When patients go to their doctors with common medical conditions, the cause of their discomfort is usually identified by examining the symptoms. People with nausea often have food poisoning. People with pain and trouble swallowing often have strep throat. When it comes to diagnosing, the “what” is usually a straight line to the “why” – which eventually leads to effective treatment.
Unfortunately, this isn’t always the case when patients present with noise in the ears. For 50 million Americans who struggle with tinnitus, the symptoms, causes and even type of tinnitus can vary widely, making getting an accurate diagnosis, and effective treatment, a long and winding road.
What is Tinnitus?
Tinnitus is sound in the head that doesn’t have an external source. The symptoms of your tinnitus can be as unique and individual as you. It’s most often heard as a ringing in the ears, but patients can experience it as buzzing, humming, roaring, whooshing, clicking, or even as the sound of their own heartbeat. The noise can be loud or soft, high or low, occasional or constant, a mild annoyance or a deeply debilitating condition.
The causes of tinnitus can vary widely, too. Tinnitus can be brought on by many things, including damage to the ears from loud noises, head and neck injuries, medication side effects, stress, or as a symptom of other health conditions, including hyper- and hypothyroidism, Ménière’s disease, Lyme disease, fibromyalgia and thoracic outlet syndrome.
Finally, the type of tinnitus can vary from one patient to the next. Many patients, and even doctors, neglect to consider the type of tinnitus they are experiencing. But learning your specific type of tinnitus can help you pinpoint the cause, manage your symptoms – and even find relief.
What Are The Four Types of Tinnitus?
There are four main types of tinnitus: subjective tinnitus, objective tinnitus, sensory/neurological tinnitus and somatic/conductive tinnitus. Let’s take a closer look at each.
This type of tinnitus can only be heard by the patient. Subjective tinnitus is the most common form, accounting for 95 percent of tinnitus cases. Subjective tinnitus can be a symptom of many health conditions, including almost every known ear disorder. Subjective tinnitus is also found in over 80 percent of hearing loss patients.
Like pain, subjective tinnitus is, well, subjective. That means two patients can experience tinnitus in completely different ways, even if the perceived volume and pitch levels are the same. For example, one patient can experience their tinnitus as background noise that’s easily ignored, while another can experience that same tinnitus as highly distracting, distressing and debilitating.
That means the severity of subjective tinnitus isn’t determined by the strength of the symptoms, but by how strongly you react to the condition. That said, many subjective tinnitus sufferers share common experiences, including finding it difficult to sleep or concentrate, and feeling depressed or anxious about their symptoms.
Related: Does Tinnitus Ever Go Away?
Objective tinnitus is sound that can be heard by both you and your doctor. Your doctor detects the sound by listening to your ear with a stethoscope. Objective tinnitus is much less common than subjective tinnitus, but it often has a cause that your doctor can identify and even cure.
Objective tinnitus is often vascular in nature, or related to your arteries, veins and blood flow. It can also be associated with abnormalities or disruptions in your Eustachian tube, and with muscle contractions inside your ear.
Sensory or neurological tinnitus is a form of subjective tinnitus and relates to the central nervous system, brain, spinal cord and nerves—specifically, how they perceive, signal and process sound.
This type of tinnitus is the result of an impaired auditory system and can often be accompanied with a loss of balance. Often, these symptoms are brought on by a disorder that affects the brain’s auditory functions, such as Meniere’s disease. Other causes of sensory tinnitus can include head injuries, whiplash, multiple sclerosis, an acoustic neuroma or a tumor.
Somatic or conductive tinnitus occurs when the sensory system contributes to your tinnitus.
The word somatic is Greek, meaning “of the body.” Somatic, or sensory, signals are generated from muscle position sensors throughout your body, including in the face, neck, head, trunk, arms, tongue, and in the temporomandibular joint (TMJ).
There are several signals throughout the body that can get disrupted and lead to tinnitus. One of the most common occurs with muscle spasms of the sternocleidomastoid muscle, the large muscle under the ear that helps rotate your head.
For some patients, anything that twists or curves the neck (for example, using a pillow at night) causes a muscle spasm that produces tinnitus. The spasm and tinnitus may not happen immediately, but can start several hours after the neck is twisted. This type of tinnitus can often be relieved with massage therapy.
Dental problems like tooth abscesses, impacted wisdom teeth and TMJ dysfunction are other common causes of somatic tinnitus. A very small number of people can even modulate tinnitus with movements of their eyes, a condition known as gaze-evoked tinnitus.