The Diverse Types Of Tinnitus: A Comprehensive Guide

Tinnitus isn’t just a ringing in your ears. Although some people hear exactly that, not all tinnitus is the same. There are different types of tinnitus that depend on the cause, onset, duration, type, sound, and many other factors. By understanding the different types, characteristics, and factors related to tinnitus, you and your healthcare provider can develop an effective treatment plan to reduce your symptoms and improve your quality of life.

What Is Tinnitus?

In all cases, tinnitus is the perception of sound when no external noise is present. The National Institute on Deafness and Other Communication Disorders (NIDCD) estimates that 10 percent of the adult population — over 25 million Americans — experiences some form of tinnitus at some point in their lives. Tinnitus is one of the most common health conditions in the country, and the way in which it affects your life can vary greatly.

What Does Tinnitus Sound Like?

The actual sound of tinnitus can be different from person to person, but most people describe tinnitus as a phantom ringing sound. Others hear a hissing, whistling, swooshing, chirping, beeping, or buzzing noise – in some rare cases, tinnitus can even be musical. 

Some people experience acute tinnitus that only lasts a short period of time, while others experience chronic tinnitus which can be a frustrating, stressful experience.

Causes of Tinnitus

Understanding the root cause of your tinnitus can help explain your experience and provide insight into which management techniques might be most effective. Tinnitus itself is not a disease, but often a symptom of something else. It can be related to many different health conditions, and this typically determines the onset, type, and duration of your tinnitus perception. 

Hearing Loss

An estimated 90% of people with tinnitus also have hearing loss and most of these people report that the frequency of their tinnitus is linked to the severity and frequency of their hearing difficulty. It is important to note that hearing loss and tinnitus however are not directly related. There are many who just have hearing loss and others who have both hearing loss and tinnitus, but do not experience changes to tinnitus alongside changes to their hearing.  An audiologist can perform audiometric tests to measure the true extent of your hearing loss and establish a treatment plan.

Sensorineural hearing loss (that is, hearing loss stemming from the inner ear) is commonly accompanied by tinnitus. The most common forms of sensorineural hearing loss are:

• Age-related. People typically experience age-related hearing loss (presbycusis) gradually. This type of tinnitus is usually perceived in both ears. 
• Noise-induced. Loud noise exposure can be a single, sudden event – like an explosion – or repetitive excessive noise – like working with heavy machinery. Tinnitus of this type can occur in one or both ears.

Researchers are still studying the exact biological process by which hearing loss is associated with tinnitus, but we do know lack of auditory input leads to changes in how the brain processes sound. The brain processes sound differently if it receives incomplete or incorrect auditory input, and tinnitus may be the brain’s way of filling a void when not receiving as much sound input as it needs or expects.

Obstructions in the Outer Ear and Middle Ear

Blockages in your ear canal can affect the function of your eardrum, leading to subjective tinnitus and changes in your hearing. If your tinnitus is due to an obstruction, you’ll likely notice it more acutely in the affected ear.

Obstructions or blockages are often due to excessive earwax, dirt, foreign objects, ear infections, or congestion. If you think you have any obstructions in your ear, visit your doctor right away to prevent infection and restore your hearing. In many cases, safely removing the obstruction or managing infections or congestion will put an end to tinnitus symptoms.

Head and Neck Trauma

Any trauma to your head or neck – including traumatic brain injury (TBI) may lead to tinnitus. These injuries can cause nerve, blood flow, and muscle issues that result in changes to your hearing. A TBI, such as a concussion, can damage the brain’s auditory processing areas and cause tinnitus symptoms. Next to hearing loss caused by excessive noise exposure, head injuries are among the most common tinnitus causes for military and veteran populations.

Tinnitus sufferers who have experienced head or neck trauma often describe fluctuation in the sounds they hear, the volume of the tinnitus, and the location of where the sound seems to be coming from. Tinnitus related to the head, neck, or dental issues is sometimes referred to as somatic tinnitus. Somatic tinnitus is related to physical movement and touch. Muscle spasms or tension, inflammation, injuries, and poor posture can all contribute to this kind of tinnitus.

Temporomandibular Joint Dysfunction (TMJ)

Temporomandibular joint dysfunction is another example of somatic tinnitus. This joint connects your lower jaw (mandible) to your skull just in front of your ears. This joint is very close to your ear canal, middle ear, and inner ear, so strain, swelling, or inflammation can impact your hearing. There is a common ligament and nerve connections between your jaw and auditory system. 

Jaw joint dysfunction is often caused by grinding your teeth, misaligned bite, or injury. TMJ disorder can occur on one or both sides of your mouth, and if it’s causing tinnitus, the ringing typically follows suit. With your dentist or oral healthcare professional’s help, managing TMJ disorder will typically reduce tinnitus symptoms.

