Types of Tinnitus

Tinnitus is usually characterized by a ringing, buzzing or hissing noise that seems to originate in the ear or head. In this article, we’ll discuss the different types of tinnitus, their causes, and manifestations.

Overview

Basically, the types of tinnitus can be divided into subjective and objective tinnitus.

Subjective Tinnitus

Subjective tinnitus is the most common form, accounting for over 99% of cases, according to the American Tinnitus Association. This type is perceived only by the individual and cannot be heard by others or detected through objective tests. It can be a constant or intermittent sound, and vary in its tonality from a low roar to a high squeal. However, despite the variations, it often manifests as a ringing, buzzing, hissing, or humming noise.

Subjective tinnitus is often linked with hearing loss and is usually caused by damage to the auditory system. Let’s go a bit into the details here: Inside our ears, we have tiny hair cells. They transmit sounds to the brain by converting sound vibrations into electrical signals. When these hair cells get damaged – due to aging, exposure to loud noises, certain medications – they might begin to send random signals to the brain. This can lead to the perception of sound when no external sound is present, which is exactly what we know as tinnitus.

According to the Hearing Loss Association of America, 90% of adults with tinnitus also reported some form of hearing loss. However, it’s important to remember that correlation doesn’t imply causation. While there’s a strong association between tinnitus and hearing loss, not everyone with tinnitus has hearing loss, and vice versa. The relationship between the two is complex and involves a variety of factors. Moreover, the mechanisms of tinnitus are not entirely clear and remain a topic of ongoing research.

With this in mind, subjective tinnitus can be classified into the following types.

Acute Subjective Tinnitus

This is a temporary form of tinnitus, lasting up to three months. It is usually a result of exposure to loud noises, sudden hearing loss, or certain medications. The symptoms often alleviate once the underlying cause is addressed.

Chronic Subjective Tinnitus

This form of tinnitus is persistent and lasts for more than three months. It’s commonly associated with age-related hearing loss, long-term exposure to loud noises, earwax blockage, or changes in the ear bones. Identifying the exact cause can be challenging, making the management of chronic subjective tinnitus more complex.

Neurological Tinnitus

This type of tinnitus is caused by disorders, like Ménière disease, that affect the brain’s auditory functions. Ménière disease, an inner ear disorder, results in tinnitus accompanied by vertigo and hearing loss. This condition is usually caused by abnormal inner ear fluid pressure. While it’s possible to diagnose the Ménière disease, the optional accompanying tinnitus is still subjective. The sound can only be heard by the individual, is not audible to anyone else, and cannot be measured using audio testing devices.

Somatic Tinnitus

Somatic tinnitus is a type that’s associated with the sensory system. This condition is often triggered or worsened by body movements, such as clenching the jaw or turning the head. The somatic signals from the body’s movements interfere with the auditory pathways, leading to or increasing the intensity of the tinnitus.

Musical Tinnitus

Musical Tinnitus, also known as musical hallucination or auditory imagery, is a very rare form of tinnitus. Individuals hear music, songs, or tunes that are not playing in their external environment. This type of tinnitus can occur with any type of hearing loss, and it’s not necessarily associated with psychiatric conditions. The music heard can be a song the person knows well or a tune they can’t place, and it often repeats. This is more than a so-called “earworm”, a song stuck in your head. Unlike musical tinnitus, an earworm is recognized as a memory and is not usually perceived as being external.

Objective Tinnitus

Objective tinnitus is a rare form of tinnitus in which both the person experiencing the symptoms and an outside observer (usually a doctor) can hear the tinnitus sound. This distinguishes it from the more common subjective tinnitus, which is only audible to the individual.

Objective tinnitus typically arises from a physical cause within the body, often linked to the systems responsible for blood circulation or sensory responses. These causes can often be addressed with medical or surgical treatments.
Let’s delve deeper into some of the common causes:

1. Vascular Abnormalities: In some cases, the sounds of objective tinnitus can be a result of turbulent blood flow caused by vascular abnormalities or disorders. As you probably know, the body’s blood vessels function as the transport system for blood. When these vessels encounter issues like being overly narrow or having an irregular shape, it can create an unusual sound as the blood moves through.
2. Involuntary Muscle Contractions: The tiny muscles in the middle ear can sometimes contract or twitch without command. This can cause sounds that are audible to both the patient and an outside listener. This can result in a rhythmic clicking or other noise.
3. Temporomandibular Joint (TMJ) Disorders: The Temporomandibular Joint serves as the mechanism allowing the jaw’s movement for activities such as eating or speaking. If this joint faces issues such as inflammation or strain, it can lead to a noticeable sound due to its close location to the ear.
4. Eustachian Tube Dysfunction: The Eustachian tube, which connects the middle ear to the back of the nose, plays a crucial role in balancing the ear’s pressure. If this tube is not functioning properly, it can result in symptoms including tinnitus. This dysfunction can be due to a number of reasons, such as colds, or allergies.

Pulsatile Tinnitus

Pulsatile tinnitus can be both subjective and objective, depending on the specific case.

Subjective pulsatile tinnitus is where only the individual can hear the rhythmic noise, often in tune with their heartbeat. This type is more common and is usually caused by increased blood flow or turbulence near the ear, such as from general increased blood flow, local blood flow turbulence, or altered awareness.

Objective pulsatile tinnitus, on the other hand, is less common and is when a doctor or healthcare provider can also hear the pulsating noise during an examination. This usually happens when there’s an actual sound being produced by the structure of the individual’s body. It can occur for various reasons such as muscle-related issues (muscular tinnitus), abnormalities in the blood vessels, or tumors that disrupt the smooth flow of blood.