What Is Tinnitus?

Tinnitus is characterized by hearing sounds—often a ringing or buzzing—in the absence of an outside source causing the sound. It often accompanies hearing loss and can be triggered by loud noises or certain diseases, among other factors. Almost everyone experiences it from time to time, with nearly one in 10 adults in the United States reporting tinnitus within the last year.

Tinnitus can cause you to hear different kinds of sounds, including ringing, buzzing, or hissing. Usually, it is a symptom rather than a consistent feeling, like the kind of ringing you get after a loud concert or noise. It usually goes away within minutes and is rarely the sign of anything life-threatening.

That said, some people develop chronic cases, which can seriously impact their quality of life and mental health. The treatment of tinnitus depends on the individual case, but common approaches include medications and sound therapy.

Types of Tinnitus

Though there’s some debate about it, tinnitus can be categorized based on various factors, including who can hear it, where in the body the sound is occurring, its underlying cause, the nature of the sound, and how long it occurs. These types can overlap in a variety of ways.

Types Based on Who Can Hear It

Almost all forms of tinnitus are subjective, meaning only one person hears it. Rarely, the sound can be examined by a healthcare professional. These are called subjective and objective tinnitus:

• Subjective tinnitus: This is the most common overarching type of tinnitus, characterized by only being heard by the person who is experiencing it. It is often associated with underlying hearing loss or damage to the auditory system. It can manifest as a broad variety of sounds, such as ringing, buzzing, hissing, or whistling.
• Objective tinnitus: Objective tinnitus is an extremely rare form in which the noise is not only heard by the person with tinnitus but can also be heard by a healthcare provider using a stethoscope or other medical instruments. It is typically caused by vascular or muscular problems in the head and neck.

Types Based on Where The Sound Is Occurring

Tinnitus can also be classified by where in the body the sound is occurring: the ear or the brain.

• Peripheral tinnitus: The source of the symptoms is in the ear itself. This type is caused by the activity of cells in the cochlea of the inner ear and the auditory pathways (the order of events that occur in your ear in order for you to hear). These nerve cells are triggered by sound vibrations, sending that information to the parts of your brain associated with hearing (auditory centers). The phantom sounds you hear occur due to these cells firing irregularly.
• Central tinnitus refers to cases with origins in the auditory centers of the brain. With this type, the inner ear isn’t damaged; rather, the neurons (brain cells) associated with hearing are functioning abnormally.

Types Based on Underlying Causes

While the ultimate cause of tinnitus is unknown, there are some conditions and injuries that can trigger or even cause it, These are classified as:

• Pulsatile tinnitus: This type of tinnitus is characterized by rhythmic or pulsing sounds that occur simultaneously with the heartbeat. It is often associated with blood flow abnormalities or vascular issues near the ear, such as high blood pressure.
• Non-pulsatile tinnitus: Unlike pulsatile tinnitus, non-pulsatile tinnitus does not have a rhythmic pattern and can occur constantly or irregularly. It is typically related to damage or dysfunction of the auditory system.
• Somatic tinnitus (or somatosensory tinnitus): Somatic tinnitus is influenced by body movements or muscle contractions. It can be triggered or modulated by movements of the head, neck, jaw, or other parts of the body. Temporomandibular joint (TMJ) disorders and cervical spine issues are often associated with somatic tinnitus.
• Noise-induced tinnitus: This can be caused by exposure to loud noises, such as concerts, gunfire, or industrial machinery. It is often accompanied by hearing loss and can be temporary or permanent.

Types Based on Type of Sound

The sound that someone with tinnitus hears can vary, but is generally classified into two major groups:

• Tonal tinnitus: Tonal tinnitus is characterized by a consistent, continuous sound, similar to a high-pitched whistle.
• Musical tinnitus (musical ear syndrome): Some people with tinnitus report hearing music, melodies, or specific musical tones. This type is less common than tonal tinnitus.

