Can I have tinnitus without hearing loss?
Learn about what it means to have tinnitus when you think your hearing is normal.
The 3 key takeaways
- Tinnitus can be a sign of hearing loss, but not always — Tinnitus without hearing loss can exist for a variety of reasons.
- Getting a hearing test is an important first step in getting help for your tinnitus — Even if you don’t think you have a hearing problem, it is important to rule out hearing loss as a cause.
- Tinnitus is a common symptom that presents in many health conditions — The Centers for Disease Control and Prevention (CDC) estimates that about 25 million Americans have experienced tinnitus. Tinnitus can be a symptom of many underlying health conditions.
Although many people have heard about tinnitus or encountered it at one time or another, it doesn’t make it any less concerning when it happens. Tinnitus is most often a symptom of hearing loss, but what does it mean when you have tinnitus and no trouble hearing? Rest assured: tinnitus is typically harmless, but we will explore some of the common causes of tinnitus without hearing loss and when it is important that you seek medical help.
You’ve probably heard the old wives’ tale that when you hear ringing in your ears, it means someone is talking about you. If only it were that simple! Tinnitus is actually a symptom that occurs when you perceive sound with no external source. It could sound like ringing, hissing, static, or any number of noises. Some people have tinnitus in one ear or both, while others instead perceive a sound in their head. Tinnitus can be constant, or it can be intermittent. For some people, tinnitus can be easily ignored and may just be a nuisance. For others, it can be a serious and debilitating problem.
Tinnitus is a phenomenon that is not entirely understood, which can sometimes complicate diagnosis and treatment. There is also no test for tinnitus, as it is mostly subjective– only you perceive it. Since tinnitus can be a symptom of underlying medical conditions, it is important to let your healthcare provider know if you experience tinnitus.
The common connection between tinnitus and hearing loss
Tinnitus is incredibly common in people who have hearing loss. It is suspected that when a hearing loss is present, a misfiring of auditory neurons (nerve cells) occurs, which the brain interprets as sound even when no sound is there. Tinnitus might be the brain’s way of adapting to the lack of sounds it receives from the ears. Tinnitus can occur with temporary causes of hearing loss, such as ear infections or impacted ear wax. It can also be a sign of damage to the auditory system, such as with exposure to loud noise or music. There are also numerous vestibular disorders that can cause tinnitus, particularly Meniere’s disease, whose hallmark is a loud roaring sound.
Even if you don’t suspect a hearing loss, it is highly recommended that you get a hearing test if you are dealing with tinnitus. Hearing tests are quick and painless and can provide a lot of valuable information to help narrow down the cause of your tinnitus. During a hearing test, an audiologist will review your medical history and evaluate all parts of your ear for any potential problems. Although there are no tests for tinnitus, some audiologists who specialize in tinnitus might perform a tinnitus assessment, which can be done through survey tools and by matching the pitch and loudness of your tinnitus. Tinnitus assessments are especially important in helping develop a treatment plan, even if your hearing turns out to be normal.
Can tinnitus exist without hearing loss?
Although hearing loss might be the most common cause of tinnitus, it is certainly not the only one. Tinnitus is a symptom that can coexist with numerous health conditions. If hearing loss has been ruled out, your audiologist might refer you back to your primary healthcare provider or to another specialist for further evaluation and review of your medical history. It is important to understand that sometimes tinnitus is also idiopathic, which means a cause cannot be determined.
Diseases or problems that affect the brain have the potential to cause tinnitus. Some of these include a traumatic brain injury, migraine headaches, and tumors of the brain, head, or neck.
Mental Health Disorders
Tinnitus is a common symptom of mental health disorders such as depression, anxiety, and stress. Although the research is still not clear whether or not mental health problems cause tinnitus, we know there is a strong relationship between them. We also know that untreated tinnitus can lead to these disorders in some people.
Conditions that affect blood flow have the potential to cause tinnitus. If you have tinnitus that follows the beat of your heart, called pulsatile tinnitus, it is important to tell your healthcare provider so that they can rule out blockages of your arteries and vessels. People with diabetes or high blood pressure are at higher risk for vascular diseases.
Temporomandibular Joint (TMJ) Disorder
The temporomandibular joint (TMJ) is a joint that connects the lower jaw to the skull. TMJ disorder can cause tinnitus, along with other ear symptoms such as ear fullness, popping, and ear pain.
Other chronic medical conditions
Various metabolic and autoimmune diseases can cause tinnitus without hearing loss. However, we often do not know the exact reasons why tinnitus occurs for many of these diseases.
