Why Are My Ears Ringing?
Understanding the Facts
Do you (or a loved one) experience ringing, buzzing, whooshing, or other sound/s in your ear/s or head that no one else can hear? If so, you are not alone. You have tinnitus, an audiological and neurological condition experienced by more than 25 million American adults.
Tinnitus is the perception of sound when no actual external noise is present. While it is commonly referred to as “ringing in the ears,” tinnitus can manifest many different perceptions of sound, including buzzing, hissing, whistling, swooshing, and clicking. In some rare cases, tinnitus patients report hearing music. Tinnitus can be both an acute (temporary) condition or a chronic (ongoing) health condition.
Millions of Americans experience tinnitus, making it one of the most common health conditions in the country. The National Institute on Deafness and Other Communication Disorders (NIDCD) estimates that approximately 10 percent of the U.S. adult population — over 25 million Americans — experience some form of tinnitus.1 Roughly 5 million people struggle with burdensome chronic tinnitus, while 2 million find it debilitating.
There are two types of tinnitus:
Subjective Tinnitus: Head or ear noises that are perceivable only to the specific patient. Subjective tinnitus is usually traceable to auditory and neurological reactions to hearing loss but can also be caused by an array of other catalysts. More than 99% of all reported tinnitus cases are of the subjective variety.
Objective Tinnitus: Head or ear noises that are audible to other people, as well as the patient. These sounds are usually produced by internal functions in the body’s circulatory (blood flow) and somatic (musculoskeletal movement) systems. Objective tinnitus is very rare, representing less than 1% of total tinnitus cases.
Tinnitus is a symptom associated with an array of other health conditions.
Tinnitus is not a disease, but rather a symptom of some other underlying health condition. In most cases, tinnitus is a sensorineural reaction in the brain to damage in the auditory system. While tinnitus is often associated with hearing loss, there are roughly 200 different health disorders that can generate tinnitus as a symptom. Below is a list of some of the most commonly reported catalysts for tinnitus.
Note: Tinnitus, by itself, does not necessarily indicate any one of the items listed below. Patients experiencing tinnitus should see their physician or a hearing health professional for a full examination to diagnose the underlying cause of symptoms. In some cases, resolving the root cause will alleviate the perception of tinnitus.
Sensorineural hearing loss is commonly accompanied by tinnitus. Some researchers believe that subjective tinnitus cannot exist without some prior damage to the auditory system. The underlying hearing loss can be the result of:
- Age-related hearing loss (presbycusis) - Hearing often deteriorates as people get older, typically starting around the age of 60. This form of hearing loss tends to be bilateral (in both ears) and involves the sensory loss of high-frequency sounds. Age-related hearing loss explains, in part, why tinnitus is so prevalent among elderly people.
- Noise-induced hearing loss - Exposure to loud noise, either a single traumatic experience or over time, can damage the auditory system and result in hearing loss and sometimes tinnitus as well. Traumatic noise exposure can happen at work (e.g. loud machinery), at play (e.g. loud sporting events, concerts, other recreational activities), and/or by accident (e.g. a backfiring engine.) Noise-induced hearing loss is sometimes unilateral (one ear only) and typically causes patients to lose hearing around the frequency of the triggering sound trauma.
It is important to note that existing hearing loss is sometimes not directly observable by the patient, who may not perceive the inability to hear lost frequencies. But that does not mean that hearing damage has not occurred. An audiologist or other hearing health professional can perform audiometric tests to precisely measure the true extent of hearing loss.
The exact biological process by which hearing loss is associated with tinnitus is still being investigated by researchers. However, we do know that the loss of certain sound frequencies leads to specific changes in how the brain processes sound. In short, as the brain receives less external stimuli around a specific frequency, it begins to adapt and change. Tinnitus may be the brain’s way of filling in the missing sound frequencies it no longer receives from the auditory system.
Obstructions in the Middle Ear
Blockages in the ear canal can cause pressure to build up in the inner ear, affecting the operation of the eardrum. Moreover, objects directly touching the eardrum can irritate the organ and cause the perception of tinnitus symptoms. Common obstructions include:
- Excessive earwax (ceruminosis)
- Head congestion
- Loose hair from the ear canal
- Dirt or foreign objects
In many cases, the removal of the blockage will alleviate tinnitus symptoms. However, in some situations, the blockage may have caused permanent damage that leads to chronic tinnitus.
