Tinnitus is the perception of sound that has no external cause. This condition is often referred to as ringing in the ears, but tinnitus can cause a variety of sounds, like roaring or buzzing. When tinnitus affects both ears, it is called bilateral tinnitus.

In this article, we’ll go over the symptoms of bilateral tinnitus. We’ll also discuss potential causes and risk factors for this condition, as well as diagnosis and treatment.

Tinnitus is a common condition that affects around 10 percent of the population. It can affect one or both ears. Tinnitus that affects both ears is bilateral tinnitus. Tinnitus that affects one ear is unilateral tinnitus.

There are several types of tinnitus that can be bilateral:

  • Subjective. Subjective tinnitus is the most common type. Only you can hear the noise in your ears, and it’s not related to external sounds.
  • Objective. For this type of tinnitus, the noise can be heard by others through a stethoscope or microphone.
  • Pulsatile. The tinnitus noise for this type is rhythmic and in sync with your heartbeat.
  • Muscular. This tinnitus noise is rhythmic and caused by irregular contractions or spasms of muscles in or near the ear.

Tinnitus is derived from the Latin word tinnire, which means to ring. Tinnitus is commonly referred to as ringing in the ears, but the sounds caused by tinnitus vary and can include:

  • roaring
  • ringing
  • hissing
  • whistling
  • buzzing
  • clicking
  • whooshing
  • crickets
  • chirping

If you have bilateral tinnitus, you will hear sounds in both ears. Tinnitus sounds can be soft or loud. They can also vary and fluctuate in pitch and loudness.

Tinnitus sounds may be continuous and without end, or they can come and go.

Tinnitus can be difficult to live with. For that reason, additional symptoms of bilateral tinnitus include anxiety, insomnia, and depression.

Tinnitus symptoms that may indicate an underlying cause

Some tinnitus symptoms are associated with specific underlying causes:

  • When tinnitus is accompanied by symptoms such as ear pain or drainage, the underlying cause may be a sinus or ear infection or a cholesteatoma.
  • When tinnitus is accompanied by dizziness, the underlying cause may be a neurological problem or Meniere’s disease.

According to the American Tinnitus Association, tinnitus is not a disease but instead a symptom of an underlying condition. There are approximately 200 health disorders or conditions that can have bilateral tinnitus as a symptom.

Bilateral tinnitus is experienced in the ears but is caused by neural circuits in the brain. Scientists are not sure why tinnitus occurs.

It’s believed that the network of brain cells that interpret sound may create an illusion of sound where none exists. This might be due to damage to the hair cells within the inner ear.

Causes and risk factors for bilateral tinnitus include:

  • Age-related hearing loss. Aging is a risk factor for tinnitus because hearing loss becomes more prevalent as people get older.
  • Noise-induced hearing loss. Loud noise exposure over time can reduce hearing and increase the risk for bilateral tinnitus. Just one severe exposure to extremely loud noises can also have this effect.
  • Other forms of hearing loss. Age and noise-related hearing loss are the most common causes of tinnitus, but other types of hearing loss, like irregular bone growths or a ruptured eardrum, can also cause tinnitus.
  • Ototoxic medications. Ototoxic medications can damage the ear and cause hearing loss. There are over 200 prescription and over-the-counter drugs that can have this effect. They include chemotherapy drugs and salicylic pain relievers, such as aspirin.
  • Disorders of the blood vessels or muscular system. Certain blood or muscular system disorders are associated with objective tinnitus.
  • Amyotrophic lateral sclerosis (ALS). ALS can cause muscular tinnitus.
  • Multiple sclerosis. MS is a cause of muscular tinnitus
  • Meniere’s disease. This disorder of the inner ear can cause tinnitus.
  • Ear and sinus infections. Infections of the inner ear may cause tinnitus.
  • Hormone changes. Hormonal changes in people assigned female at birth during times like perimenopause, menopause, and pregnancy may cause tinnitus.
  • Impacted earwax buildup. A buildup of earwax may cause tinnitus.
  • Temporomandibular joint disorders (TMJ). Disorders of the TMJ joint have been associated with tinnitus.
  • Hyperthyroidism. Hyperthyroidism is a cause of pulsatile tinnitus
  • Brain tumor. Brain tumors can cause tinnitus depending on their size and location.

