Many causes have been empirically proposed for tinnitus based on the correlation between them and the symptom on a representative set of patients. However, besides in gross cases involving blows to the head, ototoxic medication overdoses, exposure to loud noises, the link between tinnitus and its supposed cause is not clear. For example it is not clear whether depression is an onsetting factor for tinnitus or vice-versa.

Commonly cited causes for tinnitus are

• Ear infection and inflammation
• Medication (usually overdoses)
• Stress and anxiety
• Cerumen (earwax) building up in the auditory canal. Some specialists believe however, that the occlusion of the canal is not sufficient for causing tinnitus; contact with the tympanic membrane must also occur
• Ménière's disease (usually accompanied by vertigo or dizziness and hearing loss)
• Tumor affecting the eight (vestibulocochlear, also known as auditory or acoustic) nerve

Pulsatile tinnitus is easier to diagnose - usually it's caused by a condition such as anemia, hypertension, hypothyroidism, migraines (Novartis Foundation, previously CIBA Foundation, 1981:232-236), atherosclerosis or others affecting the blood flow through the ear.