Head and Neck Trauma
Injury to the head or neck can cause nerve, blood flow, and muscle issues that result in the perception of tinnitus. Patients who ascribe their condition to head and neck trauma often report higher tinnitus volume and perceived burden, as well as greater variability in sound/s, frequency, and location of their tinnitus.
Tinnitus related to head, neck, or dental issues is sometimes referred to as somatic tinnitus. (“Somatic” derives from the Greek somatikos, meaning “of the body.”)
Temporomandibular Joint Disorder
Another example of somatic tinnitus is that caused by temporomandibular joint disorder. The temporomandibular joint (TMJ) is where the lower jaw connects to the skull, which is located in front of the ears. Damage to the muscles, ligaments, or cartilage in the TMJ can lead to tinnitus symptoms. The TMJ is adjacent to the auditory system and shares some ligaments and nerve connections with structures in the middle ear.
Tinnitus patients with a TMJ disorder may experience pain in the face and/or jaw, limited ability to move the jaw, and regular popping sounds while chewing or talking. A dentist, craniofacial surgeon, or other oral health professional can appropriately diagnose and often fix TMJ issues. In many scenarios, fixing the TMJ disorder will alleviate/reduce tinnitus symptoms.
Sinus Pressure and Barometric Trauma
Nasal congestion from a severe cold, flu, or sinus infection can create abnormal pressure in the middle ear, impacting normal hearing and causing tinnitus symptoms.
Acute barotrauma, caused by extreme or rapid changes in air or water pressure, can also damage the middle and inner ear. Potential sources of barotrauma include:
- Diving / Snorkeling / Scuba Diving
- Flying (only during extreme, abnormal elevation changes; normal commercial air travel is generally safe)
- Concussive explosive blasts
Traumatic Brain Injury (TBI)
Traumatic brain injury, caused by concussive shock, can damage the brain’s auditory processing areas and generate tinnitus symptoms. TBI is one of the major catalysts for tinnitus in military and veteran populations. Nearly 60% of tinnitus cases diagnosed by the U.S. Department of Veterans Affairs are attributable to mild-to-severe traumatic brain injuries.
Tinnitus is a potential side effect of many prescription medications. However, in most cases and for most drugs, tinnitus is an acute, short-lived side effect, meaning if the patient stops taking the medication, the tinnitus symptoms typically subside. However, there are some ototoxic drugs that cause permanent tinnitus symptoms. These include:
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
- Certain antibiotics
- Certain cancer medications
- Water pills and diuretics
- Quinine-based medications
If you are worried about tinnitus as a side effect of your medications, please consult your prescribing physician or pharmacist. You should never stop taking a medication without first consulting your healthcare provider. The risk of stopping a medication may far exceed any potential benefit in the reduction of the tinnitus sound.
Other Diseases & Medical Conditions
Tinnitus is a reported symptom of the following medical conditions:
- Metabolic Disorders: Hypothyroidism, Hyperthyroidism, Anemia
- Autoimmune Disorders: Lyme Disease, Fibromyalgia
- Blood Vessel Disorders: High Blood Pressure, Atherosclerosis
- Psychiatric Disorders: Depression, Anxiety, Stress
- Vestibular Disorders: Ménière's Disease,Thoracic Outlet Syndrome, Otosclerosis
- Tumor-Related Disorders (very rare): Acoustic Neuroma, Vestibular Schwannoma, other tumorous growths
Again, a person experiencing tinnitus should not assume that he/she has one of the medical conditions listed above. Only a trained healthcare provider can appropriately diagnose the underlying cause of tinnitus.
There is currently no scientifically validated cure for most types of tinnitus. If clinicians can find an underlying cause, such as high blood pressure or temporomandibular joint dysfunction, they may be able to treat that problem – which, in turn, may reduce or eliminate the tinnitus. There are, however, treatment options that can ease the perceived burden of tinnitus, allowing patients to live more comfortable, productive lives. The ATA is leading the charge in the ongoing search for definitive cures for tinnitus and better treatments.
