About Tinnitus

What is Tinnitus?

Tinnitus is defined as being able to hear a sound that is not being made from an external source.

Patients may experience an occasional ringing in the ears or buzzing, humming, hissing and roaring noises.

Every individual has their own personal tinnitus tone, which can vary in volume, tone and severity and can change over time.

Tinnitus affects 1 in 7 people globally and 7.6 million people in the UK are affected alone, from occasional to severe disabling noises, with the numbers increasing with time.

There are 2 forms of tinnitus

Subjective

Subjective is known to be the most common form of tinnitus.

We will normally find these noises to be covered up by ambient sounds. If a person was sitting in a complete soundproof room, they will hear these noises in their heads.

If you have a hearing loss and are unable to hear sounds in the outside world, the internal noises in our head will become more noticeable and distinct.
There is a strong correlation between hearing loss and tinnitus. Damage to the inner ear or auditory nerve can trigger the brain to create phantom sounds like ringing or buzzing. This connection often stems from the brain trying to “fill in” missing auditory signals from a damaged cochlea or nerve, but tinnitus can also occur with normal hearing or other issues like loud noise exposure, earwax, medications, anxiety and stress.

Objective

Objective is uncommon.

Sounds that come from the body structures near the ear. These noises may be cause by small muscle spasms or abnormalities of the blood vessels in and around the ear.

It is a noise often rhythmic like a heartbeat (pulsatile), which can be heard by the patient and the examiner. Pulsatile tinnitus can occur when there is increased blood flow to the ear, usually when there is an infection or inflammation but also because of anatomical abnormalities of the blood vessels.

Causes of Tinnitus

The most common causes of tinnitus are: –

  • Colds and Infections
  • Particular medication
  • Noise trauma
  • Head/ear trauma
  • Flights
  • Diseases of the ear
  • Heightened anxiety
  • Anger

When people have long term tinnitus it is usually because one of the causes in the list above has at some point led to an auditory malfunction.

The nerve cells assemble in a specific area of the auditory cortex and these are tuned in to a certain frequency similarly to the arrangement of piano keys. Whatever the trigger for tinnitus, noise trauma, diseases of the ear etc – these all lead to an increase in the spontaneous firing rate in the brain.

Why Tinnitus Doesn’t Just Fade Away

For many people, tinnitus doesn’t simply fade or disappear over time. This is due to four key neurological and physiological factors that sustain and reinforce the perception of sound.

  • Permanent Auditory Damage

    When the auditory nerve is damaged, often from noise exposure, aging, or other triggers its signals become less accurate or reduced. This lack of clear input disrupts the normal communication between the ear and the brain, setting the stage for tinnitus to take hold.

  • The Brain’s Central Gain Adjustment

    In response to this reduced input, the central auditory system attempts to compensate. It increases its “neural gain” essentially turning up the internal volume. This results in hyperexcitability and reorganisation in brain structures such as the brainstem, thalamus, and auditory cortex. Rather than restoring normal sound perception, this process often leads to the perception of phantom noise.

  • Failure of the Brain’s Filtering System

    Under normal circumstances, the brain filters out unimportant background noise. In chronic tinnitus, this filtering system breaks down. The brain begins to treat the internal ringing as a signal that demands attention, making it feel intrusive and impossible to ignore.

  • The Stress Feedback Loop

    Tinnitus doesn’t exist in isolation. It’s often fuelled by the brain’s emotional centres. The sound itself causes stress and anxiety, which activates the nervous system and puts it on high alert. This heightened state of awareness causes the brain to focus even more on the tinnitus, increasing its intensity and persistence in a self-reinforcing cycle.

Understanding the Persistence of Tinnitus

This complex interaction between the ear, brain, and emotional centres explains why:

  • Tinnitus can continue even after the initial ear damage is stable
  • The perceived pitch of tinnitus often matches the frequency range of hearing loss
  • Central processes like attention, emotion, and the limbic system have a powerful influence on how loud or distressing tinnitus feels

The Piano Metaphor: How the Brain “Learns” Tinnitus

Imagine the auditory system as a piano. When there’s hearing loss, certain keys no longer work—they’re silent because no sound information reaches them. But the nerve cells in those regions are used to being stimulated.

