Tinnitus in One Ear vs Both Ears
Tinnitus in One Ear vs Both Ears: What It Means
Do you hear ringing, buzzing, or whooshing in just one ear—or in both? The side (or sides) where you hear tinnitus
can offer important clues about what’s going on and how urgently you should seek help.
Why Which Ear Matters
When patients come to our San Mateo or San Carlos offices, one of the first questions we ask is:
“Do you hear tinnitus in one ear, both ears, or in the middle of your head?”
That’s because:
-
Tinnitus in both ears is often related to more generalized issues, such as
hearing loss, age-related changes, or ongoing noise exposure. -
Tinnitus in one ear only is more likely to be associated with certain medical or structural
conditions and may warrant faster medical follow-up.
For a broader overview of tinnitus itself, start with
What Is Tinnitus? and
Tinnitus Causes & Triggers.
Both ears: Often tied to hearing loss, noise exposure, or systemic factors.
One ear only: More likely to be linked to conditions that need a closer medical look—especially
if tinnitus is new, loud, or paired with hearing loss, dizziness, or other symptoms.
Unilateral vs Bilateral Tinnitus: Definitions
Audiologists and ENT specialists typically use these terms:
- Unilateral tinnitus: Sound is perceived in one ear only (left or right).
-
Bilateral tinnitus: Sound is perceived in both ears, either equally or with
one side slightly more noticeable. - “In the head” tinnitus: Some people don’t localize the sound to either ear; it feels centered.
All of these patterns are common in the Bay Area patients we see. The key is what else is happening at the same
time—such as changes in hearing, balance, or general health. Learn more about risk factors in
Is My Tinnitus Permanent?.
Tinnitus in One Ear (Unilateral)
One-sided tinnitus doesn’t automatically mean something serious is wrong—but it raises the stakes
enough that we pay close attention, especially if:
- The sound started suddenly
- There is noticeable hearing loss in that ear
- You also have fullness, pressure, dizziness, or imbalance
- The sound is pulsatile—whooshing or beating in time with your heartbeat
Possible causes of unilateral tinnitus include:
Earwax, Fluid, or Middle Ear Problems
A wax plug, middle ear infection, or fluid behind one eardrum can change how sound is perceived and trigger
one-sided tinnitus. These conditions require medical treatment but are often reversible.
See Can Earwax Cause Tinnitus?.
Muffled sound
Sudden Hearing Loss in One Ear
Sudden sensorineural hearing loss can cause abrupt tinnitus and muffled or distorted hearing on one side.
This situation is considered urgent—early medical treatment may improve outcomes. Learn more in
Sudden Tinnitus: Should I Go to the ER?.
Urgent ENT
Inner Ear Disorders (e.g., Meniere’s)
Conditions such as Meniere’s disease often start in one ear with a triad
of tinnitus, hearing changes, and episodes of vertigo. Over time, more symptoms may appear if not managed.
Fullness
Acoustic Neuroma (Vestibular Schwannoma)
A benign tumor on the hearing and balance nerve can cause one-sided tinnitus and hearing loss. It is
typically rare but important to rule out in cases of unexplained, persistent unilateral tinnitus and hearing
loss. This is usually evaluated with MRI ordered by a physician.
Imaging
Vascular (Blood Flow–Related) Causes
If tinnitus in one ear sounds like a heartbeat or whooshing, especially when you lie down, a vascular cause
may be involved. Read more in What Is Pulsatile Tinnitus? and always
discuss with your doctor.
Blood flow
Jaw or Neck (Somatic) Tinnitus
Tinnitus linked to TMJ disorders or neck issues may feel stronger on one side,
especially if it changes when you open your mouth, turn your head, or clench your teeth.
Neck tension
Because the stakes can be higher, one-sided tinnitus should never be ignored. If you’re unsure
whether your situation is urgent, review
When to See a Doctor About Tinnitus and
Sudden Tinnitus: Should I Go to the ER?.
Tinnitus in Both Ears (Bilateral)
Tinnitus in both ears—or “in the head” without a clear side—is extremely common. It often relates to:
- Age-related hearing loss (presbycusis)
- Long-term noise exposure from work, music, or daily life
- Systemic factors such as blood pressure, metabolic issues, or medications
- Stress and sleep problems that make tinnitus more noticeable
To understand the hearing connection, see
Tinnitus and Hearing Loss and
Can Hearing Aids Help with Tinnitus? – Insights for Palo Alto Residents
.
Hearing Loss in Both Ears
When the brain receives less sound input from the ears—due to hearing loss—it may “fill in the gaps” with
ringing or buzzing. This is one reason why hearing aids for tinnitus
can be so helpful for many Bay Area patients.
Noise damage
Long-Term Noise Exposure
Frequent concerts, loud workplaces, or daily headphone use can slowly damage both ears over time. Tinnitus
often appears in both ears as a result. Learn practical protection tips in
Simple Steps to Protect and Preserve Your Hearing
.
