Ask an expert: What is tinnitus?

Do you hear sounds that no one else notices? If so, you’re not alone.

Audiologist Richard Tyler

Tinnitus is the perception of a sound even though no outside noise is present. People with tinnitus may experience a steady drone of ringing, buzzing, hissing, or whooshing sounds or even a high-pitched tone. Tinnitus can be a temporary problem or one that doesn’t go away.

While tinnitus is a fairly common condition, many people have never heard of it. Richard Tyler, PhD, an audiologist in the University of Iowa Department of Otolaryngology, shares his expertise.

How would you characterize tinnitus?

Like hearing loss, it’s an invisible problem in that other people cannot see what’s going on. But tinnitus affects the way you communicate, the way you think—those things become drastically diminished if you have this unwanted sound in your ears that never goes away. In terms of prevalence, tinnitus affects about 4 to 5 percent of the population. For adults over age 60, it’s closer to 25 percent.

Is tinnitus a sign or precursor of hearing loss?

We all experience hearing loss as we get older. For many people who work in a noisy factory, one of the first symptoms of the damaging effects of excessive noise is ringing in the ears. If you have tinnitus, there’s a roughly 95 percent chance you will have hearing loss. If you have hearing loss, there’s probably a 30 percent chance you will have tinnitus.

What causes tinnitus?

There is spontaneous activity in the nerves of the auditory system in the brain all the time. With normal listeners, the brain ignores that activity. With tinnitus, somewhere in the auditory system there is likely some sort of increase of spontaneous activity and the brain is interpreting that as a ringing sound. It could be due to neural damage or a chemical imbalance, but wherever it starts, it’s perceived in the auditory cortex of the brain.

How does tinnitus start?

It varies, but for some people it might arise gradually from long-term noise exposure—like the factory experience. For others, it could be an explosion or a car accident; all of the sudden, the tinnitus is just there. The biggest challenges often occur at the beginning—people want to know, “What is this? Is there something else wrong? Is this going to be with me forever?” Or “I don’t have any control over this!” These are normal reactions.

What are effective treatments for tinnitus?

Most effective are what we call Tinnitus Activities Treatments—a combination of counseling and sound therapy. The counseling part is divided into four modules that focus on your thoughts and emotions, your hearing, your sleep, and your concentration. There are different focusing and relaxation exercises, for example, as well as imagery training and other techniques to help patients redirect their thoughts. We also have patients keep a log of their symptoms. The idea is that we might not be able to change the sound, but we can help you change your reaction to that sound.

Sound therapy means using some sort of background sound—a fan, music, or spa tones, for example—to “mask” or reduce the prominence of the tinnitus. There are wearable devices designed for sound therapy, and hearing aids are often helpful. We’re involved in some research studies to document and try to maximize the benefit of these types of devices.

I get calls and emails from people with tinnitus from all over the country and all over the world. What’s interesting is that many say they’ve learned to live with their condition—but they’d come to Iowa City tomorrow if a cure was available.

Tinnitus terms

A sound that is heard in one or both ears or the head when no external stimulus is present
Sensorineural hearing loss
Hearing loss due to damage to the sensory (cochlear) or neural (auditory nerve) portion of hearing mechanism
Moderately intense sounds that are perceived as very uncomfortable
Hearing aid
Devices that fit either in the ear or behind the ear that help make sounds louder
Sound therapy
The use of background noise/sound to help with managing tinnitus
Healthcare professional that measures hearing
A diagram of hearing
Tinnitus masker
An electronic device that produces a steady state sound used to mask tinnitus
Combination instrument
An electronic device that includes a hearing aid and a tinnitus masker
Last reviewed: 
December 2018

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