Types Based on Span of Time Experienced

Tinnitus can occur for a long period of time or just temporarily. These are classified as the following:

• Acute tinnitus: Some people experience tinnitus suddenly, without any apparent cause. Sudden-onset tinnitus may be related to viral infections, head trauma, or other underlying medical conditions or injuries.
• Chronic tinnitus: Tinnitus is considered chronic when it persists for an extended period, typically more than six months. Chronic tinnitus can be a result of various underlying causes, including age-related hearing loss, noise exposure, or underlying medical conditions.

Symptoms

The most common symptom of tinnitus is hearing sound that others cannot and isn’t coming from an external source. You might hear it in one ear, both ears, or originating from inside your own head. Depending on the case, the noise may come and go or fluctuate in volume. For some, the sound is louder when they’re in quiet environments, though others report strong symptoms in noisier environments.

What makes categorizing the signs of tinnitus difficult is that they’re always subjective. It’s something that you hear but others cannot. People with tinnitus may describe what they hear as:

• Ringing
• Buzzing
• Hissing
• Humming
• Chirping
• Whooshing
• Whistling
• Screeching
• Roaring

What Causes Tinnitus? 

Tinnitus occurs due to the abnormal activity of nerve and brain cells involved with hearing. This irregular firing (sending of signals) is seen in the cochlea of the inner ear, parts of the brain involved in hearing (the auditory cortex), or often both. Research has yet to determine what causes this reaction. It may be due to damage in the inner ear, problems within the auditory cortex, or disorders of blood vessels around the ear.

Tinnitus is less of a disease and more of a symptom. It can be triggered by many factors, including:

• Exposure to loud noises
• Hearing loss
• Ear infection or ear wax
• Ménière’s disease, a disorder of the inner ear
• Problems with the eustachian tube, which runs from the middle ear to your throat
• NSAID pain-relievers (like ibuprofen), certain antibiotics, antidepressants, and cancer drugs, among others
• Temporomandibular (TMJ) joint disorders (problems affecting the jaw joint)
• Vestibular schwannoma, a benign tumor that arises on a nerve of the inner ear
• Brain tumor
• Hypertension (high blood pressure)

Risk Factors

Certain people are more likely to have tinnitus. Those at higher risk include:

• War veterans
• Children with severe hearing loss
• Adults over 65
• People living with type 2 diabetes, migraine, thyroid disorder, and other chronic diseases
• People with obesity
• People who’ve had a head injury

Diagnosis

Typically, the diagnosis of tinnitus is a multi-step process. Though you’ll see your primary care provider first, you’ll need a specialist, such as an otolaryngologist (an ear, nose, and throat specialist) or an audiologist (hearing specialist) to confirm the condition. Identifying the cause of your symptoms will help them determine what treatments can help you.

Following an assessment of your medical history and status, as well as any medications you’re taking, several methods may used to evaluate you, including:

• Physical evaluation: The provider uses an otoscope to assess the ear canal and tympanic membrane (ear drum) for signs of infection, wax, or discharge build-up.
• Bedside hearing tests: Initial evaluations of hearing rely on using tuning forks or other devices to assess well how you can hear.
• Nerve tests: You’ll be asked to perform tasks to assess your reflexes, ability to balance, strength of your limbs, and sense of touch and feel; this assesses your cortical nerves.
• Stethoscope: To check for vascular (blood vessel) causes, your healthcare provider will use a stethoscope to listen to blood flow through your vessels along the neck and neck and next to the ear.
• Audiogram: To test the impact on hearing function, an audiologist uses a device to play a sound, asking if it matches the tone you hear due to tinnitus.
• Air-bone test: To detect otosclerosis (abnormal bone growth), you compare what you hear from an earphone versus sound projected to the bone.
• Tone masking: Another aspect of the audiogram test, the audiologist plays tones to see how long and well they can inhibit (mask) the sound of the tinnitus.   

Treatments for Tinnitus  

The specific approach to the treatment of tinnitus depends on the underlying cause and individual case. If it’s linked to earwax or ear infection, then treating those conditions typically resolves symptoms. However, in chronic or persistent cases of tinnitus, there may be no outright cure. In these cases, therapies focus on reducing the severity and impact of the tinnitus symptoms.

