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What is tinnitus?

What is tinnitus?

  • Tinnitus is a sound that is perceived by the person inside one or both ears that does not originate from an external sound source.


Various ways in which patients express Tinnitus complaint:

  • Ringing
  • Hissing
  • Buzzing
  • Roaring
  • Clicking
  • Ocean sound
  • Pulsating Heartbeat
  • Sound similar to the one made by insect Cricket


Types of tinnitus

  • Subjective

            Can only be perceived by the patient

            Most common type (95%)

  • Objective

            Can be heard by others

            Rare (<5% of all tinnitus cases)

            Usually pulsatile (in sync with heartbeat)

            Causes: vascular or muscular


Causes of Tinnitus

  • Most caused by some sort of change to the auditory system

 80% of patients with SNHL (Sensorineural Hearing Loss) have tinnitus Hearing loss results in changes in the neural activity of the auditory system, which the auditory cortex interprets as sound

  • Hearing loss, in cases of noise-induced hearing loss (NIHL)
  • External or middle ear issues (wax, osteoma, ear drum perforation, otosclerosis, fluid behind ear drum)
  • Internal ear (Meniere’s disease, Damage of hair cells in inner ear)
  • Acoustic neuroma (UNILATERAL tinnitus)
  • Medications
  • Sinus/allergy issues
  • Dental issues (TMJ-temporal-mandibular joint syndrome)
  • Neurological (Multiple sclerosis)
  • Stress & anxiety
  • Cardiovascular


Reaction to Tinnitus aggravate it:

  • Only about 20% of people with tinnitus are bothered by it
  • The tinnitus itself isn’t the problem.  The person’s REACTION to it is what is problematic.
  • Tinnitus may result in irritability, fatigue/sleep disturbance, depression, suicidal thoughts
  • These patient’s need to be referred to a mental health professional





  1. Hearing Aids for SNHL induced tinnitus
  2. Surgery for causes like:
  • Perforation in ear drum
  • Osteoma (External ear tumor)
  • Fluid behind ear drum
  • Otosclerosis
  • Acoustic Neuroma
  1.  Medication for causes like:

o   Meniere’s disease

  • Sinusitis
  • Cardiovascular diseases
  • Stress & Anxiety
  1.  Masking:
  • Use of noise to temporarily mask or “cover up” the tinnitus so it cannot be perceived
  • This is often successfully accomplished when patients with hearing loss use traditional hearing aids. The amplification of environmental noises often reduces or completely masks tinnitus.
  • New generation hearing aids have optional tinnitus maskers built-in for when hearing aids aren’t enough to mask tinnitus
  • Different types of noise are utilized in masking: white  noise, pink noise, brown noise, grey noise (all have  varying complexity based on frequency components)
  • Maskers with or without hearing aid are available and customised for every patient according to hearing test and tinnitus mapping.


  1. Tinnitus Retraining Therapy
  • Jastreboff created TRT
  • Combines counselling with use of noise generators
  • Counselling: reclassify tinnitus to a  category of neutral signals
  • Sound therapy: weaken the tinnitus-related neural activity
  • Goal: Habituation to the tinnitus (no longer pay attention  to it)
  1.  Neuromonics
  • Six to eight months therapy protocol
  • Uses spectrally modified music that has been tailored  according to each patient’s hearing and tinnitus  characteristics
  • Combined with an underlying neural stimulus
  • Retrains the brain to filter out  tinnitus disturbance


  1. Recent Advances
  • Acoustic coordinated reset neuromodulation
  • Magnetic and Electrical brain stimulation


Take home Message:

Don’t deal with tinnitus by sitting at home. Kindly go and visit your doctor for finding the cause behind your tinnitus. Tinnitus is a symptom not a disease. We need to find the cause behind tinnitus to treat it. 

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