The word “tinnitus” is of Latin origin, meaning "to ring or tinkle." Tinnitus has two different pronunciations, both of which are correct and interchangeable:
- ti-NIGHT-us :: typically used by patients and laypeople
- TINN-a-tus :: typically used by clinicians and researchers
How Sound Works
It is important to understand how sound works. Here we share with you a video from the National Institute on Deafness and Other Communication Disorders (NIDCD) that demonstrates how sound makes its journey from an external source, traveling through the ear to the brain, where it is perceived and understood.
Note: Please make sure your volume on your computer is turned down to a comfortable volume before playing.
- NIDCD data on tinnitus prevalence was obtained from (1) the 2008 National Health Interview Survey (NHIS); (2) the estimated number of American adults reporting tinnitus was calculated by multiplying the prevalence of tinnitus by the 2013 U.S. Census population estimate for the number of adults (18 years and older).
Tinnitus Healthcare Providers
If you, or someone you know, have tinnitus that is causing a problem, you can seek help from a variety of healthcare providers, including, but not limited to, audiologists, otolaryngologists, psychologists, licensed clinical social workers, dentists, and physical therapists.
Below is a description of providers, their training, and possible ways they might be to help. Providers listed below are required to be licensed by the state in which they practice. Licensure can be verified by checking the licensing board in your state.
It is important to note that individual providers may not specialize in the evaluation and management of tinnitus. Also, tinnitus treatment is not within the scope of practice of hearing-aid dispensers in every state.
Audiologist: A hearing healthcare professional trained to identify, diagnose, and manage or treat disorders of the auditory (e.g., hearing loss and tinnitus) and vestibular systems (e.g., dizziness). As part of a treatment program, audiologists may recommend hearing aids to make day-to-day listening easier, improve awareness, and help with tinnitus. Some audiologists may also have additional training in the specialized evaluation and management of tinnitus and provide services such as Tinnitus Retraining Therapy, Tinnitus Activities Treatment, Progressive Tinnitus Management, etc. (https://ata.org/about-tinnitus/therapy-and-treatment-options/).
Audiologists hold either a master’s (M.A. or M.S.) or doctorate (Au.D. or Ph.D.) degree in audiology. Audiologists work predominantly in private practices, otolaryngology (ENT) practices, academic medical centers, and hospitals.
Dentist: A medical doctor trained to diagnose, treat and prevent oral diseases, promote oral health, and create treatment plans to maintain or restore the oral health of their patients. Dentists also diagnose temporomandibular joint disorders. If you are suffering from frequent headaches, jaw aches, and/or aching facial pain, it could stem from a temporomandibular joint disorder, also known as TMJ or TMD. Associations between tinnitus and TMJ/TMD have been reported, so if there are symptoms of TMJ or TMD and treatment is pursued, there may be some relief from tinnitus. Dentists hold either a Doctor of Dental Surgery (DDS) or Doctor of Dental Medicine (DDM).
Hearing aid dispenser: A person licensed by the state to measure hearing and fit and sell hearing aids. Hearing aids have been shown to mitigate the intrusiveness of tinnitus. A hearing aid dispenser does not have a college degree related to audiology but may have a college degree in an unrelated field of study. Hearing aid dispensers may be certified (Board Certified Hearing Instrument Specialist, BC-HIS). Hearing aid dispensers work in private offices and big box stores.
Licensed clinical social worker (LCSW): A professional trained to provide mental health services for the prevention, diagnosis, and treatment of mental, behavioral, and emotional disorders. The professional’s goal is to enhance and maintain physical, psychological and social function. Some LCSWs are trained to provide cognitive behavioral therapy, which is a treatment option recommended by the American Academy of Otolaryngology – Head and Neck Surgery’s Clinical Practice Guideline: Tinnitus. LCSWs hold a master’s degree in social work. LCSWs work in private practices, community health centers, and hospitals.
Neurologist: A medical doctor who specializes in the evaluation and treatment of disorders that affect the brain, spinal cord, and nerves. If you have headaches associated with your tinnitus or sensitivity to sound, you may benefit from a consultation with a neurologist. Neurologists work in private practices, academic medical centers, and hospitals.
Neurotologist: A medical doctor who has trained in the field of otolaryngology-head and neck surgery and evaluates and manages neurological disorders of the ear. See otolaryngologist.
