Tinnitus explained

Tinnitus

Hearing a sound that is not coming from outside

Tinnitus is sound in the head or ears with no external source. It is very common, it varies enormously between people, and it is not a disease in itself — it is something the hearing system is doing. This page explains the types, why it happens, and what an assessment involves.

What it can sound like

People describe it very differently, and there is no single correct description:

Ringing
Buzzing or humming
Hissing, like steam or static
Whistling
Clicking or pulsing

It may be in one ear, both ears, or seem to come from inside the head. It may be constant or come and go, and it is usually more noticeable in a quiet room — particularly at night, when there is less else to listen to.

Nearly everyone hears something in true silence

This is worth knowing before you worry about it. The New Zealand Audiological Society notes that most people will hear some sound in their ears if they sit in a very quiet room for long enough.

Occasional awareness of tinnitus is described as quite normal. What matters clinically is not whether you can detect a sound, but whether it is intruding on your life.

Subjective tinnitus

By far the most common type. It is sound generated by the hearing system itself, and only you can hear it. It is most often described as a hissing or ringing.

Because there is no external sound, there is nothing for anyone else to detect — which is part of what makes tinnitus isolating, and why being believed matters.

Objective tinnitus, or somatosounds

Much less common. These are real sounds near the ears rather than sound generated by the hearing system. They can pulse in time with your heartbeat, and can sometimes be heard by another person.

A pulsing, heartbeat-timed sound is one of the patterns worth having looked at promptly rather than at leisure — see below.

How common is tinnitus?

Tinnitus that can be heard most of the time affects almost one in ten New Zealanders, according to the New Zealand Audiological Society.

That is a large number of people, and it is worth saying plainly: if you have it, you are not unusual, and you are not imagining it.

Why tinnitus happens

The New Zealand Audiological Society describes tinnitus as often caused by hearing damage, with awareness of it frequently beginning after a period of stress. Changes in the ear and the hearing pathways are misinterpreted by the brain as sound.

It also describes tinnitus as tending to be most problematic when the brain has focused significant attention on the signal and a strong negative emotional association has formed around it. That is a useful thing to understand, because it explains something people often find confusing — why tinnitus can seem louder on a bad day without anything having changed in the ear.

It is rare for tinnitus to be a symptom of a medical condition requiring treatment. That does not mean it should be ignored, but it does mean the common assumption that it signals something serious is usually wrong.

Tinnitus is also frequently associated with hearing loss, with noise exposure, with a blocked ear canal, and with some medicines. Because it accompanies so many different things, it is generally treated as a reason to have your hearing assessed rather than as a diagnosis on its own. See what causes hearing loss.

Getting it looked at

What a tinnitus assessment involves

The New Zealand Audiological Society advises seeing an MNZAS audiologist for assessment of your tinnitus and your hearing if the tinnitus is causing significant distress.

Your hearing is measured too
Tinnitus is assessed alongside hearing, not separately, because the two so often travel together. See our page on hearing tests for what that involves.
The tinnitus itself is characterised
What it sounds like, where it seems to be, when it started, when it is worst, and how much it is intruding on sleep, concentration and mood.
Medical referral where appropriate
An audiologist will arrange referral for medical investigation if anything about the pattern warrants it. That decision is theirs to make with you, not something to self-assess.
A plan, not a prescription
What follows depends on what was found. It may involve addressing hearing loss, counselling, sound therapy, or a combination.

What audiologists actually do about it

There is currently no medical cure for tinnitus. We are stating that plainly because it is true, and because anyone offering you a cure is not being straight with you.

What the New Zealand Audiological Society describes is this: where tinnitus is accompanied by hearing loss, managing that hearing loss is usually where management starts — and it notes that the accompanying loss can be quite mild and not itself causing obvious difficulty. Audiologists also provide counselling, and may use sound therapy.

Sound therapy means playing soft sound — the Society gives the examples of a hissing rain sound or ocean waves — which makes the tinnitus harder to pick out and, over time, helps train the brain to stop attending to it.

Many MNZAS audiologists specialise specifically in tinnitus assessment and management.