Ototoxic Medications

An ototoxic medication is any drug or medication that can affect your auditory system. Common NSAIDs like ibuprofen, antidepressants like Wellbutrin, and cancer medications can lead to tinnitus.

Tinnitus is a potential side-effect of certain medications, but this kind of tinnitus is typically short-lived in nature. It tends to subside shortly after you stop taking the ototoxic medication. However, there are some ototoxic drugs that can cause permanent, more severe symptoms like chronic tinnitus or hearing damage. Nevertheless, you should never stop taking any medication without consulting your doctor first.  

Other Diseases and Medical Conditions

Tinnitus is not a disease in itself, but can be a side effect of a health condition. Tinnitus related to other medical conditions can vary based on the onset of your disease, the effect on your hearing levels, the frequency of your symptoms, and many other factors. Some of the most common conditions related to tinnitus are:

• Anemia
• Lyme disease
• Fibromyalgia
• High blood pressure
• Depression
• Anxiety
• Stress
• Meniere’s disease
• Otosclerosis
• Acoustic neuroma

Tinnitus may be related to many other health conditions, but it’s not necessarily an indication that you’re suffering from a serious disease. Always talk to your doctor or healthcare professional for an appropriate diagnosis to determine the underlying cause of tinnitus. 

Subjective Tinnitus vs Objective Tinnitus

Subjective tinnitus – that is, tinnitus that only you can hear – is the most common type, making up over 99% of all tinnitus cases. It’s most often caused by hearing loss, but there are many other tinnitus causes. It is believed that subjective tinnitus stems from unusual brain activity in the neural pathway. If there is damage to your auditory nerve, ears, or hearing organ, and the brain may attempt to compensate for missing or incorrect auditory input, leading to subjective tinnitus.

Objective tinnitus is much more rare. Less than 1% of people with tinnitus experience objective tinnitus. In these cases, other people can actually hear the sounds of your tinnitus. These sounds are usually produced by your body’s internal functions, like your blood flow (circulatory system) or musculoskeletal movement (somatic system). If objective tinnitus is related to vascular deformities, it is typically pulsatile.

Pulsatile vs Non-Pulsatile Tinnitus

Pulsatile tinnitus is a relatively rare type of tinnitus characterized by a rhythmic noise heard in your head or ears, usually in sync with your heartbeat. Rhythmic tinnitus can be either subjective or objective, depending on the root cause. Pulsatile tinnitus may be related to:

• High blood pressure
• Blood vessel disorders
• Chronic neck muscle tension or stiffness
• Idiopathic intracranial hypertension (increased pressure in your skull)
• Conditions where blood flow is affected, including cardiovascular disease

Non-pulsatile tinnitus, on the other hand, is much more common. When most people discuss tinnitus, they are referring to non-pulsatile tinnitus. This type of tinnitus is subjective, so it likely originates from the auditory pathway, mostly from the central nervous system. 

However, it’s possible for non-pulsatile tinnitus to stem from vascular causes (that is, related to veins and arteries). Because this kind of tinnitus can’t be detected clinically or radiologically, it is sometimes misdiagnosed as central tinnitus. In this case, it’s most often diagnosed if typical management strategies don’t work. For this reason, it’s important to provide your doctor with all relevant health information to get to the bottom of the ringing in your ears.

Musical Tinnitus

Very rarely, you may experience musical tinnitus, or musical hallucinations – which is not the same as getting a catchy song stuck in your head. Musical hallucinations are a complex, rare form of auditory hallucination or tinnitus characterized by the perception of melodies, music, or songs in one or both ears without an external source. This music can be simple or complex, and it may last from seconds to hours. 

Only about 0.16% of a general hospital population experiences musical hallucinations. This rare form of tinnitus is typically associated with psychiatric disorders or degenerative neurological diseases. In some cases, people with hearing loss may experience musical hallucinations as part of an auditory processing condition involving neural loops. There is no specific treatment for musical hallucinations, but treating the underlying condition may help.

Tinnitus Management Options

There are several types of tinnitus and everyone experiences it differently, so you and your doctor should explore your management options and find the technique that works for you. Management options can either work directly to reduce the intensity of your symptoms, or they can work indirectly by managing the known cause of tinnitus. 

Most people won’t need to use specific tinnitus management techniques if the underlying health condition is resolved. However, not all underlying conditions – such as sensorineural hearing loss – can be cured. In this case, focus on improving your quality of life with management options like:

• Hearing aids
• Sound generating devices
• Tinnitus retraining therapy (TRT)
• Cognitive behavioral therapy (behavioral strategies)
• FDA-approved drug treatment for your underlying cause. There is no specific medication for treating tinnitus directly.

No matter what causes your tinnitus, you should speak with your doctor and audiologist to understand your treatment options. Finding relief from tinnitus may not happen overnight, but with perseverance, you can make progress and move forward on your journey.