Tinnitus is commonly described simply as a ringing in the ears, but that label hardly captures the wide variety of experiences tinnitus patients have. The condition is classified into various categories, and figuring out what kind of tinnitus you have is the key to discovering the correct course of treatment. Read on to learn about the types of tinnitus and how to identify them.
The Main Types Of Tinnitus
Medical science classifies all tinnitus broadly into two groups based on whether the sound the patient hears can be observed from the outside. Let’s look at the two primary types of tinnitus.
Subjective Tinnitus is by far the most common form of tinnitus, accounting for the vast majority of tinnitus cases. It’s called subjective tinnitus because it can only be experienced subjectively. In other words, only you can hear the sounds but not an outside observer.
The length and intensity of subjective tinnitus sounds vary from person to person. They could take the form of hums, whistles, a buzzing noise and even music.
Diagnosing subjective tinnitus can be tricky. Because it can’t be measured, hearing professionals must rely on the patient’s self-reported symptoms to figure out the underlying cause.
Common causes of subjective tinnitus include:
- Noise-induced and age-related hearing loss
- An acoustic neuroma or other tumors of the ear
- Medications that damage the ear cause
- Multiple sclerosis
- Head injury
- Metabolic conditions
- Vitamin B12 deficiency
- Depression and anxiety
What distinguishes objective tinnitus from subjective tinnitus is that the ringing, clicking or whooshing sound in your ears can be recorded or experienced by an outside observer.
However, objective tinnitus isn’t typically loud enough to be heard without equipment. It almost always requires a stethoscope or a sensitive microphone.
Objective tinnitus is a much rarer type of tinnitus, comprising less than 1 percent of cases.
Often the culprit is a defect somewhere in your circulatory system. Your inner ear is surrounded by blood vessels that generate a sound called a vascular hum. Usually, this noise is imperceptible, but turbulent blood flow due to a disorder can cause a phantom ringing.
Here’s a short list of cardiovascular conditions and phenomena that might cause you to develop tinnitus:
- Arteriovenous malformations or fistulas
- Cavernous hemangiomas
- Stenoses of the carotid arteries
- Vascular tumors
- High blood pressure.
Issues in the musculoskeletal system can also cause objective tinnitus. Many muscles and bones are adjacent to your ear, and you could start to experience tinnitus if they go haywire.
Muscle spasms in the neck’s tendons can sometimes be picked up by the sensitive hair cells of the inner ear. Also, your jaw connects close to the ear, so any conditions that cause clicking or teeth grinding are likely to cause tinnitus as well.
Here are a few of the musculoskeletal causes of objective tinnitus:
- Temporomandibular joint dysfunction
- Myofascial dysfunction
- Head or neck trauma
Subtypes of Tinnitus
There are several other subcategories underneath the broader umbrella of objective and subjective tinnitus. These types of tinnitus are defined either according to the kind of sound one hears or the underlying condition.
Somatic tinnitus is caused by physical movement or touch. It refers to any type of tinnitus rooted in muscle spasms in the neck or the ear.
The spasm could be due to sleeping the wrong way on a pillow or injuring your neck while playing sports. It could also be the result of a musculoskeletal disorder or nutrient deficiency. Treating the underlying condition usually makes the tinnitus symptoms go away. If it’s an injury, massage or physical therapy could help.
Pulsatile tinnitus manifests as a whooshing sound that throbs in time with your heartbeat.
Pulsatile tinnitus is by far the most common type of objective tinnitus.
A change in blood flow to the inner ear or an increased vascular hum in the blood vessels surrounding the ear causes this rhythmic tinnitus. It’s called pulsatile tinnitus because of the pulsing sound it generates.
Increased pressure in the skull or plaque deposits in the blood vessels can cause turbulent blood flow. This produces a constant sound that presents as tinnitus. Treatment of these secondary conditions alleviates the ringing in the ears.
Sensory tinnitus occurs due to a defect of the auditory system within the ear. In this type of tinnitus, you will hear sounds that have no physical correlation.
They are sometimes called phantom ringing or ghost sounds. Treatments for sensory tinnitus sufferers include medications, cognitive-behavioral therapy (CBT), and sound therapy.
Neurological tinnitus is caused by neurological disorders like Meniere’s disease or other vestibular disorders that impact a person’s balance and the auditory functions of the brain. This usually affects only one ear.
Musical tinnitus is commonly referred to as Music Ear Syndrome, and it’s one of the rarest types of tinnitus. A person hears loops of music playing or people singing.
