Tinnitus & Hyperacusis


Ringing in the ear, or tinnitus, is a widespread condition that affects an estimated 50 million Americans. Some people describe it as a hissing, roaring, whooshing or buzzing sound instead of ringing. It may be sporadic or constant, and is a symptom of an underlying condition rather than a disease itself. There are many factors that can cause tinnitus.

What Are the Causes of Tinnitus?

Tinnitus is categorized as being either pulsatile or nonpulsatile.

People who suffer from pulsatile tinnitus report hearing the sound of their own pulse. It is caused by abnormal blood flow within the arteries of the neck or inside the ear, and is fairly rare. Possible causes include:

  • Fluid in the middle ear.
  • Ear infections.
  • High blood pressure.
  • Head and neck tumors.
  • Blocked arteries.

Nonpulsatile tinnitus – ringing in the ears not accompanied by any type of rhythm – is considerably more common. It can be caused by a variety of conditions including:

  • Presbycusis (age-related hearing loss).
  • Noise exposure.
  • Impacted earwax.
  • Otosclerosis (stiffening of the bones in the middle ear).
  • Meniere’s disease.
  • TMJ disorders.
  • Ototoxic medications.
  • Thyroid conditions.
  • Head or neck trauma.
  • Acoustic neuromas.

Tinnitus is also classified as being either subjective (heard only by the patient) or objective (ringing can be heard by an impartial observer, such as a doctor). Most cases of tinnitus are subjective in nature.

How Is Tinnitus Treated?

Tinnitus can’t be cured, but there are treatments that make it less of a distraction. The approach taken depends on the underlying condition responsible for the ringing in your ears. Sometimes, simple steps like removing built-up earwax or switching to a new medication can markedly decrease symptoms.

Others benefit from noise suppression therapy or masking techniques designed to cover up the ringing noise. White noise machines, fans, air conditioners and humidifiers are all popular, easy to use options.

Tinnitus retraining devices, which rely on patterned tones, are a newer technique that has proven beneficial to many patients.


Hyperacusis is a heightened sensitivity to everyday sounds that most people can tolerate easily. A person suffering from hyperacusis may find sounds like a running dishwasher, a nearby conversation or even the shuffling of papers unpleasantly loud or even painful. For some, the sensitivity is only to certain frequencies or pitches.

Hyperacusis is rare, affecting only one in 50,000 people. This number is higher among tinnitus sufferers, however, affecting about one in 1,000. Hyperacusis can affect people of any age, and it can occur in one or both ears. Untreated hyperacusis can cause social isolation, phonophobia (fear of sounds), depression and more.

What Are the Causes of Hyperacusis?

It is extremely uncommon for someone to be born with hyperacusis. Hyperacusis can be caused by a number of diseases including Bell’s palsy, Lyme disease, Meniere’s disease, head injury, temporomandibular joint (TMJ) syndrome and noise induced hearing loss. Hyperacusis is also linked with neurologic conditions such as PTSD, epilepsy, depression, migraines, cerebral palsy and autism.

For those whose hyperacusis is the result of trauma to the head or hearing system, symptoms may go away as the injury heals. Identifying the underlying cause is always the first step in treating hyperacusis.

How Is Hyperacusis Treated?

Some suffering from hyperacusis might seek relief by wearing earplugs or earmuffs. While this may help in the short term, it actually decreases the already poor tolerance of noise, increasing sensitivity in the long run. This result is most obvious immediately after removing the ear protection.

An effective treatment option is called sound desensitization, wherein a specialist works with you by exposing you to white noise at initially a very low volume, increasing it over time to improve tolerance. This treatment may take six months to a year, and maybe even longer for certain patients.

If you suspect you may have hyperacusis, seek an evaluation by an audiologist at Callier Center for Communication Disorders. A hearing specialist will conduct a full audiologic evaluation, including a hearing test, and take a record of your medical history to accurately diagnose your condition and determine your Loudness Discomfort Levels (LDL). An audiologist can also guide your treatment and counsel you about the latest hearing solutions available.