What is tinnitus — and why can something no one else can hear feel so real?
What is tinnitus — and why can something no one else can hear feel so real?
Tinnitus is the perception of sound when there is no corresponding external sound source. It may be heard as ringing, buzzing, humming, hissing, clicking or another sound entirely.
For some people it is barely noticeable. For others, it can affect sleep, concentration, hearing, sound tolerance and everyday life.
Understanding what tinnitus is — and why your brain keeps noticing it — is an important first step.
Tinnitus is a real auditory perception.
The absence of an external sound does not make tinnitus imaginary. The experience involves activity within the auditory system and the way the brain processes and responds to sound.
Tinnitus is not one single disease with one single cause.
Although tinnitus is perceived as sound, there is no external sound producing it.
Changes anywhere along the auditory pathway — from the ear through to the brain's processing of sound — can alter neural activity and contribute to tinnitus perception.
Hearing tinnitus and being distressed by tinnitus are not necessarily the same thing.
The auditory system
Changes in hearing or auditory input can influence the way sound is processed and may contribute to tinnitus perception.
The brain
The brain continuously detects, interprets and assigns importance to sensory information — including tinnitus.
Your individual response
Attention, sleep, stress, sound tolerance and the meaning attached to tinnitus can influence how noticeable or intrusive it becomes.
There isn't one single cause of tinnitus.
Tinnitus can occur alongside many different changes or conditions, and sometimes there is no obvious single event that explains why it began.
Hearing changes
Age-related hearing changes, noise exposure or other changes within the auditory system may be associated with tinnitus.
Ear & medical factors
Ear conditions, illness, medication-related factors and other medical changes may sometimes be relevant.
Noise exposure
Tinnitus may begin or temporarily increase following significant sound or noise exposure.
Jaw & neck factors
For some people, tinnitus can be influenced or changed by jaw movement, neck movement, muscle tension or other musculoskeletal factors.
For some people, movement or tension involving the jaw, neck or surrounding structures can change the tinnitus they hear.
This is one reason an individual tinnitus assessment matters. The aim isn't simply to confirm that you have tinnitus — it is to understand your particular presentation and what may be contributing to, exacerbating or maintaining it.
What happens during an assessment →Your brain is very good at noticing things it believes are important.
When tinnitus is new, unexpected or concerning, attention can be drawn towards it. That attention can make the signal easier to detect.
A signal is detected
Tinnitus is present within the auditory system and becomes consciously noticeable.
Attention is drawn to it
This is particularly common when tinnitus is new, unfamiliar or interpreted as potentially important.
The brain monitors it
Questions such as “Is it still there?” or “Has it changed?” can keep attention focused on the signal.
It becomes easier to detect
The more efficiently the brain monitors a signal, the easier that signal may become to notice.
This doesn't mean tinnitus is imaginary or “all in your head”. It means the brain is doing what brains are designed to do — pay attention to information it considers important.
Your brain already filters enormous amounts of information.
How can someone have tinnitus and barely notice it?
Most of us are surrounded by sensory information that reaches the nervous system without repeatedly entering conscious awareness.
The brain has not stopped receiving those signals. It has simply learned that they are not important enough to require ongoing attention.
A similar process can occur with tinnitus.
Habituation does not necessarily mean tinnitus disappears. You may still be able to hear it when you deliberately listen for it, but it no longer repeatedly interrupts what you are doing, triggers the same response or occupies the same amount of attention.
Tinnitus isn't always constant.
Many people notice that tinnitus changes from day to day or becomes more noticeable in particular situations.
Poor sleep
Tinnitus may feel more intrusive when you are tired or sleep deprived.
Stress
Increased arousal and attention can make tinnitus easier to notice.
Quiet environments
Greater contrast between tinnitus and the surrounding environment can make tinnitus more apparent.
Sound exposure
Some people experience temporary tinnitus changes following significant sound exposure.
Attention
Repeatedly checking tinnitus can make it easier for the brain to detect.
Jaw & neck
Some tinnitus can change with movement, muscle tension or other musculoskeletal factors.
A temporary increase in tinnitus does not automatically mean something has been permanently damaged.
Most tinnitus is not an emergency — but some presentations warrant further investigation.
Speak with your GP, audiologist or ENT if tinnitus is new or unexplained, particularly when it is strongly one-sided, pulses in time with your heartbeat, occurs with a sudden change in hearing, or is accompanied by other concerning ear or neurological symptoms.
Sudden hearing loss should be assessed urgently.
Not everyone with tinnitus needs treatment.
What happens next should depend on how tinnitus is affecting you and what your assessment identifies.
We assess first and treat second.
Six things to know about tinnitus
Tinnitus is real, even though there is no external sound producing it.
Tinnitus is a symptom with many possible contributing factors — not one single disease.
Hearing tinnitus does not automatically mean something dangerous is happening.
How noticeable tinnitus feels can change with attention, sleep, stress, sound environment and other factors.
The brain can learn to give tinnitus much less attention. This process is known as habituation.
If tinnitus remains intrusive, there are evidence-based ways to assess and manage it.
Being told “there’s nothing you can do for tinnitus” does not necessarily mean that no management options are available.
It may mean that the clinician or service you have seen does not provide specialist tinnitus assessment and management.
Understanding your tinnitus starts with understanding your individual presentation.
A comprehensive tinnitus assessment looks beyond the sound itself — considering your hearing, sound tolerance, symptoms and the factors that may be contributing to, exacerbating or maintaining your tinnitus.
