Tinnitus is the experience of hearing sounds like buzzing, hissing, or ringing when no external noise exists. This perception of sound, often described as “phantom sounds,” affects a significant portion of the population. This leads to the question of whether individuals who are deaf or profoundly hard of hearing can also experience this persistent, internal noise. Understanding how tinnitus is generated is key to answering this question.
Understanding Tinnitus and Phantom Sounds
Tinnitus is not a disease in itself but rather a symptom, representing the perception of sound in the head or ears without a corresponding external acoustic source. The vast majority of cases fall under the category of subjective tinnitus, meaning the sound is only audible to the person experiencing it. This form of tinnitus is often linked to changes in the auditory system.
A much rarer form is objective tinnitus, which can be heard by an examiner using specialized equipment. This type usually stems from physical occurrences like vascular problems, such as turbulent blood flow, or muscle spasms in the middle ear. However, over 99% of people experience subjective tinnitus, which is rooted in neurological activity rather than a simple ear problem.
Tinnitus in People With Varying Degrees of Hearing Loss
Deaf people and those with severe-to-profound hearing loss often experience tinnitus, as the severity of hearing impairment does not offer immunity from the condition. It is estimated that around 80% of individuals with severe-to-profound hearing loss report having tinnitus.
The prevalence of this phantom sound is particularly high in cases of acquired deafness, where hearing is lost later in life, with rates cited between 60% and 90%. Individuals with congenital deafness (born deaf) are far less likely to report tinnitus. This distinction suggests that the brain’s prior experience with sound plays a role in the development of the condition.
The Brain’s Role in Creating Phantom Sounds
Tinnitus is fundamentally a neurological event, originating in the central nervous system rather than solely in the ear structure. The process begins with auditory deprivation, which occurs when damage to the sensory hair cells in the inner ear reduces the amount of sound information transmitted to the brain. This lack of expected input triggers a compensatory change in the central auditory pathways.
The brain attempts to fill the resulting “silence” through a process called cortical reorganization. This involves the auditory cortex increasing its own activity, a phenomenon often described as increased neural gain or hyperactivity. Neurons in the auditory cortex may begin to fire more synchronously and spontaneously to compensate for the missing external input.
This hyperactivity is perceived as the phantom sound and is thought to be the brain’s attempt to restore a balanced level of neural activity. The specific pitch of the perceived tinnitus often relates to the frequency region where the hearing loss is most pronounced. Tinnitus is a form of phantom sensation, analogous to phantom limb pain, where the brain generates its own signal to maintain sensory input.
Management and Coping Strategies
For individuals with profound hearing loss, standard sound-based therapies like simple masking are often ineffective. Management therefore focuses on teaching the brain to reclassify the internal sound as unimportant, a process known as habituation. Cognitive Behavioral Therapy (CBT) is recommended because it addresses the emotional distress and negative reaction the tinnitus can cause, helping patients manage anxiety and focus less on the sound.
Another specialized approach is Tinnitus Retraining Therapy (TRT), which combines directive counseling with low-level, broadband noise to promote habituation. For the deaf population, a significant intervention is the use of cochlear implants, which bypass the damaged inner ear and restore a sense of hearing. In a substantial number of cases, the restoration of auditory input from the implant can suppress or significantly reduce pre-existing tinnitus, with improvement rates reported between 28% and 51%.