Understanding Tinnitus


Basic Tinnitus Facts

Tinnitus is defined as a phantom sound in the ear(s), varying in intensity, loudness, and pitch in the absence of an external sound.  It is more commonly known as “ringing in the ears”.  People often describe the sound as a steady high pitched tone, cicadas, crickets, running water, hissing, roaring, whistling, chirping, or clicking.  The intensity of tinnitus can range from only being heard in quiet to being heard over external sounds.  It varies with each person.

Incidence Rate

Tinnitus affects approximately 10-15% of the overall population.  The incidence increases with age, with about one in five people between 55-65 years of age reporting some symptoms of tinnitus.

Etiology & Pathology

Tinnitus itself is not a disease.  It is a symptom of a variety of conditions related to the ear(s), such as hearing loss, impacted wax, TMJ, head or neck injury, otitis media, hypertension, rheumatoid arthritis, anxiety, depression, etc.

The Cause of Tinnitus

The current theory suggests that tinnitus is generated in the brain, triggered by a lack of auditory input from the cochlea to the brain.  This lack of auditory input alters the neural activity in the central auditory system which is perceived by the patient as tinnitus.

Tinnitus and Hearing Loss

80% of tinnitus patients also have hearing loss and 20% of tinnitus patients are without a hearing loss.  While the link between hearing loss and tinnitus is strong, there is little correlation between the degree of hearing loss and the severity of the patient’s tinnitus. Tinnitus is typically subjectively measured to be approximately 10dB above the patients hearing threshold.  The variable factor, however, is the degree to which a patient reacts to their tinnitus and how it affects their daily life.

Some Tinnitus Triggers

  • small number of medications
  • aspirin in large doses
  • amino glycoside antibiotics
  • diuretics in large doses
  • caffeine
  • alcohol
  • nicotine
  • salt intake
  • stress
  • traumatic events
  • anxiety
  • depression


Tinnitus Questionnaire

The Tinnitus Handicap Inventory is an assessment we use with patients to better show how each patient experiences and perceives their tinnitus, i.e. how often do they hear it, when and where they perceive it, how much it bothers them on a daily basis, etc.  Some of the benefits of a tinnitus questionnaire is it acknowledges the “realness” of the patients issue, it sets a baseline for future improvements or fluctuations, and most importantly, allows us to score each patients tinnitus and provide recommendations based upon their results. In a very small number of cases, it gives light to those who need to be referred for professional counseling.

Audiologic Assessment

An audiologic assessment of each patient’s tinnitus can be provided in conjunction with their hearing evaluation.  A tinnitus pitch and loudness match can be conducted, followed up with education, counseling, and sound enrichment options, such as a hearing aid(s) with a balance noise generator. The balance noise generator is matched to the patient’s tinnitus via software when the hearing aid(s) is fitted. The noise generated is typically a pink or white noise either programmed into the hearing aids automatic (start up) program or a separate program the patient can select themselves.  A tinnitus management plan booklet is also dispensed to allow the patient to report how they are managing with their tinnitus hearing aid(s) at follow-up visits.