Tinnitus Science: Why the Brain Creates Sound (and How It Can Calm Down)
Tinnitus is real—and it’s generated by your nervous system. Understanding how it works can make it less scary, less “sticky,” and more manageable.
- Tinnitus is a brain-based sound perception, often triggered by changes in the ear (like noise exposure, aging, or other hearing changes).
- Loudness and distress are not the same. A quiet tinnitus can feel unbearable; a louder tinnitus can be tolerable—depending on attention, emotion, and stress systems.
- Many people improve over time. The brain can “de-prioritize” tinnitus (habituation), especially with the right supports.
- Evidence-supported help exists. CBT-based approaches, hearing aids (when hearing loss is present), and sound enrichment are the best-supported strategies in current guidelines.
- Safety matters. Some tinnitus patterns (sudden hearing change, pulsatile tinnitus, one-sided new tinnitus) should be checked promptly.
What is tinnitus?
Tinnitus is often described as “ringing in the ears,” but it is a sound perception created by the nervous system rather than an external sound source [1]. People describe it as ringing, buzzing, humming, hissing, clicking, or a high-pitched tone.
- Subjective tinnitus: The most common type. Only the person can hear it; it reflects activity within the auditory system.
- Objective tinnitus: Rare. A physical sound in the body (for example, blood flow or muscle movement) may sometimes be heard by a clinician.
Tinnitus is often described by timeframe: acute tinnitus (new onset, often improving over weeks to months) versus chronic tinnitus (persisting beyond ~6 months) [1,9]. Chronic tinnitus may not disappear completely, but distress often decreases as the brain adapts.
Tinnitus is common: population estimates often range from about 8% to over 20% of adults reporting tinnitus at some point [1]. Most cases are mild; a smaller fraction (often cited around 1–3%) find it severely impacts quality of life [1].
Why (and how) the brain creates sound
Even when tinnitus is “triggered” by the ear, the experience of tinnitus is generated by brain networks that process sound, attention, and emotion [2,3]. Several models try to explain why tinnitus emerges and why it can become intrusive.
1) Reduced input and “central gain”
A common idea is that when the brain receives less input from the ear (for example, after inner ear injury or age-related changes), it compensates by increasing sensitivity—like turning up the gain on a microphone [2]. This can make spontaneous neural activity more noticeable and more likely to be perceived as sound.
“Candle in a dark room” analogy. Draw two panels. Panel A: a small candle in a dark room looks very bright (high contrast). Panel B: the same candle in a bright room is much less noticeable (low contrast). Caption: “When the auditory system receives less external sound input (a ‘darker’ sound environment for the brain), internal signals and background neural activity can stand out more—making tinnitus easier to notice.” (This is a conceptual figure; it illustrates attention/contrast, not a literal measurement.)
2) Brain predictions and “filling in”
Another perspective comes from predictive coding: the brain continuously predicts what it expects to hear and compares that to incoming signals. If the input is reduced or uncertain, internal signals can be given more weight and become a stable perception [3]. In this model, tinnitus can become “locked in” when the brain treats the tinnitus signal as meaningful and predictable.
3) Attention, emotion, and the “salience” loop
The same tinnitus sound can be experienced very differently by different people. That’s because tinnitus distress depends heavily on attention and emotional systems. When tinnitus is labeled as threatening or alarming, it becomes more salient (important), which makes the brain monitor it more—making it feel louder and more intrusive. Stress and poor sleep can amplify this loop [1].
4) Stress and arousal can turn up the volume
Many people notice spikes in tinnitus when stressed, exhausted, or ill. Stress activates “fight-or-flight” physiology and increases vigilance, which can make internal sensations (including tinnitus) feel more intense [1]. Tinnitus itself can be stressful, creating a feedback loop.
Why tinnitus volume can change day to day
Tinnitus often fluctuates. Common influences include:
- Stress and anxiety: higher stress often increases intrusiveness [1].
- Sleep and fatigue: poor sleep can lower coping capacity and increase vigilance.
- Quiet environments: tinnitus usually stands out more in silence.
- Somatic factors: jaw/neck tension, clenching, illness, and pressure changes can modulate tinnitus for some people [5].
- Loud noise exposure: tinnitus may spike after loud environments, especially without hearing protection.
Why tests can be “normal” (and tinnitus still real)
A standard hearing test (audiogram) measures hearing thresholds for certain frequencies and conditions. It does not measure every aspect of hearing function. Some people have bothersome tinnitus even when their standard audiogram looks normal.
