Tinnitus may be present all the time, or it may come and go or you might experience it all the time. The presence of sound may be intermittent or continuous. Some people find their tinnitus is an irritation they can learn to live with. For others, it can be very distressing. People commonly describe the symptoms of tinnitus include:

Signs and symptoms of hearing loss may include:

The noises of tinnitus may vary in pitch from a low to high intensity, and you may hear it in one or both ears. In some cases, the sound can be so loud, it interferes with your ability to concentrate or hear external sound. or you might experience it all the time. Some people find their tinnitus is an irritation they can learn to live with. For others, it can be very distressing and experiencing anxiety or depression.

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Tinnitus is a common cause of various medical conditions, which it can either induce or worsen tinnitus. It can occur when there is a problem with the auditory (or hearing) system, or can also occur in people who have normal hearing sensitivity.

In many cases, an exact cause is never found.

Some of the more common causes of tinnitus includes the following:
  • Hearing loss
  • Excessive ear wax
  • Ear Blockage
  • Ear and sinus infections
  • Certain medications
  • Head and Neck injuries
  • Noise-induced hearing loss
  • Age related hearing loss
Other causes include:
  • Temporo-mandibular joint (TMJ) disorders
  • Diseases of the heart or blood vessels
  • Meniere’s disease
  • Acoustic neuroma
  • Brain tumors
  • Blood vessel disorders
  • Vertigo: Dizziness is a common associated complaint in cases of tinnitus caused by a neurological condition, vestibular dysfunction, or Meniere’s disease.


A tinnitus evaluation can provide a valuable basis for communication between the examiner and the patient about the symptoms. An evaluation gives the clinician an objective picture of the tinnitus rather than relying on the patient’s subjective description of the sound or sounds they hear for to support diagnosis

An assessment also helps to reproduce a similar sound to demonstrate and measurements also can provide treatment guidelines.

Tinnitus Psycho-acoustic Assessment

Need for assessment

  • To provide reassurance to the patient that their tinnitus is real
  • To provide information that might assist in determination of site in the auditory system where the tinnitus originates.
  • To distinguish different subcategories of tinnitus
  • To determine whether the tinnitus has changed.
  • To determine if a treatment has had an effect
  • To provide treatment guideline
  • To determine which patients are likely to benefit from some types of treatment.
Audiological Test Battery

Questionnaires : Patients should complete written questionnaire to assess the perceived severity of their tinnitus.

  • Tinnitus severity index (Folmer, Stevenson & Tran 2002). It has 12 items and has been documented for internal consistency.
  • Tinnitus handicap inventory (Newman, Tacobson & Spitzh, 1998) is also recommended by (Dobie, 2002).

Otoscopic examination : Otoscopy is performed routinely to every individual. It is a tool which shines a beam of light to help to visualize and examine the condition of the ear canal and eardrum.Examining the ear reveals possible causes of your tinnitus, such as earwax or inflammation from an infection.

Immittance Audiometry : The primary purpose of this test is to determine the status of the outer and middle ear and also measures how middle ear responds to sound energy and how it reacts dynamically to changes in atmospheric pressure. The secondary purpose is to evaluate the acoustic reflex pathways, which include facial nerve and auditory nerve.

Comprehensive Distortion Product Oto Acoustic Emissions(DPOAE) : Will be measured from 0.5-10 kHz, bilaterally. Presence DPOAE responses indicate normal cochlear outer hair cell function for the tested frequencies.

Pure Tone Audiometry(PTA) : It helps for to evaluate pure tone thresholds in tinnitus patients. PTA for octave frequencies from 250 to 8 kHz and inter octave frequencies of 1, 5, 3 & 6 kHz.

Speech Audiometry : It provides an information on word recognition and about discomfort or tolerance to speech stimuli.Word recognition performance at patient most comfortable level.

High frequency audiometry(HFA) : In addition to conventional audiometry (125-8,000 Hz), extended high-frequency audiometry measures threshold estimation responses above 10 kHz to 20 KHz.

