The experience of hearing a sound with no external source can be deeply unsettling. This perception of sound, known medically as tinnitus, is a symptom, not a disease itself. Tinnitus is defined as the perception of sound in the ears or head when no actual external sound is present. This article will help you understand the nature of what you are hearing and provide a framework for determining the next steps.
Defining the Sound and the Experience
If you are hearing internal sounds, they are a genuine neurological phenomenon. Tinnitus results from the brain creating sound in response to changes in the auditory system, often due to damage to the inner ear’s delicate hair cells. This is similar to how phantom limb pain occurs, as the brain attempts to compensate for a lack of external auditory input.
The most common form is subjective tinnitus, accounting for over 99% of all cases, and only the person experiencing it can hear the sound. Descriptions vary widely and can include:
- Ringing
- Buzzing
- Hissing
- Roaring
- Clicking
- Whooshing
Objective tinnitus is extremely rare and is caused by physical sources, such as muscle spasms or blood vessel issues. A clinician may be able to hear objective tinnitus during an examination.
While the sound originates internally, its impact can be profound, affecting concentration, sleep, and emotional well-being. The noise can range from a soft background hum to a sound so loud it seems to block out environmental noise. Recognizing that this experience is a physical symptom of an underlying issue is often the first step toward managing it.
Common Causes and Risk Factors
Tinnitus is linked to physical and environmental factors that affect the auditory system. The most common cause is noise exposure, where loud sounds from sources like machinery, firearms, or concerts damage the inner ear’s sensory hair cells. This damage disrupts sound signal transmission, prompting the brain to generate the perception of sound.
Age-related hearing loss (presbycusis) is another major contributor, as the natural decline in functioning nerve fibers can lead to hearing problems associated with tinnitus. About one-third of adults over 65 experience ringing in the ears due to this process. Ear-related conditions like excessive earwax buildup or a middle ear infection can also cause temporary hearing loss and subsequent tinnitus by obstructing sound waves.
Certain medications are ototoxic, meaning they can damage the inner ear and induce or worsen tinnitus. These include some nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen, especially when taken at high doses. High doses of aspirin, certain antibiotics, chemotherapy drugs, and specific diuretics can also produce this side effect. Tinnitus can also be a symptom of underlying health issues, such as Ménière’s disease, temporomandibular joint (TMJ) disorders, high blood pressure, and head or neck injuries.
Differentiating Tinnitus from Temporary Sounds
The difference between chronic tinnitus and a harmless acoustic event lies in the sound’s persistence and impact. Everyone occasionally experiences transient ear noise—a fleeting ringing or whistling that typically lasts for only a few seconds. This temporary noise often follows exposure to a loud sound or a brief feeling of fullness in the ear, but it resolves without intervention.
Tinnitus is considered chronic when the sound lasts for three months or longer, though its intensity and length can be highly variable. Persistent or regularly recurring sound is likely true tinnitus, indicating a lasting change in the auditory system. A clear indicator of severity is when the sound interferes with daily functioning, making it difficult to concentrate or disrupting sleep.
Pulsatile tinnitus warrants immediate attention. This type is a whooshing, throbbing, or humming sound synchronized with the heartbeat. It is often linked to changes in blood flow near the ear, such as high blood pressure or blood vessel abnormalities. Any sound that significantly affects quality of life moves the condition beyond a simple temporary annoyance.
When to Seek Professional Confirmation
A definitive diagnosis of tinnitus and its underlying cause must be made by a healthcare professional. Seek an evaluation if the sound persists for longer than a week, or if it starts to interfere with sleep or concentration. An initial visit with a primary care physician can help rule out simple causes like earwax buildup or an ear infection.
Seek urgent medical attention if the tinnitus is only present in one ear, or if its onset was sudden and accompanied by other symptoms. These warning signs include dizziness, balance problems, facial weakness, or sudden hearing loss. For a comprehensive assessment, consulting a specialist like an Otolaryngologist (ENT) or an Audiologist is recommended. An Audiologist performs a thorough hearing assessment to determine if hearing loss is a contributing factor, while an ENT investigates potential medical causes and rules out serious underlying conditions.