If you’re hearing tinnitus noise, you should contact a doctor, audiologist, or ENT (ear, nose, and throat specialist).

Your doctor will ask about your health history, medications you’re taking, and symptoms. They’ll take an oral history to find out how long you’ve been hearing tinnitus noises and what they sound like.

There’s no medical test that can confirm a diagnosis of subjective tinnitus. For that reason, your description of your symptoms will be very important. An audiogram (hearing test) will be administered to check for hearing loss.

Pulsatile tinnitus is uncommon. If your doctor suspects you have this type of tinnitus, it’s important to find the underlying cause so it can be corrected.

If the noises you hear are rhythmic, you may have imaging tests to check for blood vessel irregularities and scans to check for sinus wall irregularities.

Tests may include:

Uncovering the root cause of bilateral tinnitus is helpful for determining treatment. Sometimes, an easily correctable issue will be uncovered, such as an ear infection or wax buildup.

If you have an ear infection, you may be given antibiotics or anti-inflammatory medication. Earwax can be flushed out or removed with suction in a doctor’s office.

However, most cases of tinnitus do not have an easily correctable cause.

If an underlying issue cannot be found or treated, treatments will be recommended that reduce your perception of the tinnitus sound. You may also be treated for anxiety or depression so that you’re better able to handle tinnitus.

Tinnitus masking

If you have hearing loss, your doctor will recommend hearing aids. Increasing your ability to hear external sound is often enough to reduce or diminish tinnitus sounds.

Many hearing aids also include built-in tinnitus masking sounds that you can adjust. These sounds include white noises, like static, and nature sounds, like waves.

If you don’t use hearing aids, you can download tinnitus sound therapy or relaxation apps that play soft music or sounds to your phone. Tinnitus can be worse at night when there is less external noise to distract you.

Tinnitus sound therapy apps can be especially beneficial when you’re trying to sleep. White or pink noise machines can also be used for this purpose. Fans or air purifiers can also help mask the sound of tinnitus.


Tinnitus sound therapy uses habituation, a technique that retrains the brain to ignore tinnitus sounds. Hearing aids and audiology devices that are worn as hearing aids can be used for tinnitus sound therapy.

During habitation, a sound is emitted by your device that matches or is equal to the tinnitus sound. The tinnitus sound and the introduced sound start to mix together.

You may have to continually adjust your device to alter the level of the introduced sound. Over time, your brain learns that the noises made by tinnitus are unimportant and delegates them to the background, getting rid of the need for ongoing habituation.

Tinnitus sound therapy can take time to master but is very effective for many people who live with this condition.

You might also consider making an appointment with an audiologist or psychologist who specializes in tinnitus retraining therapy. Your doctor can provide recommendations for a specialist near you.

Lifestyle changes

Lifestyle changes that include stress reduction can help. Tinnitus can be difficult to live with. Finding support from friends, a therapist, or a tinnitus support group can help you find balance and coping skills.

Cigarettes, alcohol, and caffeinated beverages can all raise blood pressure, making tinnitus worse. Eliminating or reducing these substances may help.

If you have Meniere’s disease or high blood pressure associated with tinnitus, reducing your salt intake may also be beneficial for reducing symptoms of tinnitus.

Keeping active and remaining social can also help you enjoy life and distract you from bilateral tinnitus.

Clinical trials

Taking charge of your condition can be empowering. Tinnitus is being studied worldwide by multiple teams of researchers and specialists.

If participating in a clinical trial appeals to you, talk with your doctor or check ClinicalTrials.gov for ongoing research you may participate in.

Tinnitus is the experience of hearing sounds that no one else can hear. Bilateral tinnitus is tinnitus that affects both ears.

Tinnitus may result from many health conditions and other underlying causes. Age-related hearing loss and noise-related hearing loss are two of the most common causes of bilateral tinnitus.

Talk with a doctor about treatments that can help reduce your perception of the unwanted sounds in your ears.