Hearing sounds in the ear or head without a source of noise. Buzzing in the ears can be caused by an ear-wax blockage, but it more frequently occurs in an ear that has been damaged in some other way: by loud noise, medication, otitis, surgery, accident or old age. All these are likely to involve slight hearing loss. Tinnitus associated with vertigo is a symptom of Meniere’s disease. It can also be caused by high blood pressure, and more rarely by a tumour of the pons. The cause of tinnitus should always be sought. It is sometimes a genuine noise (a constricted blood vessel or a dragging muscle in the neck), and this may be susceptible to treatment, but in almost half of all cases no apparent cause can be found. Even then the cause of tinnitus can rarely be treated, but there are ways of reducing discomfort. The noise can be masked by a sound produced by an instrument mounted on the ear, or a hearing aid can be used to amplify normal sounds. Medication affects mental condition rather than the tinnitus. Destruction of the organ of hearing or the auditory nerve is no longer used as a treatment because it seems to bring about little improvement. The symptoms often remain, and sometimes worsen.