Otolaryngologist (ENT): A medical doctor who specializes in the evaluation and treatment of disorders of the ear, nose and throat and related structures of the head and neck. An otolaryngologist can rule out physical causes of tinnitus, such as excessive ear wax, problems with the middle ear (e.g., fluid, stiffened bones), or benign tumors on the auditory nerve. Otolaryngologists work in private practices, academic medical centers, community health centers, and hospitals.
Physical therapist (PT): A healthcare professional trained to diagnose and treat individuals who have medical problems or other health-related conditions that limit their abilities to move and perform functional daily activities. PTs evaluate a patient to develop a treatment plan that promotes improved movement and function, reduction in pain, and prevention of disability. If you notice changes in your tinnitus associated with head and/or neck movement, or have been experiencing pain in your head or neck, your tinnitus might be connected and a physical therapist might be able to provide relief. PTs hold a masters (MPT, MSPT) or doctorate (DPT) in physical therapy. Physical therapists work in hospitals, private practices, outpatient clinics, home health agencies, schools, sports and fitness facilities, work settings, and nursing homes. See http://www.apta.org/AboutPTs/.
Psychiatrist: A medical doctor (M.D. or D.O.) trained to evaluate, diagnose and treat people who are affected by temporary or chronic mental health issues. Psychiatrists are qualified to assess both the mental and physical aspects of psychological problems and can prescribe medication. If you have symptoms of depression and/or anxiety, a psychiatrist can diagnose and treat these conditions, which may result in mitigation of your tinnitus. See https://www.psychiatry.org/patients-families/what-is-psychiatry.
Psychologist: A healthcare professional trained to help people cope more effectively with challenges in life and mental health issues. Psychologists are usually trained in cognitive behavioral therapy, mindful meditation, and acceptance and commitment therapy, which are methods that can be helpful for reducing the impact of tinnitus on sleep, concentration, and mood. Psychologists hold either a master’s (M.A. or M.S.) or doctorate (Psy.D., Ph.D. or Ed.D). Psychologists work in private practices, community health centers, hospitals, and schools. See http://www.apa.org/helpcenter/about-psychologists.aspx.
The ATA has an online directory of hearing health professionals, who have self-identified as tinnitus specialists. Such professionals should be knowledgeable of tinnitus treatment and management options.
If you’ve suddenly developed tinnitus, or your tinnitus has become more intrusive, you should:
Tinnitus can be very frightening, especially if it develops rapidly, without warning, or without a clear triggering event. Nonetheless, it is important to stay calm and not panic, because tinnitus is very rarely indicative of an underlying emergency or life-threatening medical condition. In some cases, tinnitus goes away after a few days or weeks.
Note: If your tinnitus symptoms were triggered by a traumatic physical event (head/neck damage, concussive trauma, etc.), you should immediately seek medical care.
Visit your primary care provider (PCP) and audiologist
If your tinnitus continues beyond a week, becomes bothersome, starts to interfere with your sleep and/or your concentration, or makes you depressed or anxious, seek help from a trained healthcare professional. Your PCP should be able to diagnose/rule out certain causes of tinnitus, such as obstructions in the ear canal or temporomandibular joint dysfunction (TMJ), and provide a referral to an appropriate specialist. If no underlying medical issues are found, see an audiologist for a hearing assessment and evaluation of tinnitus treatment options. Note: Not all audiologists are trained in tinnitus management.
It is also important that tinnitus patients educate themselves about tinnitus and its management so they can be their own advocates in the healthcare process. (In some cases, the patient may have to educate the provider about tinnitus distress and treatment options.) The ATA encourages patients to independently research their condition, drawing on credible sources, in preparation for appointments. Relevant questions might include:
- Do you follow best practice guidelines for tinnitus management, as developed by the American Academy of Otolaryngology?
- What tests do you require or suggest? What are the tests designed to reveal?
- What is your diagnosis?
- Have you ruled out possible physical causes of tinnitus, including TMJ, head/neck trauma, obstruction in the ear canal, or tumors?
- Are you familiar with the full range of tinnitus management options currently available?
- What tinnitus management option is best for my situation? Do you offer this service?
- What tinnitus treatments do you use in your practice?
- What is your treatment plan for me? Can you provide this service or will you refer me to another provider?
- How much will treatment cost? How many visits do you think I’ll need? Will my treatment be covered by insurance?
- Do you have additional information for me to review?