Tinnitus loudness and pitch matching

It is important to identify whether the tinnitus sounds more like a tone or more like noise.

Tinnitus loudness : Tones of different frequencies are presented in octave intervals to gradually approach and identify the octave frequency that is close to the perceived tinnitus pitch. Inter-octave tones are also presented to more closely to identify the exact tinnitus frequency.

pitch matching : Following a final pitch match, the threshold of the pitch matched tone is obtained to the closest 5 dB steps. The tone is the obtained at 2dB and 1dB steps to determine the loudness match at the pitch match frequency.

Minimum Masking Level (MML) : The masking noise is presented binaurally for the patients with bilateral tinnitus and monaurally for patients with unilateral tinnitus.

Noise level is adjusted to present in each ear at the hearing threshold levels. Noise level will be raised in 1 dB steps, until the patients tinnitus is completely masked.

Residual Inhibition(RI) : Residual inhibition refers to the phenomenon where the tinnitus perception is reduced in intensity or eliminated altogether following with the presence of 1minute auditory stimulation which is Performed immediately after the MML is established.

Patient will be informed not to respond in anyway, when the noise presented continuously for exactly 1minute.

Complete RI : complete absence of tinnitus perception in one or both the ears. 
Partial RI : Reduction of tinnitus loudness in one or both the ears. 
Absent RI : No change of tinnitus loudness in one or both the ears.

Other Diagnostic Tests

Brainstem Evoked Response Audiometry (BERA) : Neuro-diagnostic assessment is performed to rule out Retro Cochlear Pathology(RCP).

Vestibular test battery : (ENG, Fistula test, caloric test, Rotatory chain test and posterography) to rule out vestibular involvement. 

Measurement of the maskability or the pitch matching can help the professional to set the level and spectrum of the stimulation used in the sound therapy. An assessment might also provide some clues for the otologists to determine the site of origin of the tinnitus. 


Current tinnitus therapies are more successful at managing a patient’s reaction to the tinnitus rather than addressing the tinnitus, and no one therapy is effective for all the patients. A treatment that targets the underlying mechanism would greatly improve clinical outcomes for patients. 

These are the current available treatments for tinnitus that are mainly preferred.  
  • Tinnitus Retraining Therapy (TRT) 
  • Cognitive Behavioral Therapy (CBT) 
  • Hearings Aids 
  • Tinnitus maskers 
  • Relaxation therapy 
  • Sound therapy 
  • Counselling 

The external sound of the masker is generally a more acceptable sound than the patients tinnitus.
Control of tinnitus through the extension of residual inhibition

Masking Options:

Wearable maskers are available through Audiologists. They will conduct a tinnitus and hearing evaluation which will determine frequency and loudness of tinnitus and degree of hearing loss, if any. Wearable maskers fall into two general categories:

  • Can be fitted in patients with hearing loss and tinnitus.
  • Hearing aids can help people with hearing loss and in many cases they also reduce tinnitus symptoms. There seem to be two or more reasons for this.
  • First, tinnitus is exacerbated by silence because the brain turns up its sensitivity by seeking the neural stimulation it’s being deprived of due to hearing loss. Amplification increases neural activity and assists the brain in turning down its sensitivity.
  • Second, hearing aids amplify enough background noise to partially mask tinnitus sounds for many people.

The external sound of the masker is generally a more acceptable sound than the patients tinnitus. Control of tinnitus through the extension of residual inhibition

