Tinnitus

Tinnitus is not classified as a disease in itself, but a symptom. The most important step is therefore to determine whether there is an underlying cause that can be treated or managed.

Some people experience tinnitus temporarily, for example following exposure to loud noise, stress, earwax build-up or an ear infection. Others experience tinnitus more persistently. Troublesome tinnitus should always be investigated, and severe or persistent symptoms should be assessed by an Ear, Nose and Throat (ENT) specialist.

Our modern understanding of tinnitus is that it does not originate in the ear itself, but primarily within the brain. One of the most widely accepted theories suggests that tinnitus may result from the brain attempting to compensate for reduced sound input from the ear.

When hearing becomes reduced—even slightly—the auditory centres of the brain receive fewer signals. The brain, however, is not passive. It constantly seeks to maintain a certain level of activity. When auditory input decreases, the nervous system may effectively “turn up the gain” (increased neural gain), leading to increased spontaneous activity and synchronisation within the auditory networks. This activity may be perceived as tinnitus.

A commonly used comparison is phantom limb pain following an amputation. Even when a limb is no longer present, the brain may still generate sensations that appear to originate from it. In a similar way, the brain can create the perception of sound even when no external sound is present.

Research suggests, however, that this is only part of the explanation:

• Many people with tinnitus have measurable hearing loss.

• Some have what is known as hidden hearing loss (cochlear synaptopathy), where conventional hearing tests may appear relatively normal.

• The brain's attention networks, emotional centres and stress-response systems also play an important role in determining how intrusive tinnitus becomes.

• Two individuals with tinnitus of similar loudness may experience very different levels of distress depending on factors such as sleep quality, stress, anxiety, attention and coping strategies.

For this reason, it is more accurate to say that:

Tinnitus most likely arises from changes in the brain's processing of sound, often triggered by reduced auditory input from the ear, but also influenced by the brain's attention, emotional and stress-regulation systems.

There is now broad scientific agreement that tinnitus is a brain-based condition that often develops following changes in auditory input. However, there is still no complete consensus regarding the precise neural mechanisms involved or why some individuals develop tinnitus while others with similar hearing loss do not. This remains an active area of scientific research.

In simple terms, tinnitus can often be understood as the brain's response to missing sound information from the ear. The brain attempts to compensate by increasing the sensitivity of the auditory pathways, which may then be perceived as a sound that does not actually exist in the external environment.

Tinnitus can have a variety of causes. The most common include:

• Hearing loss

• Noise-induced hearing damage

• Earwax blockage

• Ear infections or pressure-related ear problems

• Stress and sleep disturbances

• Jaw tension or neck tension

• Sudden hearing loss

• Certain medical conditions

In cases of hearing loss or noise-induced hearing damage, tinnitus may develop because the sensory cells of the inner ear no longer transmit the same amount of sound information to the brain. Tinnitus can occur with any type of hearing loss.

Many people associate hearing loss with simply being unable to hear. In reality, the situation is often more subtle. A person may still hear sounds but struggle to understand speech, particularly in noisy environments, at dinner parties or when several people are speaking at the same time.

When the brain receives less sound information from the ear, it may become more aware of internal signals. This can make tinnitus more noticeable. For this reason, a comprehensive hearing assessment is often an important first step when tinnitus is present.

Yes. For some people, hearing aids can reduce the perception of tinnitus, particularly when hearing loss is also present. By improving auditory stimulation, hearing aids provide the brain with more meaningful external sound information, which may reduce the prominence of tinnitus.

This does not mean that hearing aids eliminate tinnitus for everyone. However, where hearing loss is documented, international guidelines recommend considering hearing aids as part of the management strategy. The American Academy of Otolaryngology recommends hearing aid assessment for persistent and bothersome tinnitus associated with hearing loss.

You should seek assessment if your tinnitus:

• Is new and does not resolve

• Occurs in only one ear

• Is associated with hearing loss

• Is pulsatile

• Affects sleep, concentration or well-being

• Occurs together with dizziness

• Develops suddenly alongside reduced hearing

Sudden hearing loss accompanied by tinnitus requires prompt medical assessment. Danish healthcare guidance describes sudden sensorineural hearing loss as an acute condition that may be accompanied by tinnitus and/or dizziness.

Treatment depends on the underlying cause. The first step is typically a hearing assessment and examination of the ear. If hearing loss is present, hearing aids may be an appropriate option.

If tinnitus is associated with stress, sleep difficulties or a high level of mental strain, counselling, sound enrichment and therapeutic interventions may also be beneficial.

The NICE tinnitus guidelines recommend appropriate assessment, counselling and referral where necessary. When tinnitus occurs alongside hearing loss, hearing evaluation should be considered a central part of the management process.

At Rhino Hearing Clinic, we begin with a comprehensive hearing assessment and a detailed discussion about how tinnitus affects your daily life. We consider your hearing, symptoms and individual needs before recommending a suitable course of action.

Because Rhino Hearing Clinic is an integrated part of Rhinoklinikken Private Hospital, we are able to combine audiological expertise with specialist ENT assessment whenever appropriate. This provides a reassuring and professional pathway where tinnitus is not viewed simply as a sound, but as a condition that must be understood in the context of both hearing and everyday life.

For some patients, tinnitus has such a significant impact on daily life that treatment should also include psychological and emotional coping strategies. There is good evidence that Cognitive Behavioural Therapy (CBT) can reduce tinnitus-related distress, stress and the overall burden associated with tinnitus. International guidelines now recognise CBT as one of the most well-documented treatment approaches for bothersome tinnitus.

Some patients also report benefits from body-oriented approaches such as Somatic Experiencing (SE), which focuses on the nervous system’s stress response and the body's state of physiological alertness. The evidence for these approaches is currently more limited, although research continues into the relationship between tinnitus, stress responses and the somatosensory nervous system.

Is Tinnitus Dangerous?

In most cases, tinnitus is not dangerous, but it can be highly distressing. New-onset, one-sided, pulsatile or severe tinnitus should always be assessed.

Will Tinnitus Go Away?

For some people, tinnitus resolves on its own. For others, it remains present, but the impact can often be reduced with the right advice, support and treatment.

Can Tinnitus Be Caused by Hearing Loss?

Yes. Tinnitus is frequently associated with hearing loss, and even mild hearing loss can make tinnitus more noticeable.

Can Hearing Aids Help?

Yes. If hearing loss is present, hearing aids can often reduce the perception of tinnitus by providing the brain with more meaningful sound input.

Should I Have a Hearing Test?

Yes. If tinnitus persists, affects your quality of life or is associated with hearing difficulties, a hearing assessment is an appropriate first step.

This article has been clinically reviewed by Lars-Bo Kjær, BA Audiology (University of Southern Denmark), Audiologist at Rhino Hearing Clinic.

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