Tinnitus is one word for many different things, and sorting which kind you have is the first real step. A one-sided or pulsing sound is a different situation from the common ringing that follows a loud concert — and the difference decides what to do next.
About 99% of tinnitus is subjective — only you can hear it. A small fraction is objective (usually pulsatile): a real sound, often blood flow, that a clinician can sometimes detect. Pulsatile tinnitus that beats in time with your heartbeat is the important exception — it can point to treatable vascular causes and warrants a proper workup rather than reassurance. Evidence ●●●●○
By far the biggest is noise-induced hearing loss, followed by age-related hearing loss — and a crucial point is that most tinnitus travels with some hearing loss, even when a standard audiogram reads normal ('hidden hearing loss,' or cochlear synaptopathy). Other common drivers: earwax, ototoxic drugs (high-dose aspirin/NSAIDs, some antibiotics, loop diuretics, certain chemotherapies), jaw and neck problems (somatic tinnitus, often modulated by clenching or head movement), Ménière's disease, and head or neck injury. Stress doesn't cause it but reliably amplifies it. Evidence ●●●●○
Uncommon but important: one-sided (unilateral) tinnitus with hearing loss can rarely signal an acoustic neuroma (a benign nerve tumour) and warrants an MRI, and pulsatile tinnitus warrants a vascular workup. These are the minority — but they're precisely why a one-off proper assessment beats years of guessing. The next sections cover exactly when to get checked.
When to get it checked promptly
See a professional promptly if your tinnitus is in one ear only, pulsing in time with your heartbeat, sudden in onset, or accompanied by hearing loss, dizziness, or facial weakness. Sudden hearing loss in particular is a time-critical emergency. These patterns deserve a real assessment, not reassurance from a guide.
The Tinnitus Guide