Tinnitus and Hearing Aids: How They’re Connected and What It Means for You?

Tinnitus is a hearing impairment that manifests as an (in some cases particularly disturbing) acoustic sensation experienced in the form of whistling, buzzing, rattling, hissing and other sounds, with no external source producing it. These sensations may be perceived by only one ear or by both ears, or they may be located in the center of the head.

In medicine, tinnitus is divided into two categories (compensated tinnitus and decompensated tinnitus) and four different degrees of severity. As for the first category:

  • Compensated Tinnitus: People who suffer from this form of tinnitus experience ringing in the ears, but can cope with it without too much trouble. As a result, no physical or psychological problems are detected and the quality of life is only minimally affected.
  • Decompensated Tinnitus: In people with decompensated tinnitus, ringing has a significant impact on physical and/or mental health and can cause a high degree of suffering.

Regarding severity, experts usually divide tinnitus into four degrees of severity that identify the degree of suffering in tinnitus patients:

  • Severity I: the person does not suffer;
  • Severity II: the tinnitus mainly occurs in environments with complete silence and especially in combination with a lot of tension or stress.
  • Severity III: people who suffer from this form of tinnitus experience it in their private life and at work. There are also associated symptoms such as sleep, concentration and balance disorders.
  • Severity IV: People who suffer from tinnitus severity IV experience this condition as limiting in their daily lives. Related health problems, such as migraines and depression, can also occur.

In addition, it is important to know that, depending on the duration of the whistling and buzzing, three types of tinnitus can be distinguished:

  • Acute Tinnitus: People with acute tinnitus suffer from annoying ringing in the ears that comes on suddenly and can last up to three months.
  • Subacute Tinnitus: Subacute tinnitus occurs when the ringing persists for three to 12 months.
  • Chronic Tinnitus: In this case, the tinnitus lasts for more than a year and is observed permanently.

Sound masking devices can emit a continuous low volume white noise or other forms of sound that drown out the tinnitus buzz, allowing the sufferer to ‘forget’ the buzz, making it more bearable.

Symptoms of Tinnitus

The main symptom of tinnitus is hearing a ringing in one or both ears. The perception of this sound may increase or decrease depending on the ambient noise, resulting in a “ masking effect ”. This means that the person may experience mild tinnitus in the noisiest places (e.g. shopping malls, particularly busy streets) or more intense tinnitus in quieter places (e.g. at night, when he/she falls asleep).

It should be noted that tinnitus becomes more common with age: about one in three cases of tinnitus are diagnosed in patients between the ages of 60 and 69. This is not surprising, as the primary catalyst for tinnitus is hearing loss, which in turn increases after age 60.

Tinnitus can be accompanied by a number of associated symptoms, including:

  • Feeling of pressure in the head or ear
  • Sleep disturbances, concentration problems, nervousness, irritability
  • Dizziness, disturbances of balance
  • Headache, Migraine
  • Earache
  • Forms of anxiety and mood swings
  • Muscle tensions in the area of ​​the cervical spine or jaw
  • Dysacusis, ie a distorted and altered perception of sounds
  • Hyperacusis, ie a hypersensitivity to loud noises

From a clinical point of view, tinnitus is often classified into two different types: subjective tinnitus and objective tinnitus.

The Most Common Causes Of Tinnitus

40% of people diagnosed with tinnitus cannot identify the possible causes or origin of these symptoms. In this regard, it is worth bearing in mind that this condition (in 75% of cases) may be associated with emotional stress as a trigger rather than inner ear problems. In addition, tinnitus can be a symptom of a variety of diseases, including hearing loss, otosclerosis, or acoustic neuroma. The causes of tinnitus can be divided into four groups: otological (ear related), neurological, infectious and drug related. Below are all the features.