- Are you a professional member of the American Tinnitus Association?
If you have additional questions or concerns, you should not hesitate to ask your doctor for more information. Communicating your feelings and concerns is the best way to get the information and assurance you need to move forward in your treatment. Also, remember to write down your doctor’s responses so you can review this information later.
Do not accept “no options” diagnoses
It is unfortunate that many patients are told incorrectly by doctors that there is nothing that can be done for tinnitus. While it is true that there are no cures for subjective tinnitus, there are proven tools that can significantly lower the burden of tinnitus and improve a patient’s overall quality of life.
If you are told that you have no options for managing your tinnitus, or that you have to “learn to live with it,” then you should immediately seek a second opinion from a hearing health professional with training in tinnitus management.
Consider seeing a behavioral health therapist
Tinnitus symptoms often trigger feelings of despair and anxiety in patients. Current estimates suggest that 48-78% of patients with severe tinnitus also experience depression, anxiety, or some other behavioral disorder. A behavioral health therapist can help a tinnitus patient cope more effectively with the negative emotions associated with tinnitus. There are several behavioral and educational treatment programs specifically for tinnitus management. Therapy that addresses anxiety and depression may also be beneficial.
Take action and stick to it
Once you and your healthcare provider have agreed on the best management option for your specific situation, you should fully embrace that treatment and take action to realize its full benefits.
It is important to note that patients may not see an immediate improvement upon starting a management program. Many of the best tinnitus management therapies (cognitive behavioral therapy and tinnitus retraining therapy, for instance) require ongoing, active patient participation, over the course of 3-12 months. These programs generate the best outcomes when patients remain optimistic, engaged, and see the treatment through to completion.
Take care of yourself
In addition to active tinnitus management therapies, patients can improve their condition through general wellness and relaxation practices:
- Don’t be self-critical. Patients shouldn’t feel guilty about their condition and how it makes them feel — you didn’t do anything to deserve this.
- Find ways to increase relaxation. Patients often report that their tinnitus is less pronounced when they are relaxed. Engage in activities and behaviors that help you relax: exercise, yoga, meditation, gardening, soothing music, anything that helps you be calm and content.
- Get a good night’s sleep. Sleeping can be a challenge when you have tinnitus, but a restful night’s sleep can improve your overall health and may reduce the perceived intensity of tinnitus during waking hours. Many patients use sound machines, headbands or pillows with speakers that generate soothing sounds, radio static, or a fan to mask their tinnitus and help them sleep. You should also monitor consumption of caffeine, alcohol, cigarettes, as well as medication that can impact your ability to sleep.
Find a support network
You should not feel alone in your struggles with tinnitus. Patients who successfully manage their tinnitus often have strong support networks to help them during challenging periods. Spouses, partners, family, friends, colleagues, and peers can all play a positive support role for tinnitus patients. A strong support group can improve emotional wellness, general feelings of contentment, and optimism; it can also reduce feelings of social isolation and depression.
It can be helpful to speak with other people who have tinnitus — people going through the same struggles, participating in the same treatments, utilizing similar management options as you. The ATA can direct you to local tinnitus support groups where you can meet with and learn from fellow patients, in a caring, welcoming, and safe environment. The ATA can also direct you to our network of telephone support volunteers who are willing to share their experiences with tinnitus via one-on-one phone calls or email correspondence
Supporting tinnitus research
The process outlined above provides a general framework for making the most of tinnitus management tools, which can lessen the burden of tinnitus and help patients live fuller, happier and more peaceful lives. These services can (and do) help people feel better. But “managing” tinnitus is not the same as “curing” tinnitus. Finding definitive cures for tinnitus is an ongoing objective for the ATA. To achieve this goal, we need more research, including investigations that advance our understanding of the underlying mechanisms of tinnitus and explore innovative medical solutions to treat and/or cure the condition.
The ATA is one of the only national and international nonprofit organizations that invests in cutting-edge tinnitus research aimed at finding cures and better treatments. Each year, we provide seed grants to researchers with innovative projects that help us better understand, treat, and (eventually, we hope) cure tinnitus. These grants are entirely funded by our members and donors — most of whom are tinnitus patients just like you. To show your support for this noble and important work, please consider becoming an ATA member or making a contribution to our organization.