Side effects of persistent tinnitus
Although tinnitus alone cannot physically harm you, its side effects can negatively affect your overall well-being. Untreated tinnitus is associated with a number of mental health disorders that, over time, could lead to physical health issues as well. If you can relate to the following symptoms, it might be time to consider seeking treatment for your tinnitus.
- Trouble concentrating. Tinnitus can be distracting, especially when loud and constant.
- Stress. Chronic tinnitus can lead to stress, and continued stress can make tinnitus worse.
- Poor sleep. Many people are woken up by their tinnitus or have trouble falling asleep because of it. This can lead to fatigue during the day.
- Depression. Untreated tinnitus can cause you to lose interest in activities and withdraw socially.
- Anxiety. Anxiety triggers the body’s “fight or flight” response, which can lead to increased nerve activity in the brain and can possibly make tinnitus worse.
- Mood changes. Irritability and mood swings are side effects of tinnitus and the other mental health symptoms that come with it.
Treatment options for tinnitus without hearing loss
The good news is that there are many options for treatment of tinnitus without hearing loss. Most of the treatment options available are the same as those available for someone with tinnitus caused by hearing loss. Tinnitus treatment is not one-size-fits-all. It may involve you trying different treatment options or a combination of options to find what works for you. If you are not sure where to begin, search our directory to find a licensed audiologist near you. Audiologists can not only provide an assessment, but they can get you in touch with other resources and professionals in your area that may be able to help.
Cognitive-behavioral therapy (CBT)
Cognitive behavioral therapy (CBT) is a type of psychological therapy aimed at managing thoughts and behaviors to reduce negative effects of mental health issues. CBT can be applied to tinnitus to reduce stress and negative emotions that result from it. CBT can help you change how your brain and body react to tinnitus, with the goal of you eventually getting used to it. Licensed mental health professionals, such as psychologists, and licensed social workers can provide CBT.
Sound therapy involves introducing sounds into your environment in order to distract your brain and mask the tinnitus. Sound therapy can be very simple, such as running a fan at night when it is quiet or listening to relaxing sounds. There are smartphone apps available that provide soundscapes and noises to listen to when you feel bothered by your tinnitus or if you are having a hard time falling asleep. You can also purchase small electronic sound generators.
Stress management and relaxation techniques
When people are stressed, their tinnitus is often worse. Relaxation and mindfulness techniques, such as meditation or biofeedback, can help you calm your brain, reduce stress, and reduce the negative effects of tinnitus. These techniques can also be a component of CBT.
Tinnitus retraining therapy (TRT)
Tinnitus retraining therapy (TRT) uses a combination of sound therapy and counseling to reduce your negative responses to tinnitus and learn to habituate to it. TRT has been heavily researched and is proven to be an effective treatment for many patients. TRT is provided by an audiologist; you will want to find one who specializes in this area, as it not something all audiologists provide.
Unfortunately there are no medications available that are proven to reduce or eliminate tinnitus. However, if your tinnitus is a side effect of a larger medical condition, such as depression or anxiety, medications used to treat those might bring about some relief. Antidepressants and anti anxiety medications can help reduce the harmful effects of stress, depression, and anxiety and might lead to an improvement in how you manage your tinnitus.
Although many times tinnitus is something out of your control, there are still some ways you can try to prevent it.
- Avoid or limit exposure to loud noise. Loud noise can damage your hearing and lead to tinnitus. Wear hearing protection whenever possible when you go to live music events or use machinery or power tools. Lower the volume on your headphones and stereos. Loud noise can not only cause tinnitus, but it can make existing tinnitus worse.
- Reduce stress. Sometimes this is easier said than done, but it is important to make an effort to reduce stress in your everyday life. Long-term stress can lead to physical medical problems and is linked to tinnitus.
- Take care of your heart. Cardiovascular problems can cause tinnitus. Try to eat a healthy diet with a lot of variety and stay active. If you need help following a healthy lifestyle, talk to your healhcare provider.
- Take care of your mental health. Practice good sleep hygiene and see a licensed mental health provider if you have symptoms of anxiety or depression. Mental health is just as important as physical health!
Tinnitus can be a frustrating and scary symptom. Whether you have tinnitus that came on suddenly, or existing tinnitus that you can’t tolerate anymore, start by getting an evaluation with an audiologist, even if you don’t think you have hearing loss. The important thing to know is that tinnitus can be managed and treated, and you don’t have to figure it out alone.