What Is Tinnitus?

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Tinnitus is ringing in the ear, though describe it more as a whistling, crackling, humming, or roaring sound. Typically, only you can hear it, and it happens despite there being no external sound present when it occurs. There are several conditions that can cause this symptom, including some kinds of hearing loss, prolonged exposure to loud noises, muscle spasms within the ear, neurological disorders, and other concerns.

types of tinnitus
Verywell / Gary Ferster

Tinnitus Types and Causes

There are two main types of tinnitus—subjective tinnitus (more common) and objective tinnitus (less common).

Subjective Tinnitus

Subjective tinnitus is believed to occur as a result of abnormal nerve activity in the part of your brain that processes sound/hearing information (called the auditory cortex).

Basically, experts suspect that some sort of disruption within the auditory pathway causes the central nervous system to abnormally perceive sound when it is not there—similar to phantom limb syndrome.

The most common conditions associated with subjective tinnitus are:

Conditions that cause conductive hearing loss, such as cerumen (wax) impaction, middle ear effusion (fluid build-up), and eustachian tube dysfunction, are also associated with tinnitus.

Additional causes of subjective tinnitus include:

Many causes of tinnitus are related to hearing loss—however, tinnitus does not directly cause hearing loss. Rather, in many cases, tinnitus is a consequence of hearing loss.

Objective Tinnitus

With objective tinnitus, a person hears an internal sound (a noise coming from an actual physiologic process occurring near the middle ear). Interestingly, the noise of objective tinnitus can sometimes be heard by the healthcare provider examining the patient's ear.

With objective tinnitus, the noise (often described as a pulsing sound) comes from problematic blood vessels, such as a carotid artery affected by atherosclerosis (fatty build-up) or a vascular malformation.

Sometimes the noise occurs as a result of a muscle spasm within the middle ear.

Diagnosis

A careful medical history and physical examination are the primary tools used to diagnose tinnitus.

Medical History

In order to narrow down a diagnosis, your doctor will ask you several questions related to your tinnitus.

Examples of questions may include:

  • Can you describe the specifics of the sound you are hearing (e.g., pitch, quality, loudness)?
  • Are you experiencing any associated symptoms (e.g., hearing loss, vertigo, headache, or temporomandibular joint pain)
  • Have you experienced any recent head or neck trauma?
  • What medications are you taking?
  • How is your tinnitus affecting your daily functioning—does it affect your sleep, work, and/or personal activities?

Physical Examination

During your physical exam, your doctor will focus on evaluating your head, neck, eyes, ear, and neurological system.

For instance, during the ear exam, your doctor will check for and remove any impacted wax to determine if that is the culprit behind your tinnitus. He may also listen to the blood vessels in your neck, chest, and around your ears with his stethoscope.

Special Tests

Depending on your doctor's findings and the features of your tinnitus (if it's persistent or associated with certain symptoms), one or more specialized tests may be recommended.

Some of these tests include:

Treatment

Tinnitus may be managed through a variety of techniques. The first step is to treat the underlying problem (e.g., stopping the offending medication or correcting the hearing loss). Interventions that help alleviate the tinnitus and minimize the impact this symptom has on your quality of life are then explored.

Correcting Hearing Loss

Fixing hearing loss with hearing aids may ease or correct tinnitus. If you have both severe hearing loss and tinnitus, cochlear implants can help by electrically stimulating the inner ear.

Tinnitus Masking

Another technique used to treat tinnitus is called tinnitus masking. This is a form of sound therapy that uses sound to mask or "cancel out" the tinnitus.

Lifestyle Modifications

Since stress, sleep problems, and the use of stimulants, like caffeine, can irritate underlying tinnitus, strategies to address these exacerbating factors may be incorporated into your treatment plan.

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy, either face-to-face with a trained therapist or via a web platform, can help you develop distraction and relaxation skills, as well as strategies to help you think and react differently to tinnitus.

Medications

There are no FDA-approved drugs for treating tinnitus. Various antidepressants are sometimes used to help relieve tinnitus, though the scientific evidence backing up their benefit remains inconclusive.

Complementary Therapies

While there are many anecdotal reports of using various complementary therapies to treat tinnitus, such as acupuncture and gingko biloba, the scientific evidence backing up their benefit is scant.

That said, it's sensible to consider incorporating a complementary therapy into your treatment plan. If anything, various therapies like practicing mindfulness meditation, biofeedback, or other relaxation techniques may improve your overall health and help you cope with the stress of living with tinnitus.

Speak with your doctor about what might be best for you.

A Word From Verywell

Living with tinnitus can be frustrating and anxiety-provoking, and it can negatively affect your ability to socialize, work, and navigate family relationships.

If you or a loved one has tinnitus, please seek out care from your primary care doctor or an ear, nose, and throat (ENT) doctor. This way you can obtain a proper diagnosis and develop a treatment plan that is scientifically-based and unique to your needs.

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