Tinnitus is the perception of sound when no external noise is present. It is commonly referred to as "ringing in the ears" but can take many forms such as hissing, buzzing, or whooshing. Tinnitus can be either subjective (heard only by the patient) or objective (audible to others). It is associated with hearing loss, ear injuries, and other medical conditions. Management options include sound therapy, hearing aids, relaxation techniques, and cognitive behavioral therapy to help patients cope with tinnitus symptoms.

1. Tinnitus and it’s management
Amit Kumar Maurya
Senior Audiologist & Speech therapist
Zen Hospital, Mumbai

2. TINNITUS
Tinnitus is the perception of sound when no actual
external noise is present. While it is commonly
referred to as “ringing in the ears,” it can manifest
many different perceptions of sound including -
Buzzing, Hissing, Whistling, Swooshing, and
Clicking.

3. Types of tinnitus
 Subjective Tinnitus: Head or ear noises that are
perceivable only to the specific patient. Subjective
tinnitus is usually traceable to auditory and neurological
reactions to hearing loss, but can also be caused by an
array of other catalysts. More than 99% of all tinnitus
reported tinnitus cases are of the subjective variety.
 Objective Tinnitus: Head or ear noises that are audible
to other people, as well as the patient. These sounds are
usually produced by internal functions in the body’s
circulatory (blood flow) and somatic ( musculo-skeletal
movement) systems. Objective tinnitus is very rare,
representing less than 1% of total tinnitus cases.

5. Symptoms
Ringing
Hissing
Static
Crickets
Screeching
Whooshing
Roaring
Pulsing
Ocean waves
Buzzing
Dial tones
Even music
Commonly
referred to as
“ringing in the
ears.”

6. • Tinnitus is a symptom
associated with other health
conditions.
• Tinnitus is not a disease in
and of itself, but rather a
symptom of some other
underlying health condition.
In most cases, tinnitus is a
sensor neural reaction in
the brain to damage in the
ear and auditory system.
• While tinnitus is often
associated with hearing
loss, there are roughly 200
Causes

7.  Hearing Loss
 Age-related hearing loss
(presbycusis)
 Noise-induced hearing loss
 Obstructions in the Middle Ear
 Head and Neck Trauma
 Temporomandibular Joint Disorder
 Sinus Pressure and Barometric
Trauma
 Traumatic Brain Injury (TBI)
 Ototoxic Drugs

8. Other Diseases & Medical
Conditions
 Tinnitus is a reported symptom of the following
medical conditions:
 Metabolic Disorders: Hypothyroidism,
Hyperthyroidism, Anemia
 Autoimmune Disorders: Lyme Disease, Fibromyalgia
 Blood Vessel Disorders: High Blood Pressure,
Atherosclerosis
 Psychiatric Disorders: Depression, Anxiety, Stress
 Vestibular Disorders: Ménière's Disease,Thoracic
Outlet Syndrome, Otosclerosis
 Tumor-Related Disorders (very rare): Acoustic
Neuroma, Vestibular Schwannoma, other tumorous

9. Related Conditions
Tinnitus is affiliated with a range of co morbid
conditions, including vestibular disorders, audiological
problems, and behavioural health issues.

10.  Limbic system is
responsible for
controlling various
functions in the
body. Some of
these functions
include interpreting
emotional
responses, storing
memories, and
regulating
hormones.
 It is also involved
with sensory
perception, motor

11. Related Conditions
 Hearing Loss
 Ménière's Disease
 Hyperacusis
 Misophonia
 Phonophobia
 Depression and
Anxiety
 Other Vestibular
Conditions

13. General
Wellness
 Diet
 Physical Activity
 Social Activity
 Recreational Activities
and Hobbies
 Stress Reduction
 Hearing Protection

14. Neuromonics
Tinnitus Therapy:
 This treatment uses a
combination of testing,
counselling and
specialized masking with
white noise to help you
to effectively manage
and gradually reduce
your response to the
tinnitus.
 This treatment can take
six months or more to
complete but has a very
good rate of success.

15. Hearing Aids:
 Most people with
tinnitus have some
degree of hearing
loss. Hearing aids
create a dual benefit
of enhancing hearing
and masking and
attention effects or
covering up the
tinnitus, Auditory
Stimulation,
Improved
Communication.
 The majority of
patients with tinnitus
receive partial or
complete relief from

16. Sound-Masking
Devices:
 Tinnitus maskers are small
electronic devices that look
like hearing aids and are
tuned to generate sound that
masks or covers up the
tinnitus. Like hearing aids,
they may provide relief from
the tinnitus, but will not
enhance hearing and may
interfere with understanding
speech.
 Many types of devices, such
as fans, radios and sound
generators can be used as
tinnitus maskers to help

17. Behavioral Therapies
 Cognitive: Involving or related to the functions of
attention, knowledge, memory, judgement,
reason, and decision-making.
 Behavioral: Involving or related to physical,
emotional, and psychological action
 Cognitive Behavioral Therapy (CBT)
 Acceptance and Commitment Therapy (ACT)

18. With Tinnitus Without Tinnitus