  • Tinnitus maskers are prescribed to patients who do not have significant hearing loss. These are recommended for people who have normal and near normal hearing and who do not need amplification.
  • The devices are similar to hearing aids except that they do not amplify sound; they produce a sound which masks tinnitus.
  • Generates noise bands with adjustable frequency emphasis.  This allows more flexibility for the patient for effective masking. Also for patients who cannot tolerate loud sounds.  (NBN, WBN, music) 
  • The sound is designed to be more acceptable to the patient than the sound of the tinnitus.
  • The brain can very easily learn to ignore external sound, especially if it’s at a constant level and frequency, though it has much more difficulty ignoring internal sound such as tinnitus.
  • Therefore, if we mask the tinnitus externally, the brain will learn to ignore it and therefore ignore the tinnitus itself.
  • Recently, maskers have been developed that can be individually tuned to match the tinnitus frequency.
  • These new maskers give more flexibility to the patient because the frequency can be tuned to be both more effective at masking and more acceptable to the patient.
  • One important side effect that occurs in a small number of people who have tinnitus maskers is after the maskers are turned off, the tinnitus continues at the reduced level for a period of time.
  • This is referred to as Residual Inhibition. For most people this lasts a very short time but for others it can last a considerable amount of time.

Patients should enrich their listening environment with music or other sounds to divert attention away from the tinnitus and to partially mask it. A selection of sounds (white, pink, and brown noise and nature sounds) is available on a digital music playback system from the clinic for this purpose. 

Sound therapy: Sound therapy using hearing aids and an enriched listening environment may interfere with the central processing of the tinnitus, leading to reduced awareness of the tinnitus. 


Counseling helps you to learn how to live with your tinnitus. The majority of counselling programs provide educational material to aid in your understanding of how the brain produces tinnitus. Some counselling programs might also assist you in altering how you feel and respond to your tinnitus. You might learn some things you can do on your own to block out the noise, and to help relax during the day, or get to sleep at night. 

Frequently Asked Questions

I hear ringing like sensation in my ears, is it normal?

It can be normal. But if it’s continuous and disturbing your daily life activities it has to be evaluated and requires treatment.

What can be underlying conditions that cause my Tinnitus Sound?

It can be due to many reasons. The possible causes may be due to underlying hearing loss, balance related conditions, neurological problems and psychological conditions.

What should I do if I have Tinnitus?

It’s always better to have a Comprehensive Audiological/ Tinnitus Evaluation. To determine the cause and severity of your tinnitus, we will examine your ears, ask about your hearing health, and conduct audiometric testing. Using the information, we gather; we will explore the best treatment options for your tinnitus.

Are there any treatments available for Tinnitus?

Tinnitus can be curable, and there are a number of treatment and relief options available to ease the discomfort. In addition, if you have an underlying health problem, this can be a means to treat tinnitus.

How common is Tinnitus?

Tinnitus is a very common complaint and affects 7-9% of the population and has been associated with a range of physical and emotional disorders.

What is Tinnitus?

Tinnitus is the name for hearing noises that are not caused by an outside source.

What does Tinnitus sound like?

Everyone’s tinnitus is different, but it’s usually described as a ringing, hissing, buzzing, roaring or humming sound. There may be one or more sounds and the noise may be there all the time or come and go. For a small number of people, tinnitus is a rhythmical noise that may beat in time with the heart. This is called pulsatile tinnitus.

Are hearing aids helpful for tinnitus?

Many people with tinnitus and hearing loss find hearing aids beneficial. They are fine-tuned to amplify the sounds that someone may have difficulty hearing, such as low-level environmental noise. Hearing more environmental sounds through hearing aids can help distract the brain from paying attention to tinnitus.

How can I better sleep with Tinnitus?
  • Keep active during the day Staying active during the day can help you sleep better. However, try to avoid exercise near bedtime – it may tire you out but can also disrupt the normal sleep cycle
  • Try to clear your mind before bedtime. If you have worries, set aside around half an hour earlier in the evening to jot down ideas or issues you might want to tackle tomorrow.
  • Practice relaxation exercises Have a warm bath, read, or meditate and try to avoid bright lights, including digital devices, before going to bed.
  • Limit the amount of stimulants Tea, coffee, cola, energy drinks and nicotine are stimulants and may help keep you awake. If you can’t give them up completely, try to cut down.
  • Get up and go to another room. If you’re not asleep after 30 minutes, get up and do something relaxing like reading. Go back to bed when you feel sleepy again.
Should I have a hearing test?

Yes, many people with tinnitus also have hearing loss.  Hearing loss can cause tinnitus symptoms, especially if it isn’t managed with hearing aids. So, it’s better to have your hearing tested.

