Tinnitus is a symptom

Tinnitus is a symptom, not a disease, so there is no one-size-fits-all cure or wonder drug. Patients should be highly cautious of being misled by products or treatments claiming to cure tinnitus. There are many gimmicks available on the internet that may promise relief but do not work. Individuals with tinnitus must consult a healthcare professional to determine the underlying cause and develop a tailored treatment plan.

Trusting in unproven remedies can lead to wasted time and money, and may even result in further aggravation of tinnitus symptoms.

Never accept advice that there is “nothing to be done” or that “you have to live with it!”

What is tinnitus?

Tinnitus is the perception of noise or ringing in the ears when no external sound is present. It is a common condition that affects millions of people worldwide and can be a source of significant distress and discomfort for those who experience it. Tinnitus can be classified into different types based on various characteristics, including whether the noise heard is audible to others (objective vs. subjective tinnitus), whether the noise is in sync with the heartbeat (pulsatile vs. non-pulsatile tinnitus), and whether it is continuous or intermittent (1).

Objective tinnitus

Objective tinnitus is a type of tinnitus where the noise can be heard by someone else, usually a healthcare professional, using a stethoscope or other equipment. This type of tinnitus is often caused by vascular abnormalities or muscle contractions near the ear.

Subjective tinnitus

On the other hand, subjective tinnitus is the most common type and is only heard by the person experiencing it. It can vary in intensity and pitch and may be present continuously or come and go intermittently. Subjective tinnitus can be caused by a wide range of factors, including exposure to loud noise, age-related hearing loss, ear infections, and certain medications.

Pulsatile tinnitus

Pulsatile tinnitus is subjective tinnitus, where the noise heard is synchronized with the person’s heartbeat. This type of tinnitus is often caused by blood flow disturbances near the ear, such as atherosclerosis or vascular tumours. On the other hand, non-pulsatile tinnitus is not synchronized with the heartbeat and can have a broader range of underlying causes, including inner ear disorders and nerve damage (2).

How common is tinnitus?

The incidence of tinnitus is relatively high, with studies suggesting that 10-20% of the population experience some form of bothering tinnitus at some point in their lives. While tinnitus is more common in older adults, it can also affect people of all ages, including children (3).

The causes of tinnitus

The exact causes of tinnitus are not always clear. Still, they are thought to involve a complex interplay of factors, including hearing loss, exposure to loud noise, ear infections, and underlying medical conditions. Sometimes, tinnitus may be a symptom of a more serious underlying condition, such as a brain tumour or cardiovascular disease, and may require further investigation(4).

Intracannaliculur acoustic neuroma
A small vestibular schwannoma

Investigating tinnitus

Medical investigations for tinnitus may include a physical examination, hearing tests, imaging studies (such as MRI or CT scans), and blood tests to rule out underlying medical conditions. Treatment options for tinnitus vary depending on the underlying cause and severity of the symptoms. In some cases, addressing underlying medical conditions, such as ear infections or vascular abnormalities, may help alleviate tinnitus symptoms (5).

The link between tinnitius and hearing loss

Hearing loss and tinnitus are closely linked because hearing loss is the most common cause of tinnitus. When a person experiences hearing loss, the brain may try to compensate for the lack of sound input by creating phantom noises, which are perceived as tinnitus. This phenomenon occurs because the brain is not receiving the expected level of auditory stimulation it is accustomed to, leading to the perception of ringing, buzzing, or other sounds in the ears. Therefore, addressing hearing loss through hearing aids or other treatments can help manage tinnitus symptoms effectively. Tinnitus may also occur in the absence of hearing loss (6).

Hyperacusis, misophonia and tinnitus

Hyperacusis, misophonia, and tinnitus are all related conditions that involve sound sensitivity and perception. Hyperacusis is a heightened sensitivity to everyday sounds, while misophonia is a strong negative reaction to specific sounds. Tinnitus, on the other hand, is a perception of ringing or buzzing in the ears (7).

These conditions are often interconnected, as individuals with hyperacusis or misophonia may also experience tinnitus. The connection between these conditions lies in the brain’s processing of auditory information. Research suggests that individuals with hyperacusis or misophonia may have altered auditory pathways that contribute to the perception of tinnitus.

Furthermore, exposure to loud noises or traumatic events can exacerbate symptoms of all three conditions. Managing these conditions often involves sound therapy, cognitive behavioral therapy, and lifestyle modifications to reduce triggers and improve overall quality of life.

Tinnitus retraining therapy

Tinnitus retraining therapy (TRT) is a form of therapy designed to help individuals suffering from tinnitus. The therapy involves a combination of sound therapy and counselling to help patients habituate to sound and reduce its negative impact on their daily lives. Sound therapy uses low-level, neutral sounds to help mask the tinnitus and retrain the brain to ignore it. Counselling helps individuals develop coping strategies and change how they perceive and react to tinnitus. TRT aims to reduce the perception of tinnitus and improve the individual’s quality of life by helping them manage and eventually diminish the bothersome symptoms associated with the condition (8).

Management of tinnitus

Other management options for tinnitus may include sound therapy, where devices such as white noise machines or hearing aids mask the tinnitus noise and provide relief. Cognitive behavioural therapy (CBT) is extremely helpful in managing the emotional distress and anxiety that can accompany tinnitus
Read more about the management of tinnitus (9, 10)

Medical treatment for tinnitus

In some cases, medication may be prescribed to help manage tinnitus symptoms, such as antidepressants, antianxiety, and other drugs. However, these medications are not always effective and may have side effects, so they should be used cautiously (11).


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7. Jastreboff PJ, Jastreboff MM. Decreased sound tolerance: hyperacusis, misophonia, diplacousis, and polyacousis. Handb Clin Neurol. 2015;129:375-87. doi: 10.1016/B978-0-444-62630-1.00021-4. PMID: 25726280.

8. Jastreboff PJ. Tinnitus retraining therapy. Prog Brain Res. 2007;166:415-23. doi: 10.1016/S0079-6123(07)66040-3. PMID: 17956806.

9. Aazh H, Landgrebe M, Danesh AA, Moore BC. Cognitive Behavioral Therapy For Alleviating The Distress Caused By Tinnitus, Hyperacusis And Misophonia: Current Perspectives. Psychol Res Behav Manag. 2019 Oct 23;12:991-1002. doi: 10.2147/PRBM.S179138. PMID: 31749641; PMCID: PMC6817772.

10. Aazh H, Najjari A, Moore BCJ. A Preliminary Analysis of the Clinical Effectiveness of Audiologist-Delivered Cognitive Behavioral Therapy Delivered via Video Calls for Rehabilitation of Misophonia, Hyperacusis, and Tinnitus. Am J Audiol. 2024 Apr 23:1-16. doi: 10.1044/2024_AJA-23-00254. Epub ahead of print. PMID: 38651993.

11. Tunkel DE, Bauer CA, Sun GH, Rosenfeld RM, Chandrasekhar SS, Cunningham ER Jr, Archer SM, Blakley BW, Carter JM, Granieri EC, Henry JA, Hollingsworth D, Khan FA, Mitchell S, Monfared A, Newman CW, Omole FS, Phillips CD, Robinson SK, Taw MB, Tyler RS, Waguespack R, Whamond EJ. Clinical practice guideline: tinnitus. Otolaryngol Head Neck Surg. 2014 Oct;151(2 Suppl):S1-S40. doi: 10.1177/0194599814545325. PMID: 25273878.