Instead of staying quiet, these neurons begin to fire spontaneously. Over time, they also start firing in synchrony. This abnormal neural activity is interpreted by the brain as sound—a tinnitus tone.

To return to the piano image:
Even though the keys are broken and no one is playing them, they start to produce a tone on their own.

Once this hyperactive and synchronized state becomes established, it gets reinforced. The brain effectively “learns” the tinnitus sound, anchoring it more deeply into the auditory system. It becomes a phantom sound that is internally generated and difficult to unlearn.

Normal Hearing But Still Have Tinnitus?

Hidden Hearing Loss and Synaptic Damage

Even if your hearing appears normal on a standard audiogram, it’s still possible to experience tinnitus. This is often due to hidden hearing loss—a form of damage that affects the synapses (connections) between the inner ear and the brain.

Even if a standard hearing test appears normal, the connections (synapses) between the ear and the brain may be permanently damaged.

These synapses are crucial for transmitting sound signals clearly. When they’re damaged, the ear may no longer communicate effectively with the brain,  even if hearing thresholds appear “normal” on a basic test. This disconnect can trigger central gain mechanisms and lead to tinnitus, despite an apparently healthy ear.

Tinnitus Assessment

It could be some reassurance that you need, it could be some verification that you require, it could be some friendly advice you need just to help ease your symptoms.

Has the tinnitus just begun, or have you had it for a few weeks, months or years?, Is it one noise or a couple of different noises playing at the same time?, Is there increased sensitivity to noise that you are concerned with?, Is it distracting you from focusing in the day or falling to sleep?, Have you begun to notice an increased level of anxiety as a result?, Have you been told that you have to learn to manage it on your own…..because you don’t…..we can advise you on what to do next!

There is always treatment available which can relieve you of your tinnitus symptoms!

High quality care and customised service offered to each individual patient as we know there is no such thing as one-size-fits- all cure, so we never use a one- size- fits- all approach to your diagnosis, assessment or treatment advice.

Our Chief Audiologist, Shamim Patel, brings over seven years of experience from The Tinnitus Clinic Ltd on Harley Street.

“I was fortunate to train in a wide range of specialised tinnitus/hyperacusis treatments at the renowned Tinnitus Clinic, and I look forward to bringing these scientifically proven, evidence-based approaches to patients at London Hearing.”

Initial Assessment: What to Expect

On the day of your initial assessment, a detailed medical history is taken to ensure we have a good understanding of your symptoms, how they are impacting you, and the quality of your life. We will also conduct a range of diagnostic tests to give us an understanding of your tinnitus and audiological profile.

Some of the tests conducted include:

  • Tinnitus Matching – this test helps to identify the frequency and intensity of the patient’s tinnitus by comparing it to external sounds.
  • Minimum Masking Level – for tinnitus, this is the lowest intensity of a narrowband noise needed to completely cover the perception of tinnitus, essentially making it inaudible. This test helps us understand the magnitude of the patient’s tinnitus.
  • Residual Inhibition – this is the temporary reduction of tinnitus after exposure to a specific masked sound. This test can help classify the tinnitus and also help us understand whether sound therapy will be effective.

Expert Guidance and Ongoing Support

Whether the tinnitus has developed recently, or you have a longstanding diagnosis, our audiologist will be able to provide you with treatment options and offer expert advice based on the latest developments in tinnitus and neuroscientific research.

There will also be plenty of time for you to ask questions and explore self-help techniques.

We aim to always provide objective, straightforward and transparent advice.

Ready to Take the First Step?

If you’re struggling with tinnitus and looking for clarity, reassurance, and expert care, we’re here to help.
Book your initial assessment today and begin your journey towards better understanding and managing your tinnitus.