1. Ear Disorders

Among the triggers of tinnitus are some ear conditions, which are called otological causes, including:

  • Sensorineural hearing loss
  • Acoustic trauma caused by exposure to sound (damage to the inner ear and/or ear canals)
  • Age-related hearing loss (hearing loss related to age)
  • Otosclerosis (abnormal bone growth of the ossicle in the middle ear called the stapes)
  • Earwax accumulation
  • Dysfunction of the Eustachian tube (the tube that connects the back of the nose to the middle ear)
  • Sudden deafness (also called sudden hearing loss)
  • Meniere’s disease

2. Neurological Causes

Tinnitus can also be caused by neurological causes, including:

  • Head injury
  • Whiplash or other cervical spine (neck) problems
  • Multiple sclerosis
  • Neuroma of the auditory nerve (also called vestibular schwannoma)
  • Vascular tumors of the middle ear (eg jugular glomus)

3. Infection

In addition to diseases related to the ear and neurological causes, tinnitus can be caused by factors of an infectious nature, including:

  • Ear infections, such as middle ear infection
  • Lyme disease
  • meningitis
  • Syphilis

4. Medicines

Ototoxic drugs can have tinnitus as a side effect. It should be noted that there are over 200 drugs (both prescription and over-the-counter) used to treat pain, serious infections, cancer, heart disease, and kidney disease that have been associated with hearing loss and tinnitus (temporary or permanent).

Drugs most commonly associated with ototoxic effects include:

  • Salicylates (eg aspirin);
  • non-steroidal anti-inflammatories;
  • Aminoglycoside antibiotics (e.g., neomycin and streptomycin);
  • loop diuretics
  • Chemotherapy drugs (especially those containing platinum);
  • Tricyclic antidepressants (eg amitriptyline and imipramine).
  • Some drugs used to treat COVID-19, including hydroxychloroquine.

5. Sound-Induced Tinnitus

Prolonged exposure to sound can cause small temporary changes in the outer hair cells of the ear, triggering tinnitus symptoms and enhancing sound processing by the central auditory system.

Occasional exposure to loud noises (eg, a music concert) can cause temporary ringing in the ears, which usually resolves within 16-48 hours, after a period of time called acoustic rest. In fact, tinnitus appears to be the most common symptom of noise-induced hearing loss (NIHL) among musicians: a German study found that professional musicians are 57% more likely to develop tinnitus than any other profession.

The Relationship Between Tinnitus And Hearing Loss

Music that sounds nice and loud through your earplugs, fireworks that are lit up close or attending a concert where the music is booming through the speakers. All sounds that can cause hearing damage and cause annoying complaints, such as hearing loss, tinnitus or hyperacusis. But what is the connection between sound, hearing loss and tinnitus?

Often there is still the idea that people with tinnitus have reduced or poor hearing, but this does not always have to be the case. People with good hearing can also suffer from tinnitus and/or hyperacusis. Within the participants we treat weekly, we often see that participants have excellent hearing, but still suffer from tinnitus and related complaints. Hearing impairment and deafness, on the other hand, can increase the risk of tinnitus.

The Function Of The Cilia

When there is a hearing loss, it often happens that the cilia in the cochlea are damaged, so that no or wrong signals are transmitted to the brain. We explain how this works: the sound that enters our ear via the auricle becomes smaller and smaller from the outside in. Each part of the ear also provides a certain reinforcement. The amplification of the sound ultimately ensures that a lot of energy is delivered in a small area, so much energy that the fluid in the cochlea is then set in motion by the stirrups, creating a wave in the fluid. The cochlea contains an organ, the organ of Corti, where the cilia, also known as hair cells, are located. These cilia are the receivers of the sound, the nerve.

With hearing loss, the cilia that are damaged will not transmit sound properly to the auditory part of our brain. As a result, we do not hear certain high and/or low tones, but a wrong signal can also be passed on to the brain, causing people to hear a beep, for example: tinnitus.

What Are The Most Common Causes Of Hearing Loss In Adults?

Some of the most common causes of hearing loss include:

  • Become older
  • Exposure to excessive noise
  • Injury
  • Viral infections (such as measles or mumps)
  • Earwax accumulation
  • Ototoxic drugs (drugs that damage hearing)
  • Genetic predisposition

Hearing loss can occur at any time during your life. Regardless of the cause of your hearing loss, you can benefit from having your hearing checked by a hearing care professional.

When is Sound Harmful?

We all know that noise can cause damage, just think of that temporary beep that you sometimes experience after a night out. Fortunately, this is only temporary, but 40% of young people, for example, when listening to music, suffer hearing damage due to the frequent use of earplugs or headphones. But how do you get sound damage? This mainly concerns the duration and intensity of the sound. There is an important connection here. Logical, because the louder the sound, the less long you can tolerate the sound without causing damage to your ear.