Surgery

If your tinnitus is linked to problems with the structure of your ear or blood vessels, certain surgeries may help. Implanting a shunt—a bracket that helps open up blood vessels—may correct certain types of tinnitus. If your cause is linked to the structure of your inner ear, sinus wall reconstruction—which involves reworking the structure of your sinus passages around your nose—can completely reverse tinnitus.

Sound Therapy

Sound therapy involves using sound to ease or even relieve the tinnitus symptoms. Exposure to certain tones is thought to affect neurons in the auditory cortex, reversing changes there. In masking therapy, sounds at certain frequencies “mask” the tinnitus, dampening or completely drowning it out.

To take part in these therapies, you may have to wear or use several types of devices:

• Smartphones or table-top sound devices that emit white noise and relaxing sounds
• Hearing aids to manage hearing loss associated with tinnitus
• Wearable sound generations, which are small devices that fit in your ear, emitting low levels of sound to mask tinnitus
• Combination devices, which are hearing aids that also generate specific frequencies of sound to minimize symptoms

Behavioral Therapy

Behavioral therapies focus on strategies to change your thinking about tinnitus, and your response to it to improve your overall wellbeing. This can take several forms, including:

• Education: Working with a therapist, you learn about the condition to ease anxiety and develop coping and management strategies.
• Cognitive behavioral therapy (CBT): CBT is a form of talk therapy that focuses on changing the pattern of negative thoughts you have about tinnitus to help cope with it.
• Tinnitus retraining therapy: This involves a combination of sound and behavioral therapy, using exposure to sound to get you physically habituated (used to) the sound, and talk therapies help you realign your emotional responses to tinnitus.

Prescription Medications

No medication, prescribed or over-the-counter, can directly treat tinnitus. However, they can play a role in managing the condition. Anti-anxiety medications or anti-depressants may be prescribed to people with difficult-to-manage cases.

Prevention

Though there’s no preventing some cases of tinnitus, and others become chronic, therapies and lifestyle changes may help prevent certain types of tinnitus. These include:

• Ear protection: Since loud sounds or outside noise can set off or worsen tinnitus, wearing ear protection may help; carry earplugs or look for headphones that screen out noise at 85 decibels (dBl) or. This is especially important if you work in a loud environment, as in construction and industrial work. 
• Relaxation techniques: Though stress and anxiety don’t cause it, they can make tinnitus worse. Alongside biofeedback therapy—which teaches you how to recognize signs of tension in your body—meditation, mindfulness, and other means of managing stress may help.
• Sleep hygiene: Make sure you get enough sleep: seven to nine hours for adults, and more for teenagers and children. Some recommend sleeping with your head propped up, which reduces congestion and may help reduce the severity of your tinnitus.

Related Conditions

Tinnitus is often the result of hearing loss, so managing one typically involves managing the other. Chronic cases can cause other issues and have a particular impact on mental health. Conditions related to tinnitus include:

• Insomnia: Insomnia, or an inability to fall or stay asleep, is commonly linked with tinnitus. In a 2021 study, just over a quarter of participants with tinnitus reported sleep disturbances.
• Depression: A broad-ranging review of data from 9,979 people with tinnitus from all around the world estimated that about one in three lived with depression.
• Anxiety: According to a 2017 study, anxiety disorder—which causes feelings of panic and uncontrollable worry—was reported in 26.1% of people with tinnitus.

Living With Tinnitus  

It’s important to remember that while chronic tinnitus can be difficult, it’s rarely the sign of anything dangerous. That said, it can have a significant burden on your quality of life. Severe cases can make day-to-day functioning difficult. To cope, don’t be afraid to reach out to family and friends for help and support, and make sure to seek out any needed accommodations at work or school.  

Though there may be no outright cure for tinnitus, it can be managed. Therapies and prevention strategies continue to show benefits, and more is on the horizon. Researchers are testing out several promising approaches, such as using cochlear implants to suppress tinnitus or several means of electric stimulation of the brain.