What causes Tinnitus triggers?

It can be due to stress/ Anxiety, sleep deprivation, Loud noises, Certain medications, High sugar diet, Dehydration, Caffeine, Alcohol, recreational drugs, Food sensitivities, Pollution, Temporomandibular joint disorders, Extensive air travel and specific changes in the weather.

People who work in noisy environments are more likely to develop Tinnitus, True/False?

Yes, people who work in noisy environments are more likely to develop Tinnitus.

Chronic loud noise such as the noise from a construction site, airplanes, or loud music can damage the nerves and cells in the ear and cause tinnitus. Acute loud noises like a bomb blast can also cause nerve damage and leave the patient with tinnitus. Tinnitus is one of the most common reasons for armed service-related disability.

What are all the Tinnitus treatments available?

The best way to treat tinnitus is to get rid of the causes. In some cases, you can treat the illness or disease that causes your tinnitus. It will then go away. For most people, however, the cause is unknown. You can manage your tinnitus. Here are some ways you can manage your tinnitus:

  • Hearing Aids
  • Relaxation therapy
  • Counseling
  • Therapy to get you used to the sound
  • Tinnitus maskers
What makes tinnitus worse?
  • Loud noise.  Avoid loud sounds at all costs! Use power tools, guns, motorcycles, noisy vacuum cleaners, etc., only with appropriate hearing protection.
  • Excessive use of alcohol or so-called recreational drugs can exacerbate tinnitus in some individuals.
  • Caffeine, found in coffee, tea, chocolate and some cola drinks, can also increase tinnitus.
  • The vascular effects of nicotine, found in tobacco products, are associated with an increase in tinnitus.
  • Aspirin, quinine, some antibiotics and hundreds of other drugs are causative tinnitus agents and can make existing tinnitus worse.
  • Stress.  Many people notice a reduction in the volume of their tinnitus when they are able to control their stress levels.
Is there an operation for tinnitus?

Many patients think cutting or severing the hearing nerve will eliminate their tinnitus.  This permanent, deafness-producing procedure is not yet reliable for tinnitus relief.  In fact, the surgical destruction of a person’s hearing most often leaves tinnitus as the only sound heard.

I hear a noise in my ears but it doesn’t sound like ringing. Is it tinnitus?

Tinnitus typically manifests as a ringing in the ears but patients report hearing many other sounds as well. Buzzing, whistling, whooshing, roaring, sizzling, hissing, clicking and chirping are all common. If you’re hearing any type of sound in your ears, you should visit an audiologist for further diagnostic testing.

I used to experience tinnitus every once and a while but it’s becoming more frequent. What should I do?

Tinnitus can worsen over time, especially when it’s caused by an underlying condition that remains untreated. We recommend that anyone experiencing tinnitus see an otologist or audiologist for a tinnitus test. Even if you don’t feel like you need treatment, it’s important to try to establish a cause.

Can other people or audiologists hear my tinnitus?

In very rare cases, tinnitus is detectable to others. This is called objective tinnitus, which accounts for less than 1 percent of all cases. It’s much more likely that you’re suffering from subjective symptoms, meaning only you can hear the sounds. Through a Comprehensive Tinnitus Evaluation, we can determine the volume and pitch of the sounds you are hearing.

If you can’t find a cause for my tinnitus, why should I get an assessment?

It’s important to see a health professional if you’re experiencing tinnitus as it can indicate a more serious health problem. Although we may not be able to find the cause, going through the process to ensure you’re not damaging your hearing with ototoxic medication or experiencing a health condition is a good idea. Additionally, an assessment can help us determine what treatment options will work for you as well as deciding options that can able to manage tinnitus.

Tinnitus be prevented or prevented from worsening. True or False?

True. Tinnitus that is caused by damage to the auditory nerve from loud or repetitive noises can be prevented, or prevented from worsening, by avoiding the source of the loud noise or wearing ear protection such as earplugs or earmuffs.

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