Reduced sound tolerance

Tinnitus often gets discussed alongside a related group of difficulties: abnormal discomfort with sound. The New Zealand Audiological Society distinguishes four.

Term	What it means
Recruitment	Discomfort with loud sounds, occurring alongside hearing loss
Hyperacusis	Discomfort or pain from normal to loud sounds — can occur with normal hearing
Misophonia	A strong dislike of particular sounds, such as chewing or eating sounds
Phonophobia	Fear of sound

Like tinnitus, these are described as arising from a change in the hearing system and in how the brain processes sound, rather than from the ear alone.

The Society describes the approach as similar to tinnitus: a combination of counselling and low-level sound, used to desensitise the hearing system so that sounds are heard at a more normal loudness.

When to seek advice promptly

Most tinnitus is not an emergency. Some patterns warrant prompt attention rather than a routine appointment:

Tinnitus that appears suddenly, especially in one ear only
Tinnitus alongside a sudden drop in hearing
Tinnitus that pulses in time with your heartbeat
Tinnitus with dizziness, or with pain or discharge from the ear

If your hearing drops suddenly, or gets noticeably worse over a short time, contact a healthcare provider urgently rather than waiting for a routine appointment. Health New Zealand advises an urgent ear examination in that situation.

Not sure whether your hearing has changed?

Because tinnitus and hearing loss so often occur together, a sensible first step is finding out where your hearing sits. Our online hearing quiz is a quick way to get an initial sense of it from home.

An online check is a screen, not a measurement — it depends on your own headphones and how quiet your room is, and it cannot look inside your ear. It is a reasonable way to decide whether to book a proper test.

Common questions about tinnitus

Is tinnitus a sign of hearing loss?

It is frequently associated with hearing loss, but it does not automatically mean you have it. Because the two often occur together, tinnitus is usually a reason to have your hearing measured so you know one way or the other.

Is there a cure for tinnitus?

No. The New Zealand Audiological Society states that there is currently no medical cure for tinnitus. What exists is management — addressing any accompanying hearing loss, counselling, and sound therapy. Treat any claim of a cure with real suspicion.

What is the difference between subjective and objective tinnitus?

Subjective tinnitus is by far the more common. It is sound generated by the hearing system, and only you can hear it. Objective tinnitus, sometimes called somatosounds, refers to real sounds near the ears — these can pulse with your heartbeat and can sometimes be heard by another person.

How common is tinnitus in New Zealand?

Tinnitus that can be heard most of the time affects almost one in ten New Zealanders, according to the New Zealand Audiological Society. Occasional awareness of sound in the ears is more common still, and is described as quite normal.

Why is my tinnitus worse at night?

Tinnitus is generally more noticeable when there is less other sound to listen to. A quiet bedroom removes the background that masks it during the day, so it can seem louder without anything having changed.

Can stress cause tinnitus?

The New Zealand Audiological Society describes tinnitus as often caused by hearing damage, with awareness of it frequently beginning after a period of stress. It also notes that tinnitus tends to be most troublesome when attention and a negative emotional association have built up around the signal — which is part of why it can feel worse at difficult times.

What is sound therapy?

Playing soft sound — the New Zealand Audiological Society gives the examples of hissing rain or ocean waves — so that the tinnitus is harder to pick out. Over time the aim is to help the brain stop attending to it. It is used alongside counselling rather than on its own.

What is hyperacusis?

Discomfort or pain from sounds at normal to loud levels. Unlike recruitment, which accompanies hearing loss, hyperacusis can occur in people with normal hearing. It sits within a group of reduced sound tolerance conditions alongside misophonia and phonophobia.

Should I get tinnitus checked?

The New Zealand Audiological Society advises seeing an MNZAS audiologist if tinnitus is causing significant distress. Seek advice promptly rather than routinely if it is new and in one ear only, pulses with your heartbeat, or comes with dizziness or a change in hearing.

Book a hearing appointment

Tinnitus is assessed alongside your hearing, so a hearing test is where this normally starts. Booking one does not commit you to anything.

Book an appointment

Sources

This page is general information, not a diagnosis or individual advice.