus that is always present versus tinnitus that comes and goes. Intermittent tinnitus is common and not in itself more concerning, though a doctor will still want to know the pattern.
- Steady vs. fluctuating loudness — many people notice their tinnitus getting louder with stress, fatigue, poor sleep or noise, and quieter in calmer periods. In a 2022 study of 201 people with chronic tinnitus at one outpatient clinic, 120 said its loudness had changed. Fluctuation on its own is not a sign that something new has gone wrong; the article on tinnitus flare-ups covers tracking it.
- One ear vs. both — one-sided tinnitus is worth naming clearly to a doctor. The US guideline recommends a prompt, comprehensive hearing test when tinnitus is in one ear, has lasted 6 months or more, or comes with hearing difficulty, and it is one of the few situations in which either major guideline supports a scan. The reason is a small set of structural causes, the best known being acoustic neuroma; whether you need a scan walks through when imaging is and is not advised.
Symptoms that often come with tinnitus
Tinnitus rarely comes entirely on its own, and what travels with it is useful diagnostic information:
- Hyperacusis — ordinary sounds feeling too loud or uncomfortable, distinct from tinnitus but frequently alongside it
- A sense of ear fullness or pressure, sometimes with muffled hearing — Eustachian tube dysfunction and Ménière's disease are two of the conditions behind it
- Hearing loss, which the person may or may not have noticed — tinnitus sometimes draws attention to a gradual change that had gone unremarked
- Dizziness or imbalance, covered in the article on vertigo, dizziness and tinnitus
- Poor sleep, anxiety and low mood — a 2026 Nature Reviews Disease Primers overview lists insomnia, anxiety and depression among the conditions tinnitus most often keeps company with, alongside hearing loss, hyperacusis, migraine, mild cognitive impairment and jaw joint disorders
When tinnitus needs prompt care
Most tinnitus, however it sounds, is not an emergency, and it is rarely a sign of a tumour, stroke or MS. The UK's National Institute for Health and Care Excellence (NICE) guideline, published in 2020, is the most specific about timing, so its tiers are set out here. Health systems differ; the order of urgency is what carries over.
Immediately:
- Tinnitus with a sudden onset of significant neurological symptoms or signs, such as facial weakness, or with suspected stroke
- Tinnitus with acute, uncontrolled vertigo or other balance symptoms
- Tinnitus with a high risk of suicide, which NICE says should go straight to a crisis mental health team. If that is you, contact emergency services or a crisis line now.
Within 24 hours:
- Tinnitus with hearing loss that developed suddenly, over 3 days or less, in the past 30 days. The article on sudden sensorineural hearing loss explains why this one cannot wait for a routine appointment.
Within 2 weeks:
- Distress that affects your mental wellbeing — for example, stopping you from carrying out your usual daily activities — even after initial support
- Hearing loss that developed suddenly more than 30 days ago, or hearing loss that is getting rapidly worse over 4 to 90 days
Referral in the usual way:
- Tinnitus that still bothers you after initial support, objective tinnitus (a sound a clinician can hear too), or tinnitus with hearing loss in one ear or uneven hearing loss
- Persistent pulsatile tinnitus or persistent one-sided tinnitus, for which NICE says referral should be considered
Pulsing in time with the heartbeat stands apart from the rest. NICE recommends offering imaging to everyone with pulsatile tinnitus, and the 2026 Nature Reviews Disease Primers overview gives pulse-synchronous tinnitus as its example of a red flag that calls for vascular imaging.
One more combination points towards a problem needing direct treatment: tinnitus with significant ear pain, discharge or fever, which suggests an infection such as otitis media or, more rarely, mastoiditis.
The reverse matters too. For ordinary tinnitus in both ears, with no pulsing, no uneven hearing loss and no other neurological or ear signs, both the US and UK guidelines advise against scans. Their absence from your workup is the guideline being followed, not a corner being cut.
Which symptoms predict how much it bothers you
The features above describe what tinnitus is like. A different, more useful question is which of them predicts how much it will affect you, and the answer is not the one most people expect.
A 2022 study in Therapeutic Advances in Chronic Disease assessed 201 people with chronic tinnitus at one outpatient clinic and measured their severity with two questionnaires, the Tinnitus Handicap Inventory and the Tinnitus Evaluation Questionnaire. Five factors independently predicted the score on each, and three predicted it on both:
- Sleep quality, on the Self-Rating Scale of Sleep
- Anxiety level, on the Self-Rating Anxiety Scale
- Change in loudness — whether the tinnitus had changed in loudness, which the authors discuss as loudness increasing over the course of the condition
How loud people rated the sound at the time of the study was the strongest predictor on the second questionnaire, but it did not make the final model for the first. Which ear the tinnitus was in, and how long it had lasted, did not make either.
That points in the same direction as much of the treatment evidence: sleep and anxiety travel with how much tinnitus costs you, and both are treatable, which is one reason the treatments with the best evidence aim at distress rather than at the sound itself. The study is cross-sectional, so it shows what goes with severity rather than what causes it, and the authors call for follow-up work on the direction of cause. As a guide to what is worth reporting and what is worth treating, it still points somewhere useful.
How to describe your symptoms to a doctor
A useful way to prepare for an appointment is to be ready to answer, specifically: what does it sound like (pick from the list above, or describe your own version); is it constant or does it come and go; one ear or both; does it pulse; when did it start, and did anything happen around then; does it change with stress, sleep, noise, or moving your jaw or neck; and what else comes with it (fullness, a change in hearing, dizziness). Then the second half, which people often leave out: how much it is affecting your sleep, concentration and mood. That level of detail gives an audiologist or doctor far more to work with than "I have ringing in my ears."