Tinnitus can be associated with a range of comorbid (existence of two or more) health conditions, including vestibular disorders, audiological problems, and behavioral health issues.
It can be a symptom of a wide range of health issues. It is also a condition that often exists comorbidly with other health maladies.
Below is a list of the health issues most frequently associated with tinnitus, and most often reported as comorbid conditions by tinnitus patients.
The causal relationship between tinnitus and each comorbid condition is variable and complex. In some cases, the comorbid condition is itself the primary cause of tinnitus. This is certainly true with hearing loss and Ménière's disease, in which tinnitus is one of several symptoms caused by the primary disorder. In some situations, tinnitus may exacerbate the comorbid condition, as is the case with hyperacusis. And, in other instances, tinnitus and the comorbid condition have shared causality. This appears to be the case with behavioral health issues, which can be the product of burdensome tinnitus, but also a cause of it.
The following health conditions are commonly associated with tinnitus:
Hearing loss is the primary catalyst for tinnitus symptoms; it is common for patients to experience both conditions simultaneously. The prevalence of comorbid hearing loss and tinnitus fluctuate. Recent research suggests that approximately 90% of tinnitus patients have some degree of hearing loss. Many researchers and clinicians believe that subjective tinnitus cannot exist without some prior loss of hearing — even if such hearing loss is not discernable by the patient.
Sometimes called endolymphatic hydrops, Ménière's disease is a vestibular disorder in the inner ear that can affect hearing and balance. Patients with Ménière's often experience bouts of mild-to-severe vertigo, along with sporadic tinnitus. It is estimated that approximately .02% of the U.S. population (615,000 individuals) has Ménière's.1 About 3% of ATA’s membership reported being diagnosed with the condition.
Hyperacusis is an abnormal, extreme sensitivity to noise, including ordinary environmental sounds presented at a normal volume. Patients with hyperacusis experience physical pain (as opposed to emotional annoyance) when exposed to sound. Estimates for the prevalence of hyperacusis range from 7.7-15% of the population. Approximately 12% of ATA’s members report having hyperacusis.
Also known as selective sound sensitivity, misophonia is an abnormal negative emotional reaction to specific sounds (usually made by other people), such as chewing, sniffling, and clearing one’s throat. Patients with misophonia experience a fight-or-flight response to such sounds, which can trigger anger, disgust, or desire to escape. They may have similar reactions to particular visual stimuli. The prevalence of misophonia in the general population is unknown, but it is estimated that 4-5% of tinnitus patients experience some form of the condition. Less than 1% of ATA’s members self-identified as having misophonia.
Phonophobia is a fearful emotional reaction specific to loud sounds. The prevalence of phonophobia, both within the general population and the tinnitus population, is unknown.
Depression and Anxiety
Mental health issues can be both a contributing factor to burdensome tinnitus and a consequence of burdensome tinnitus. Tinnitus symptoms can generate feelings of despair and anxiety in many patients. Current estimates suggest that 48-78% of patients with severe tinnitus also experience depression, anxiety, or some other behavioral disorder. Approximately 13% of ATA’s membership self-identified as being diagnosed with a mental health issue. At the same time, pre-existing behavioral conditions may make it more likely that the patient will experience tinnitus as a burdensome condition. For example, one large population study posits that people with generalized anxiety disorder are nearly 7 times more likely to experience chronic tinnitus that is burdensome.
Other Vestibular Conditions
The vestibular system, which manages balance and spatial orientation, is closely connected with the auditory system, which controls hearing functions. Several structures in the inner ear play key roles in both sensory systems. As such, damage to one system (as evidenced by tinnitus) is often mirrored by a correlated vestibular condition.
Tinnitus is generally a subjective condition, but there are clinical ways to measure its audiometric qualities and impact on the patient.
The first step in treating tinnitus is appropriately diagnosing and measuring tinnitus. Below are some of the tests hearing health professionals can perform to evaluate tinnitus.
Audiometric Evaluations for Hearing Loss and Tinnitus
Trained audiologists and other hearing health professionals have tools and clinical protocols to help evaluate and diagnose tinnitus. Because tinnitus is so often caused by hearing loss, most audiologists will begin with a comprehensive audiological evaluation that measures the patient’s overall hearing health. General hearing tests include:
- Speech recognition test: A subjective measure of how well the patient hears and can repeat certain words. Sometimes called speech audiometry.