One debated explanation is cochlear synaptopathy (sometimes called “hidden hearing loss”): damage to connections between inner hair cells and auditory nerve fibers that may not shift standard thresholds but could affect how the auditory system signals at higher levels or in challenging listening situations [4]. Research is ongoing, and clinical tests that reliably detect this in individuals are still being refined—so this is an active area rather than settled fact.
What we’re still learning (uncertainties and debated areas)
Even with decades of study, several areas remain uncertain or actively debated:
- Hidden hearing loss: promising but not fully proven as a universal explanation; results vary across studies and individuals [4].
- Somatic modulation: many people can change tinnitus by moving jaw/neck/eyes; suggests cross-talk between sensory systems and auditory pathways [5].
- Peripheral vs central drivers: many models support a “spark in the ear, fire in the brain” view; the relative balance likely differs person-to-person.
What helps (evidence-based options)
There is no single “cure” that reliably stops tinnitus for everyone. But there are strategies with evidence for reducing tinnitus distress, improving sleep, and improving quality of life. The most effective approaches usually target attention, emotion, and hearing/communication—not just the sound itself.
Most supported / recommended
- Cognitive Behavioral Therapy (CBT): The strongest evidence base for reducing tinnitus distress and improving quality of life [6]. CBT does not try to “erase” the sound; it helps change the brain’s interpretation and reaction to it.
- Hearing aids (when hearing loss is present): Amplifying external sound can reduce tinnitus contrast and improve communication; guidelines recommend offering amplification when appropriate [7].
- Sound enrichment: Gentle background sound (fan, sound machine, nature sounds, apps) can reduce the sense of silence and help tinnitus fade into the background. Many people find this especially helpful at bedtime.
- Stress and sleep support: Because arousal amplifies tinnitus, addressing sleep and stress can meaningfully reduce suffering. This may include relaxation, exercise, sleep hygiene, and clinician-guided support.
Sometimes helpful (variable results)
- Tinnitus Retraining Therapy (TRT): Combines counseling and sound therapy over months; some people improve, but evidence is mixed and may overlap with benefits from counseling/sound enrichment more generally [7].
- Mindfulness / acceptance-based skills: Can reduce distress by changing relationship to the sound; studies often show improved coping rather than elimination of tinnitus.
- Specialized sound therapies: Notched music and other patterned sound approaches have mixed evidence and may help some individuals, but results are inconsistent.
Experimental / emerging
- Bimodal neuromodulation: Combines sound with mild stimulation (tongue/neck/skin) to influence brain networks. Trials show benefit for some people, not all, and optimal candidates/protocols are still being studied [8].
- Brain stimulation (rTMS, tDCS, etc.): Studied for years with mixed outcomes; not routinely recommended based on guideline-level evidence [9].
- Medications under investigation: No medication is approved specifically for tinnitus; many targets have been tested with limited or inconsistent benefit.
What to avoid and common myths
Myth: “My tinnitus will just keep getting worse.”
Reality: Many people stabilize or improve, especially as the brain habituates and distress decreases. Fluctuations are common and do not mean you’re “back to square one.”
Myth: “There’s nothing I can do.”
Reality: Evidence-based approaches (CBT-based strategies, hearing care when needed, sound enrichment, sleep/stress work) often reduce suffering significantly—even if the sound does not fully disappear [6,7].
Myth: “Supplements can cure tinnitus.”
Reality: Many supplements are marketed for tinnitus, but rigorous evidence has not shown consistent benefit over placebo, and major guidelines do not recommend them as a primary treatment [9].
Myth: “Ear candling or other alternative treatments can remove tinnitus.”
Reality: Alternative treatments (including ear candling) lack solid evidence and may carry risk. It’s reasonable to discuss any approach you’re considering with a qualified clinician.
When to get checked
- Sudden hearing change (hours to 3 days), with or without tinnitus: Treat as urgent. Sudden sensorineural hearing loss can be time-sensitive. See emergency guidance.
- Pulsatile tinnitus (heartbeat-synced whooshing) or new one-sided tinnitus (especially with one ear clearly worse): these patterns should be evaluated.
- Neurologic symptoms (new facial weakness/numbness, severe headache with neurologic signs, severe vertigo preventing safe walking, confusion, etc.): seek urgent evaluation. See emergency guidance.
