What is tinnitus? A straightforward guide to the basics

Tinnitus is the perception of sound when no external sound source is present. People most commonly describe it as ringing, but it can also present as buzzing, hissing, humming, whooshing, clicking, or pulsing. The sound may be constant or intermittent. It may be perceived in one ear, both ears, or seem to come from inside the head.

Tinnitus is not a disease. It is a symptom, a signal that something in the auditory system is generating a perception without a corresponding external stimulus. It is extremely common, and the range of experiences varies enormously from person to person.

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How common is tinnitus?

The numbers are significant. A 2022 meta-analysis of 113 studies published in JAMA Neurology found that approximately 14.4% of adults worldwide experience tinnitus, with prevalence rising to 23.6% in adults over 65 (Jarach et al., 2022). In absolute numbers, that is more than 740 million adults globally, with approximately 120 million experiencing severe tinnitus.

In the United States, a nationally representative survey published in JAMA Otolaryngology found that 21.4 million adults (9.6%) experienced tinnitus in the prior 12 months. Only 49.4% had ever discussed it with a physician, and just 4.9% had discussed masking devices (Bhatt et al., 2016).

In Canada, Statistics Canada reported that 37% of adult Canadians (approximately 9.2 million people) had experienced tinnitus in the past year, with 7% describing it as bothersome (Ramage-Morin et al., 2019). A more recent study found that tinnitus prevalence was highest among teenagers and young adults, at 50% for both groups (Feder & Marro, 2025).

Among those who experience it, the severity varies widely. For many, tinnitus is a mild background presence that they notice in quiet moments but rarely think about. For others, it is persistent and prominent enough to affect concentration, sleep, and daily life.

Age is a factor: tinnitus prevalence increases with age, particularly after 60. But it is not exclusively an older-person's condition. Noise exposure, which is the single most common associated factor, can affect people at any age. In the US data, work-related noise exposure was associated with 3.3 times higher odds of tinnitus, and recreational noise with 2.6 times higher odds (Bhatt et al., 2016).

What causes tinnitus?

Tinnitus is associated with a range of underlying factors. In most cases, it is not caused by a single identifiable event but by changes in the auditory system that alter how the brain processes sound signals.

Noise-induced hearing loss. Prolonged or sudden exposure to loud sound is the most commonly cited factor. This includes occupational noise (construction, manufacturing, music performance), recreational noise (concerts, headphones at high volume, motorsports), and sudden acoustic trauma (explosions, gunfire). Animal studies have shown that acoustic trauma triggers immediate increases in spontaneous firing rates and neural synchrony in the auditory cortex (Norena & Eggermont, 2003).

Age-related hearing changes. Gradual changes in the inner ear over time, particularly affecting the hair cells in the cochlea, are associated with both hearing loss and tinnitus. This process, sometimes called presbycusis, typically affects higher frequencies first.

Earwax blockage. A buildup of cerumen (earwax) in the ear canal can change how sound reaches the eardrum and is sometimes associated with temporary tinnitus.

Medications. Certain medications are known to be ototoxic, meaning they can affect the auditory system. These include some antibiotics, anti-inflammatory drugs, diuretics, and chemotherapy agents. Tinnitus may be a side effect that resolves when the medication is discontinued, or it may persist.

Head and neck conditions. Injuries to the head or neck, temporomandibular joint (TMJ) disorders, and muscle tension in the head and neck region can all be associated with tinnitus.

Other medical conditions. Meniere's disease, otosclerosis, acoustic neuromas, cardiovascular conditions affecting blood flow near the ear, and various neurological conditions can all include tinnitus as a symptom.

No identifiable cause. In many cases, no single cause can be identified. The tinnitus is present, it is real, and the mechanism is not fully understood. This is common and does not mean the tinnitus is imaginary.

What happens in the brain

While tinnitus is often described as an "ear problem," current understanding points to the brain as the primary site of tinnitus perception in most cases. A comprehensive review in the Journal of Neuroscience established that tinnitus is generated through changes in central auditory structures, not in the ear itself (Roberts et al., 2010).