Some researchers consider these sounds to be musical hallucinations that develop in people who have advanced hearing loss and tinnitus over a long time.
This low-pitched ringing probably occurs due to head rotations and oscillations in the semicircular canals and cochlea inside the inner ear. It’s also known as ‘the Hum’ or the ‘Taos Hum.’
People who experience this form of ringing in the ears cannot figure out whether the sound is produced internally or it’s coming from an external source. The sound, which corresponds to the two lowest octaves of the piano, has been described by some as groaning or rumbling. Others call it murmuring or humming.
Unilateral or Bilateral
Tinnitus is also classified based on whether it occurs in one ear or both. If the sound appears in only one ear, it’s considered unilateral. Bilateral tinnitus is ringing or the presence of sounds in both ears.
Identifying Types of Tinnitus
If you’re experiencing chronic tinnitus, you should speak to an audiologist or an ear, nose and throat doctor. Given the solid connection between hearing loss and tinnitus, they’ll administer an ear examination and a hearing test. They’ll also conduct a health screening and additional tests to determine the underlying cause.
While you’re waiting for your appointment, you’ll want to do a little homework on your own to help your hearing professional zero in on the type of tinnitus you’re experiencing.
The American Tinnitus Association recommends keeping a journal of your symptoms and jotting down any relevant information that might prove useful for diagnosis.
Here’s a step-by-step guide:
|When and How Did It Start?
|Where Is The Sound?
|Establish a Pattern
|Characteristics of the Sound
|When did you first notice the sounds?
|Does the sound come from outside or inside your body?
|Is it continuous or episodic?
|Can you describe how it sounds?
|Did it start as a hum or click?
|Can you localize it?
|If it’s episodic, how long does each episode last?
|Is the pitch high or low?
|Was there any trauma preceding it or loud noise?
|Is it on the left or the right?
|Is it more pronounced at the beginning of the day or the end?
|Is it complex or simple?
|Have you recently had jaw or neck surgery?
|Is it in one or both ears?
|Do you hear a pulsing?
|Is it quiet or loud?
|Did it increase progressively?
|Can anyone else hear it with a microphone?
Tinnitus is a symptom of a wide range of diseases and disorders. Some are easily treatable, but others are severe and potentially life-threatening.
Here are a few symptoms that commonly accompany tinnitus:
- Hearing loss
- Fullness in the ear
- Pain in the ear, neck or jaw
- Itchy ear
Factors Affecting Tinnitus
- Does lying down or sleeping relieve your tinnitus?
- Does anything worsen it?
- Does external sound or excessive noise aggravate the condition?
Draw up a comprehensive list of medications you’re taking, including any over-the-counter medicines that might not show up on your chart. This list will help your doctor determine if your medication is to blame.
Tinnitus is a side effect of many common medications, including:
- Anti-cancer drugs
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Do you work in a profession where you are exposed to loud sounds and noise?
- Do you use earbuds or earphones for prolonged periods?
- What decibel level do you like listening to your TV, radio, or electronic device?
Make a note of any medical conditions that might be causing tinnitus, including:
- Thyroid dysfunctions
- Neurological disorders
- Cardiovascular conditions
- High blood pressure
- Musculoskeletal disorders
- Anxiety or depression
Talk to Your Doctor
Once you’ve written everything down, you might be able to make an educated guess about the kind of tinnitus you have. After reviewing your medical history and testing, your doctor can help you pinpoint the exact type.
While there still isn’t a cure for tinnitus, there are a number of promising treatments that can make living with tinnitus a lot more manageable, such as various forms of sound therapy that help you relieve your symptoms with help from an external sound.
Some of the most effective forms of tinnitus treatment include:
- Tinnitus masking therapy
- Tinnitus retraining therapy
- Cognitive behavioral therapy
- Music therapy
- Hearing aids
The body is a beautiful, complex machine—but it’s also fragile. A defect, disorder or disease in your ear or any one of your essential systems can cause tinnitus. A timely and correct diagnosis is the key to finding the most effective treatment, so you can start feeling better and get on with your life.
Figuring out what kind of tinnitus you’re experiencing is the first step. Now that you know the different types of tinnitus, you can work with your doctor to discover the underlying cause.
2. Aage R. Møller, “Sensorineural Tinnitus: Its Pathology and Probable Therapies”, International Journal of Otolaryngology, vol. 2016, Article ID 2830157, 13 pages, 2016. https://doi.org/10.1155/2016/2830157