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Examples of causes of secondary tinnitus include 12 : Vascular conditions that generate an internal perceivable sound Musculoskeletal causes, such as head or neck injury or temporomandibular joint dysfunction Use of ototoxic medications Bacterial, viral, or fungal infections Trauma to the auditory structure, such as the ear drum Earwax impaction or improper earwax cleaning procedures 77,78 Metabolic disturbance, such as diabetes or imbalanced lipid levels Neurological conditions, such as intracranial hypertension or vestibular migraine Other problems affecting the outer and middle ear, such as cerumen impaction, tumors, fusing of the middle ear bones, or dysfunction of the tympanic membrane or eustachian tubes Medications that Can Cause Tinnitus Many medications are known to have toxic effects on auditory tissues and can cause or worsen tinnitus (Table 2), especially when used long-term and/or at high doses