- Pure tone audiogram: A subjective test that measures the patient’s hearing across multiple frequencies (measured in Hertz) and volumes (measured in decibels).
- Tympanogram: An objective test that measures the functioning of the middle ear, specifically the mobility of the tympanic membrane and the conduction bones.
- Acoustic reflex testing: An objective test that measures the contraction of the middle ear muscles in response to loud sounds.
- Otoacoustic emission testing: The use of very sensitive microphones to objectively measure the movement of hair cells within the inner ear.
It is important to determine the specific gaps in a tinnitus patient’s hearing, because this often correlates to the nature and quality of their particular tinnitus. (For instance, high-frequency hearing loss often corresponds with high-frequency tinnitus.) Moreover, specific hearing markers may inform different potential treatment options for tinnitus.
When evaluating tinnitus cases, hearing health professionals use a supplemental set of tests. While there is currently no way to objectively test for tinnitus, there are several protocols to measure the patient’s subjective perception of tinnitus sound, pitch, and volume. Specifically, the doctor may test:
- Tinnitus sound matching: The presentation of common tinnitus sounds back to patients, to help them identify their specific perception of tinnitus. The health professional may adjust the pitch and layer multiple sounds to create an exact audio recreation of the the tinnitus. Sound matching provides an important baseline for subsequent tinnitus management therapies, which are often customized for each patient.
- Minimum masking level: The volume at which an external narrowband noise masks (or covers) the perception of tinnitus. Determining the minimum masking level provides an approximate measure of how loud a patient perceives his/her tinnitus and can be used in subsequent tinnitus masking and sound therapies.
- Loudness discomfort level: The volume at which external sound becomes uncomfortable or painful for a tinnitus patient. This measurement informs the feasibility of sound therapy, masking, and hearing aids as potential tinnitus treatments. Determining loudness discomfort levels is particularly important for patients an extreme sensitivity to noise.
A hearing health professional may administer additional tests, depending on the patient’s specific symptoms, medical history, and/or attenuating risk factors. In some extreme situations, an MRI (magnetic resonance imaging) may be appropriate for someone experiencing tinnitus; however, MRIs should only be administered in cases when independent clinical evaluation suggests specific (and rare) tinnitus etiologies.
Tests To Measure Tinnitus Burden
Tinnitus doesn’t just impact hearing; it can cause a cascade of negative mental, cognitive, and physical consequences. The difference between tinnitus being a minor or major issue of the patients' is less often related to how loud tinnitus is, but rather how the tinnitus impacts other facets of patients' lives.
As such, clinicians and researchers have developed inventory tests to measure the subjective burden a patient experiences because of tinnitus. There are several varieties of these tests, but they all operate by quantifying the patient’s personal reaction to tinnitus:
You can download copies of the documents below which are hyperlinked if a copy of the questionnaire is available. Please note: this form is provided for general informational purposes only and should not be used for self-diagnosis or self-treatment. ATA recommends that you share your completed form with your hearing health professional prior to taking any action.
- Tinnitus Handicap Inventory
The Tinnitus Handicap Inventory was developed as a brief, easily administered way to evaluate the disabling consequences of tinnitus. It has potential for use in an initial evaluation of handicap or later as well as a way to measure treatment outcome.
- Tinnitus Reaction Questionnaire
The TRQ is a scale designed to assess the psychological distress associated with tinnitus.
- Tinnitus Functional Index
The TFI has eight subscales that address the intrusiveness of tinnitus, the sense of control the patient has, cognitive interference, sleep disturbance, auditory issues, relaxation issues, quality of life, and emotional distress.
- Tinnitus Severity Index
- Tinnitus Primary Functions Questionnaire
The Tinnitus Primary Functions Questionnaire was developed both for clinical trials and for use in the clinic. There is a 12 and a 20 item version. It focuses on the four main areas that can be affected by tinnitus, 1) Thoughts and Emotions, 2) Hearing, 3) Sleep and 4) concentration. It has been translated into several languages and is used worldwide.
- Tinnitus Handicap Questionnaire
The Tinnitus Handicap Questionnaire was one of the first developed for clinical trials. It has been translated into several languages and is used worldwide.
- Visual Analog Scales