What Are the Types of Tinnitus?

By Donna Pitts, AuD

Tinnitus, that pesky noise in your ears that seems only to appear when you need to concentrate, is an annoyance as well as a symptom of an underlying condition such as hearing loss, noise exposure or that something may be off medically. Tinnitus is the perception of a sound that can only heard by the person experiencing it, and it occurs when there is no other source of sound nearby that can account for it. It is an annoying sound that may appear in one ear or both ears, be constant or intermittent, and be high-pitched or low-pitched.

Most people think of and describe tinnitus as “ringing” in the ears, but the truth is that tinnitus can manifest in an array of sounds including “buzzing,” “roaring,” “clicking,” “rushing” and “hissing.” For some people, tinnitus causes distress and can wreak havoc on a person’s emotional and physical well-being.

While most people who experience tinnitus also experience a hearing loss, not everyone who experiences tinnitus will have hearing loss. Individuals may also notice that tinnitus appears suddenly or develops slowly over time. Regardless of when it shows up, how it is described or what it is attributed to, there are two main types of tinnitus: subjective tinnitus and objective tinnitus. These are very different and the type of tinnitus can help determine its etiology.

Subjective tinnitus is the most common type of tinnitus and sometimes it is referred to as “phantom” tinnitus. The reason for the term “phantom tinnitus” is that only the person experiencing it can hear it. Some of the common causes of subjective tinnitus include noise induced hearing loss, presbycusis, or hearing loss attributed to aging, middle ear infections and even impacted cerumen, or wax, in the ears.

Common risk factors for subjective tinnitus other than hearing loss include:

  • Noise exposure
  • Smoking
  • Diabetes

Less common risk factors for subjective tinnitus that may be ear related include:

  • Meniere’s disease
  • Temporomandibular joint disease
  • Acoustic neuroma
  • Head injury

It is also common for people to experience subjective tinnitus from certain medications. While there are many medications that may list tinnitus as a side effect, it is important to note that not all people who take these medications will experience tinnitus.  The most common ones include:

  • Non-steroidal anti-inflammatory drugs (NSAIDS) - Aspirin, ibuprofen and naproxen are over the counter medications often used for pain relief.
  • Aminoglycoside antibiotics - Used to treat life-threatening illnesses
  • Diuretics - Used in the treatment of hypertension (high blood pressure)
  • Chemotherapeutic agents - Used to combat certain types of cancer
  • Quinine - Used to treat malaria
  • Anti-depressants

The other type of tinnitus is called objective tinnitusoften referred to as pulsatile tinnitus and less frequently as vascular tinnitus. Pulsatile tinnitus is less common that phantom tinnitus and is usually an indication of a medical condition involving blood flow disturbances, especially in the head and neck region. With this type of tinnitus, physicians and other individuals, as well as the individual can hear it and it usually sounds like a whooshing or throbbing.

Common medical conditions that can cause pulsatile tinnitus include:

  • Hypertension (high blood pressure)
  • Head and neck tumors
  • Atherosclerosis (narrowing of the arteries)
  • Twisted arteries in the head and neck area

Less common causes of pulsatile tinnitus include:

  • Multiple sclerosis
  • Hyperthyroidism
  • Iron deficiency

In either case of tinnitus, subjective (phantom) and/or objective (pulsatile/vascular), it is important to report it to and investigate it with the appropriate medical professional, particularly if it is interfering with your daily life. Audiologists can help individuals suffering from subjective tinnitus to classify and quantify the type, while physicians can assist in finding medical conditions that may be causing objective tinnitus.

In the meantime, know that tinnitus is real but manageable, and not unique to any one person. While most people who experience tinnitus have hearing loss, if you do experience it suddenly, it does not mean you will “go deaf” or lose your hearing, or that it will get worse. So if you experience that irritating, annoying noise in your ears, whether it is “buzzing,” “roaring,” “clicking,” “rushing” and “hissing” don’t allow it to control your life. Seek help from the appropriate professional and get a handle on it before it gets a handle on you!