Loud workplaces
Systemic & Lifestyle Factors
Blood pressure, blood sugar, hormones, caffeine, and alcohol can influence how loud tinnitus feels. Helpful
reads:
Does Caffeine Affect Tinnitus?
and
Could Drinking Alcohol Affect Your Hearing?.
Alcohol
Bilateral tinnitus can still be very distressing—but it is usually less likely to represent an
isolated structural issue on just one side. Treatment often focuses on:
comprehensive tinnitus treatment options,
Coping with Tinnitus Anxiety,
Managing Tinnitus at Night, and
Tinnitus Relief Exercises.
Tinnitus That Switches Sides or Changes with Movement
Some people notice tinnitus that:
- Seems to “move” from one ear to the other
- Gets louder when turning the head, clenching the jaw, or pressing on the neck
- Feels centered until they focus on one side
These patterns are often part of somatic tinnitus, where signals from muscles, joints, or nerves
in the head and neck area interact with the auditory system. Jaw-related tinnitus is discussed in
TMJ and Tinnitus Connection.
Even though tinnitus is “heard” in the ear, the sound is generated by the auditory system and the brain. That’s
why stress, attention, and movement can make the same sound feel louder, softer, or shifted from side to side.
Learn more about this adaptation in
Understanding Tinnitus Habituation.
Red Flag Symptoms with One-Sided Tinnitus
- New tinnitus in one ear only with noticeable hearing loss
- One-sided tinnitus plus vertigo, severe dizziness, or imbalance
- One-sided tinnitus after a head or neck injury
- One-sided pulsatile tinnitus (whooshing with your heartbeat)
- One-sided tinnitus with facial weakness, numbness, or vision changes
- Sudden, extremely loud tinnitus that began all at once
These symptoms don’t mean you definitely have a serious condition—but they do mean you should
contact a physician or emergency provider promptly. For more guidance, see
When to See a Doctor About Tinnitus and
Sudden Tinnitus: Should I Go to the ER?.
How Audiologists Evaluate Side-Specific Tinnitus
At California Hearing Center, a tinnitus evaluation typically includes:
1. Detailed History
We ask when tinnitus started, which ear is affected, whether it changes with movement, and what else you’ve
noticed (hearing changes, dizziness, jaw pain, etc.). We’ll also review your medical and noise exposure
history. You can prepare using our Tinnitus Severity Assessment.
2. Ear Examination
We check for wax, infection, fluid, or eardrum changes that might explain differences between ears. If we see
a medical issue, we’ll explain the next steps.
3. Comprehensive Hearing Tests
We measure hearing in each ear separately and look for asymmetries (differences between sides).
Understanding those differences is crucial in unilateral tinnitus. For an overview, see
What to Expect at Your Tinnitus Appointment.
4. Tinnitus Characterization
When appropriate, we may match tinnitus pitch and loudness and discuss patterns throughout the day.
This helps tailor treatment options such as
sound therapy and
Tinnitus Retraining Therapy (TRT).
5. Coordinated Plan
If your pattern suggests a need for imaging or specialist evaluation, we’ll recommend follow-up with an ENT
or other physician. We’ll also explore tools like
hearing aids for tinnitus,
CBT-based tinnitus counseling, and
tinnitus relief exercises.
What You Can Do Right Now
Whether your tinnitus is in one ear or both, there are steps you can take today:
-
Protect your ears from loud sounds—especially if you suspect noise exposure is involved.
See
Simple Steps to Protect and Preserve Your Hearing
. -
Add gentle background sound (fan, sound machine, soft music) to reduce contrast. Learn more in
Sound Therapy and
Best Tinnitus Relief Apps. -
Support sleep and stress with routines from
Managing Tinnitus at Night and
Coping with Tinnitus Anxiety. -
Notice patterns—does one ear get louder with caffeine, alcohol, or certain head positions?
Jotting notes can help your audiologist or physician connect the dots. For lifestyle insights, see
Lifestyle & Diet Tips. -
Schedule a professional evaluation so you’re not left guessing about what side-specific
tinnitus means in your case.
Many people also find it reassuring to read about others’ journeys:
Tinnitus Patient Success Stories.
Next Steps with California Hearing Center
If you live in the Bay Area and have tinnitus in one ear, both ears, or a mix of both, we’re here to help you:
- Understand what your specific pattern might mean
- Check for hearing differences between ears
- Identify any red flags that need medical follow-up
- Build a treatment and coping plan tailored to your needs
You may find it helpful to review these guides before your appointment:
Set Up Your FREE Hearing Consultation with an Expert Today
SEE A HEARING DOCTOR IN SAN MATEO
San Mateo – Main Office
88 N. San Mateo Drive
San Mateo, CA 94401
Phone: (650) 342-9449
Fax: (650) 342-4435