Understanding Tinnitus: Why It Happens and Why It Becomes So Distressing
By Virginia Lindahl, PhD
One day about 15 years ago, I noticed a ringing in my ears.
At first, I assumed it would go away. But over the next few days, I found myself focusing on it more and more. I woke up checking for it, and every time my son was quiet, I’d check whether it was still there. I searched online trying to figure out what could have caused it. No loud concerts recently. No head injuries. My last scuba diving trip had been months earlier. So what caused it?
I started focusing more and more on the idea that this could be permanent and kept coming back to the same question, What if I never hear silence again?
Then one question replaced all the others: “Will this ever go away?”
As the days passed, I started checking if it was louder than yesterday. I avoided quiet places and when my 7-year-old was especially loud, I left the room. My father, who told me casually he’d had tinnitus since Vietnam, told me to “ignore it.” My mouth might have actually fallen open because how had he had this debilitating condition my entire life and I hadn’t known? Ignore it? Impossible.
If you’re living with tinnitus, you’re not alone. Tinnitus affects millions of people, yet the experience varies tremendously from one person to the next. As it turns out, many of the things people do to try to make tinnitus less intrusive can unintentionally keep it at the center of attention.
What Is Tinnitus?
Tinnitus is the perception of sound without an external source. People describe it as ringing, buzzing, humming, hissing, roaring, clicking, or whistling, although the sound varies widely.
Some people hear tinnitus in one ear, while others hear it in both ears or somewhere inside the head. For some, it’s constant. For others, it comes and goes or changes over time. I hear a sort of hissing, ringing sound in both ears, and sometimes it cuts out in one ear, like if a speaker cut out abruptly.
Tinnitus isn’t a disease itself. It’s a symptom that can have many different causes.
What Causes Tinnitus?
Tinnitus is commonly associated with hearing loss, noise exposure, aging, certain medications, ear infections, earwax blockage, head or neck injuries, viruses, and other conditions affecting the auditory system. Sometimes no single cause can be identified. I have no idea what caused mine; my ENT speculated that it was a virus, adding that it didn’t matter one bit.
Because tinnitus can occasionally reflect an underlying medical condition that requires treatment, it’s important to discuss new or changing tinnitus with a healthcare professional, particularly if it begins suddenly, affects only one ear, is accompanied by dizziness, or occurs with sudden hearing loss.
Many people hope that once they know what caused the tinnitus, it will simply go away. Unfortunately, that’s not always what happens. Even after a medical evaluation provides answers, many people are left wondering why the sound continues to dominate their attention.
Why Does Tinnitus Affect People So Differently?
One of the most surprising things about tinnitus is that two people with similar tinnitus can have completely different experiences.
One person barely notices it. Another notices it from the moment he wakes up, listens for changes throughout the day, struggles to concentrate, and worries about whether it will ever improve.
The difference usually isn’t explained by the sound alone.
Research suggests that the emotional meaning the brain attaches to tinnitus influences how much attention it receives. Over time, that attention plays a major role in how intrusive the tinnitus feels. That’s one reason two people with similar tinnitus can have very different experiences.
Why Can It Become So Hard to Ignore?
Your brain is constantly deciding what deserves your attention.
Most of the time, it filters out information that isn’t important. You probably don’t notice the feeling of your clothes against your skin, the hum of your refrigerator, or the sound of your heating system unless someone points it out.
When tinnitus first appears, it’s completely natural to begin paying close attention to it. People listen for it in quiet rooms, compare it from one day to the next, wonder whether it’s becoming louder, or try to determine what it means.
Ironically, constantly monitoring tinnitus can make it seem even more noticeable. The more attention the brain gives the sound, the more likely it is to continue bringing that sound into awareness.
Why Does Tinnitus Sometimes Seem Louder?
Many people notice that tinnitus becomes more noticeable during periods of stress, fatigue, illness, poor sleep, or emotional distress.
This doesn’t necessarily mean the tinnitus itself has permanently changed. Instead, changes in attention, stress, and overall arousal can influence how much of your awareness the tinnitus occupies.
Recognizing that these fluctuations are common can make it easier to resist the urge to monitor or interpret every change.
Can Tinnitus Get Better?
Many people assume that recovery means the tinnitus has to disappear completely.
Although that does happen for some people, it isn’t the only path to improvement.
For many people, recovery means the tinnitus gradually stops demanding attention. They may realize they’ve gone several hours without noticing it or catch themselves hearing it briefly before naturally returning their attention to whatever they’re doing.
This process is known as habituation.
It means the tinnitus gradually stops feeling important, so you notice it less and less over time. Many people don’t even realize they simply stopped noticing it most of the time until it’s happened.
What Treatments Are Supported by Research?
Treatment depends partly on what caused the tinnitus.
Anyone who develops new tinnitus should discuss it with a healthcare professional. Although tinnitus is often associated with hearing loss or other benign causes, it can occasionally reflect an underlying medical condition that requires evaluation or treatment. A medical assessment can help identify potentially treatable causes and determine whether additional testing is needed.
For persistent bothersome tinnitus, Cognitive Behavioral Therapy (CBT) is considered the gold standard psychological treatment. Clinical practice guidelines, including those developed by the Department of Veterans Affairs and Department of Defense, recommend CBT because it has the strongest evidence for reducing tinnitus-related distress and improving quality of life.
CBT doesn’t attempt to eliminate the sound itself. Instead, it helps people understand and change the patterns of attention, thinking, emotions, and behavior that can unintentionally keep tinnitus at the center of awareness. As those patterns change, many people find themselves noticing the tinnitus less often and feeling much less distressed when they do notice it.
When Should You Seek Medical Evaluation?
Anyone who develops new tinnitus should discuss it with a healthcare professional. Although tinnitus is often not caused by a serious medical condition, an evaluation can help identify potentially treatable causes and determine whether additional testing is needed.
Some situations deserve more urgent medical attention. Seek prompt evaluation if tinnitus:
begins suddenly
occurs with sudden hearing loss
is accompanied by severe dizziness or balance problems
follows a significant head injury
occurs in only one ear and is new or persistent
pulses in time with your heartbeat
Living Well With Tinnitus
When tinnitus first begins, it’s difficult to imagine ever reaching a point where you don’t notice it.
Fortunately, many people do.
Over time, many people discover that tinnitus gradually fades into the background of daily life. They stop checking for it, stop organizing life around it, and often realize they haven’t noticed it for hours. The sound may still be present, but it no longer feels like the center of attention.
Recovery doesn’t always mean silence. It often means getting your life back.
Back in 2011, I couldn’t imagine a future in which I rarely noticed my tinnitus. I was asking, “What if I never hear silence again?” Today, I never ask that question because tinnitus simply isn’t something I think about anymore.
Ironically, I spend much of my day talking about tinnitus with clients, yet I almost never notice my own unless I deliberately listen for it. Even then, it’s not at all distressing, and my attention shifts naturally away from it.
Fifteen years later, the same ringing and hissing sound is still there. But now it makes no difference at all in my life. In fact, if someone offered me a pill to make it go away, I’d probably say no. Getting rid of the sound wouldn’t meaningfully change my life anymore, so why bother?
CBT for Tinnitus in Arlington, VA
Today, I rarely notice my tinnitus unless I intentionally listen for it, and helping others reach that point has become one of the most rewarding parts of my practice.
If tinnitus has become overwhelming or is interfering with your daily life, contact me to learn how Cognitive Behavioral Therapy can help tinnitus become a much smaller part of your life. Services are available in person in my Arlington, VA office and through teletherapy.