The prevailing model involves the concept of central gain. When the auditory system experiences reduced input (from hearing loss, damage to hair cells, or other factors), the brain compensates by turning up its internal amplification (Norena, 2011). This increased gain can result in the perception of sound where no external sound exists, similar to how a microphone system produces feedback when the gain is set too high. A 2006 computational model demonstrated that homeostatic plasticity mechanisms, which normally stabilise neural firing rates, can produce hyperactivity after hearing loss (Schaette & Kempter, 2006).

This is why tinnitus often accompanies hearing loss but is not identical to it. A study of tinnitus patients with normal audiograms found physiological evidence of "hidden hearing loss": reduced auditory nerve responses despite normal hearing test results, with the central nervous system compensating through increased neural gain (Schaette & McAlpine, 2011). Hearing impairment increases the odds of developing tinnitus by a factor of 2.27 (Oosterloo et al., 2020).

Research into tinnitus mechanisms is active and ongoing. While there is compelling evidence that peripheral damage triggers central gain increases, some researchers have questioned whether gain alone explains why certain people with hearing loss develop tinnitus and others do not (Sedley, 2019). The complete picture is not yet settled. What is clear is that tinnitus is a real perceptual phenomenon with neurological underpinnings, not something that people are imagining.

When to see a professional

Tinnitus should always be evaluated by a qualified healthcare professional, particularly in the following situations:

• Sudden onset. Tinnitus that appears abruptly, especially in one ear only, warrants prompt evaluation.
• Pulsatile tinnitus. If the sound you hear has a rhythmic, pulse-like quality that matches your heartbeat, this is a specific type that can be associated with vascular conditions and should be assessed.
• Accompanied by hearing loss, dizziness, or pain. Any combination of these symptoms alongside tinnitus suggests an underlying condition that requires professional investigation.
• Affecting daily life. If tinnitus is affecting your ability to concentrate, sleep, or go about your day, an audiologist or ENT (ear, nose, and throat) specialist can provide a proper evaluation and discuss management strategies.

Even if your tinnitus seems mild, an initial evaluation is valuable. It establishes a baseline, rules out conditions that require specific intervention, and connects you with a professional who can provide guidance specific to your situation.

What is sound masking?

Sound masking is one of the approaches that people use alongside tinnitus. The concept has been studied since the early 1970s, when Feldmann published the first systematic study of tinnitus masking (Feldmann, 1971). The idea is straightforward: introducing external sound into your environment so that the tinnitus signal is not the only thing your auditory system is processing.

In a quiet room, tinnitus occupies the foreground of your auditory attention. When external sound is present, the tinnitus sits within a broader acoustic landscape. The tinnitus signal itself does not change, but the conditions around it do.

Common masking sounds include white noise, pink noise, and brown noise, as well as nature recordings and ambient textures. Different people prefer different sounds, and those preferences can change depending on the context (quiet room, noisy office, bedtime).

Sound masking is not a medical intervention. It is a way of changing the acoustic conditions of your environment. Many people use sound masking tools to create a background sound layer during quiet situations when their tinnitus is most noticeable.

How people use sound masking tools

People use sound masking in a variety of contexts:

• Sleep. Quiet bedrooms at night are one of the most common situations where tinnitus is prominent. Research shows that 72.2% of tinnitus patients rate their sleep quality as poor (Gallo et al., 2023), and 47.7% report that being in a quiet place makes their tinnitus worse (Pan et al., 2015). A sound environment running at low volume through a speaker or sleep-compatible headphones changes the acoustic conditions of the room. Building a nighttime sound environment is one of the most discussed applications.

• Focused work. Quiet offices and home workspaces present similar acoustic conditions to bedrooms: low ambient noise and high tinnitus prominence. A background sound layer can change that balance during concentration-intensive tasks.

• Quiet moments. Reading, meditation, waiting rooms, and other low-noise situations are common contexts where people run a sound masking tool.

