Ringing in the Ears (Tinnitus): Causes and Treatment

What is tinnitus or ringing in the ears?

Ringing in the ears can affect your days considerably. The reassuring news: for most people with tinnitus, nothing serious is going on. Tinnitus is the medical name for hearing sounds that do not come from an outside source. The sound sits in one ear, in both ears, or in the middle of your head, and nobody else can hear it. You may hear ringing, buzzing, whooshing, humming, hissing, or throbbing: loud or soft, high or low pitched, constant or coming and going. That is how the NHS describes tinnitus.

Do you feel the sound in your ear is linked to tension or stiffness in your neck? That is possible. During your first visit at Embody Health we look at whether your complaints could relate to the cervical spine: tension, blockages, or restricted mobility in the neck can influence the signals around the ears and the balance organ. Your first visit costs €39 and requires no referral from your GP. Most Dutch health insurers (partially) reimburse chiropractic care from the supplementary package, without touching your deductible.

In over 12 years, we have helped more than 2500 people across our three clinics in Alphen aan den Rijn, Amersfoort, and Rotterdam. Patients rate us on average 4.9 out of 5 stars on Google. Many people have lived with ringing ears for years without anyone looking at the whole picture. During the first visit we map in detail how your neck, spine, and health relate to each other.

Types of tinnitus: subjective or objective

There are different types of tinnitus. For most people the tinnitus is subjective: you hear the sound and nobody else does. Objective tinnitus is rare and can be linked to a sound source inside the body itself, such as a narrowed blood vessel or tiny muscle spasms in the middle ear. Tinnitus that beats in time with your pulse is called pulsatile tinnitus. We always discuss that signal first with your GP, just like tinnitus that started suddenly or sits in one ear only.

Symptoms of ringing in the ears

The sound is different for everyone: sometimes it barely registers, sometimes it dominates your day. Alongside the sound in the ear, these symptoms can occur:

• hearing loss or a full, dull feeling in the ear
• hyperacusis: everyday sounds come across louder or more unpleasant
• difficulty understanding speech, especially with background noise
• concentration problems, trouble sleeping, or a restless feeling
• tension, stress, or low mood from the persistent tinnitus

The impact of tinnitus mostly depends on how severe the complaints are. Most people with tinnitus get used to it over time, but chronic tinnitus can start to dominate daily life. The NHS describes which symptoms belong to tinnitus and what you can do yourself to cope better.

Causes of tinnitus

The cause of tinnitus is not always clear, but there are known triggers. Tinnitus is often linked to hearing loss, loud noise, stress, or ageing. Exposure to loud noises or loud music can damage the tiny hair cells in the inner ear. Working in noise for years, listening to music at high volume, or a sudden loud bang can all cause noise damage to the hearing nerve.

Tinnitus can have other causes too. Hearing loss is part of ageing and regularly comes with ringing ears. Ear conditions, such as a middle ear infection or abnormalities in the ear, sometimes play a role. High blood pressure can cause tinnitus, and some medicines list tinnitus as a side effect; your GP or pharmacist can tell you more. Ménière's disease is an inner ear condition with attacks of vertigo, tinnitus, and hearing loss. Part of the tinnitus complaints has nothing to do with the neck; that is why we take the medical side seriously and rule it out together with you first.

How can tinnitus start from the neck? The cervical spine contains nerves, joints, muscles, and ligaments that can all play a role in complaints around the head, ears, and balance. Tension in the neck and shoulder muscles, a forward head posture, or an earlier accident or whiplash can load the upper neck vertebrae. Whether that link applies to you is different per person; we map that during the first visit.

Our first step: rule out medical causes

A careful screening is part of every first visit at Embody Health. If the tinnitus started suddenly, sits in one ear only, or comes with hearing loss, your GP or ENT specialist should assess it first to rule out medical causes — and we gladly guide that process. The GP can do a hearing test and refer you to an ENT specialist or audiology centre if needed; tinnitus that beats in time with your pulse, tinnitus after a head injury, or tinnitus with sudden hearing loss needs urgent medical assessment. Once medical causes are ruled out, we investigate whether your cervical spine contributes: that is exactly where chiropractic can help.

How can a chiropractor help with tinnitus?

We start with an intake and a physical examination of your posture, neck, and spine. Orthopaedic and neurological tests tell us whether your neck plays a role in your complaints, or whether your GP or ENT specialist is the better first step. You get a careful approach and an honest assessment: together we determine whether chiropractic care is a useful addition and what you can realistically expect.

If your neck contributes to your complaints, we work with gentle, precise adjustments to restore the mobility of the neck joints and reduce tension in the surrounding muscles. Posture advice, relaxation exercises, and a personal treatment plan are part of the approach. For tinnitus linked to the neck — also called somatic tinnitus — the evidence is cautiously positive: a 2025 randomised trial found that manual therapy can reduce the distress, and a 2024 review names the same approach as a useful part of treatment. The studies are small, so we are honest about what you can expect. What you can realistically expect depends on the cause and how long your complaints have existed; we discuss that honestly during your first visit. We also map the treatment options for tinnitus outside our practice, such as a referral to an ENT specialist or audiology centre.

Your first visit costs €39 and requires no referral; a single follow-up consultation is €65 and a consultation in a recovery package €55. Child consultations are €35. See what your health insurer reimburses and the prices.

Living with tinnitus

There is usually no treatment that makes tinnitus disappear. Care therefore often revolves around learning to cope with the sound, and that is also what the research advises. A Cochrane review on cognitive behavioural therapy for adults with tinnitus shows this approach can reduce the distress and anxiety around tinnitus, even though the sound itself stays. Distraction helps: staying busy, exercising, or relaxation exercises make you focus less on the sound. Try to reduce stress, because stress often makes tinnitus louder. Protect your hearing against loud noises so the complaints do not get worse. People with tinnitus and hyperacusis sometimes benefit from soft background sounds; with hearing loss, a hearing aid can make the tinnitus less prominent. Read more about neck and shoulder complaints if you suspect your neck plays a role.