Not sure what level of care you need? Use the Tinnitus Triage Tool and the Care Navigator.
FAQ
Is tinnitus “in my ears” or “in my brain”?
In many cases, tinnitus is triggered by changes in the ear, but the perception is generated by brain networks that process sound and attention [2,3]. A useful way to think about it is: the ear may provide the trigger, and the brain determines how noticeable and distressing it becomes.
Why is tinnitus worse at night or in quiet rooms?
In quiet environments there’s less external sound to “compete” with tinnitus, so tinnitus has higher contrast and becomes easier to notice. Many people benefit from gentle sound enrichment at night (fan, sound machine, nature sounds) to reduce silence and support sleep.
Can stress really make tinnitus louder?
Stress and poor sleep can increase vigilance and amplify internal sensations, including tinnitus [1]. This doesn’t mean tinnitus is “imagined”—it means the nervous system is more alert and less able to tune it out.
If my hearing test is normal, does that mean “nothing is wrong”?
A normal audiogram means your thresholds in that test range are within normal limits. It does not rule out tinnitus or all types of auditory system change. One debated possibility is hidden hearing loss/cochlear synaptopathy, but research and clinical testing are still evolving [4].
Do hearing aids help tinnitus if my hearing loss is mild?
For many people with tinnitus and measurable hearing loss, even mild, hearing aids can reduce tinnitus contrast by increasing helpful external sound and improving communication [7]. Whether they help you depends on your hearing profile and your goals—an audiologist can guide a trial when appropriate.
Questions to ask your provider
- What patterns in my symptoms matter most (one-sided, pulsatile, sudden change)?
- Do I need a hearing test or other evaluation?
- Would CBT-based tinnitus therapy be appropriate for me?
- Would hearing aids or sound therapy likely help in my case?
- What should I do if my tinnitus suddenly changes?
References and further reading
- Patil JD, Alrashid F, Eltabbakh A, Fredericks S. (2023). The association between stress, emotional states, and tinnitus: a mini-review. Front Aging Neurosci. 15:1131979. DOI: 10.3389/fnagi.2023.1131979.
- Noreña AJ. (2011). An integrative model of tinnitus based on a central gain controlling neural sensitivity. Neurosci Biobehav Rev. 35(5):1089–1109. DOI: 10.1016/j.neubiorev.2010.11.003.
- Sedley W, Friston KJ, Gander PE, Kumar S, Griffiths TD. (2016). An integrative tinnitus model based on sensory precision. Trends Neurosci. 39(12):799–812. DOI: 10.1016/j.tins.2016.10.004.
- Stanley R, Nanavati N. (2025). Tinnitus and cochlear synaptopathy: exploring listening effort, speech perception in noise, and auditory brainstem response in normal-hearing adults. Egypt J Otolaryngol. 41:135. DOI: 10.1186/s43163-025-00885-5.
- Levine RA, Nam EC, Oron Y, Melcher JR. (2007). Evidence for a tinnitus subgroup responsive to somatosensory-based treatment modalities. Prog Brain Res. 166:195–207. DOI: 10.1016/S0079-6123(07)66017-8.
- Fuller T, Cima R, Langguth B, Mazurek B, Vlaeyen JW, Hoare DJ. (2020). Cognitive behavioural therapy for tinnitus. Cochrane Database Syst Rev. 1:CD012614. DOI: 10.1002/14651858.CD012614.pub2.
- De Ridder D, Schlee W, Kang S, et al. (2023). Tinnitus guidelines and their evidence base. J Clin Med. 12(9):3087. DOI: 10.3390/jcm12093087.
- Jones GR, Cercone A, Sidman E, Lenaghan JA, Ahmed SS, Shore SE. (2023). Reversing synchronized brain circuits using targeted auditory-somatosensory stimulation to treat phantom percepts (tinnitus): a randomized clinical trial. JAMA Netw Open. 6(6):e2315914. DOI: 10.1001/jamanetworkopen.2023.15914.
- Tunkel DE, Bauer CA, Sun GH, et al. (2014). Clinical practice guideline: Tinnitus. Otolaryngol Head Neck Surg. 151(2 Suppl):S1–S40. DOI: 10.1177/0194599814545325.
Next steps
Get personalized guidance. If tinnitus is affecting your sleep, focus, mood, or daily life, consider an audiology or ENT evaluation and evidence-based tinnitus care.
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