The tools used for sound masking range from simple (a fan, a basic noise app) to highly configurable. Apps with multi-layer mixing, pitch control, and frequency exploration tools offer more precision than single-sound devices. The level of control you need depends on your individual preferences and how much your tinnitus varies.

siasola Tinnitus Masking Sounds

Siasola Tinnitus Masking Sounds is a sound customization tool for iOS. It was built by Justin, who has had tinnitus since he was 18 and wanted a sound mixing tool with more precision than anything he could find.

The app includes 95+ sounds, a 5-layer mixer with independent volume and pitch controls per layer, a pitch exploration tool, DSP effects, and a sleep fade mode. It is not a medical device. It makes no claims about outcomes. It is a tool for building and customizing your sound environment with a level of control that most apps and hardware devices do not offer.

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siasola Tinnitus Masking Sounds is a sound customization tool. It is not a medical device and does not diagnose, treat, cure, or prevent any condition. If you experience tinnitus, consult an audiologist or healthcare provider for professional evaluation. The information in this post is for general educational purposes and is not a substitute for professional medical advice.

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References

• Bhatt JM, Lin HW, Bhattacharyya N. Prevalence, severity, exposures, and treatment patterns of tinnitus in the United States. JAMA Otolaryngology-Head & Neck Surgery. 2016;142(10):959-965. doi:10.1001/jamaoto.2016.1700
• Feder K, Marro L. Tinnitus prevalence and associations with leisure noise exposure among Canadians, aged 6 to 79 years. International Journal of Audiology. 2025;1-19. doi:10.1080/14992027.2024.2442744
• Feldmann H. Homolateral and contralateral masking of tinnitus by noise-bands and by pure tones. Audiology. 1971;10(3):138-144. doi:10.3109/00206097109072551
• Gallo KEB et al. Effect of tinnitus on sleep quality and insomnia. International Archives of Otorhinolaryngology. 2023;27(2):e197-e202. doi:10.1055/s-0041-1735455
• Jarach CM et al. Global prevalence and incidence of tinnitus: a systematic review and meta-analysis. JAMA Neurology. 2022;79(9):888-900. doi:10.1001/jamaneurol.2022.2189
• Norena AJ. An integrative model of tinnitus based on a central gain controlling neural sensitivity. Neuroscience & Biobehavioral Reviews. 2011;35(5):1089-1109. doi:10.1016/j.neubiorev.2010.11.003
• Norena AJ, Eggermont JJ. Changes in spontaneous neural activity immediately after an acoustic trauma. Hearing Research. 2003;183(1-2):137-153. doi:10.1016/S0378-5955(03)00225-9
• Oosterloo BC et al. Prevalence of tinnitus in an aging population and its relation to age and hearing loss. Otolaryngology-Head and Neck Surgery. 2020;164(4):859-868. doi:10.1177/0194599820957296
• Pan T et al. Differences among patients that make their tinnitus worse or better. American Journal of Audiology. 2015;24(4):469-476. doi:10.1044/2015_AJA-15-0020
• Ramage-Morin PL et al. Tinnitus in Canada. Health Reports. 2019;30(3):3-11. doi:10.25318/82-003-x201900300001-eng
• Roberts LE et al. Ringing ears: the neuroscience of tinnitus. Journal of Neuroscience. 2010;30(45):14972-14979. doi:10.1523/JNEUROSCI.4028-10.2010
• Schaette R, Kempter R. Development of tinnitus-related neuronal hyperactivity through homeostatic plasticity after hearing loss. European Journal of Neuroscience. 2006;23(11):3124-3138. doi:10.1111/j.1460-9568.2006.04774.x
• Schaette R, McAlpine D. Tinnitus with a normal audiogram: physiological evidence for hidden hearing loss and computational model. Journal of Neuroscience. 2011;31(38):13452-13457. doi:10.1523/JNEUROSCI.2156-11.2011
• Sedley W. Tinnitus: does gain explain? Neuroscience. 2019;407:213-228. doi:10.1016/j.neuroscience.2019.01.027