The most common symptoms of hearing impairment:

  • Hearing Impairment
  • Impaired understanding due to background noise (“hearing but not understanding”)
  • Ringing in the ears

In the event of sudden severe hearing loss, it is best to contact your ENT doctor immediately.

Types Of Hearing Loss

There is a distinction between hearing loss due to middle ear problems (conduction) and inner ear problems (perception) or a mixed form of both.

  • Middle ear problems are often repaired by middle ear surgery or tympanoplasty.
  • Inner ear hearing loss or mixed forms are often remedied with a hearing aid or an acoustic implant. The most common form of inner ear hearing loss is age-related hearing loss (presbycusis).
  • A cochlear implant is indicated for deafness. We always try to implant according to the internationally accepted and best technique, with respect for future new therapies.

Risk Factors And Heredity

  • Noise damage ( hearing protection! Talk to your ENT doctor)
  • Certain medications (such as some chemotherapy drugs) can lead to hearing loss and tinnitus.
  • Certain forms of hearing impairment are hereditary.


Here are some possible treatments for this condition. After the diagnosis, your doctor, together with you and the other doctors on the team, will choose the best solution for you. Your treatment may therefore deviate from the therapy(s) suggested below.

Close Eardrum Hole

Middle ear surgery in which a graft (piece of tendon, cartilage membrane or cartilage) is placed. The eardrum skin can then grow over this and close. In certain cases, a repair of the ossicular chain is also necessary.


Surgery through the ear canal for otosclerosis, in which the top part of the diseased stapes is removed and a prosthesis is placed to help you hear better.

Hearing Aid

There are many types of hearing aids in different price categories. The best hearing aid is selected for you based on your hearing profile, your (aesthetic) expectations and your budget.

Acoustic Implantation

Acoustic hearing implants help with various types of hearing loss when a conventional hearing aid or ear surgery cannot. There are fully or partially implantable devices.

Cochlear Implant (CI)

After a cochlear implant, the auditory nerve is electrically stimulated in people with (almost) deafness who cannot be helped with conventional hearing aids.

Sound is also expressed in decibels and hertz. Earlier we described that sounds are vibrations of air that moves. This is expressed in decibels and indicates how loud the sound is. The number of vibrations per second is then expressed in Hertz. 0 decibels is the so-called hearing threshold for the human ear. This does not mean that there is no sound, only the sound is not audible to us. Below you will find an overview of sounds linked to the number of decibels, with red being unsafe and green being safe. However, the damage that you may inflict on your ear by sound is of course also related to the duration of the sound to which you are exposed.

Vitamins Could Improve Your Hearing

In the quest for good health, vitamins are a tried-and-true tool. Eyes, heart, immune system—you name it, there’s a vitamin for it. It’s no surprise, then, that vitamins can help our hearing. If you’ve never considered using them to boost your aural abilities, listen up.

A Powerful Vitamin Combination for Noise-Induced Hearing Loss

Researchers recently discovered which vitamins to look for in order to fight noise-induced and age-related hearing loss. If your hearing loss is related to exposure to loud noise, consider vitamins A, C, and E taken alongside magnesium. If your hearing loss is simply an effect of growing older, folic acid may help keep your ears sharp.

To reduce noise-induced hearing loss, vitamins A, C, and E coupled with magnesium may be the answer. Noise-induced hearing loss can occur from one incident alone or as the result of long-term exposure to loud noise. Either way, it’s a widespread problem—about 30 million Americans are regularly exposed to hazardous noise levels.

University Hearing Researchers Recommend Vitamins A, C and E

University of Michigan researchers found that this nutrient mixture helps prevent noise-induced hearing loss by blocking the creation of free radicals. We typically associate free radicals with medical problems like cancer, but did you know that free radicals can also damage your hearing?

Here’s how. When the ear is exposed to loud noises, the cells of the inner ear create free radicals. When those free radicals come in contact with the tiny hair cells in the ear, they destroy the hair cells, reducing hearing ability. Once the hair cells are dead, they can’t grow back. Simultaneously, the free radicals restrict blood flow to the ear, making hearing even more difficult.

The hearing experts reported, on the sites Hearing Loss Help and Health Talk, that vitamins A, C and E work alongside magnesium to stop the free radicals from forming in reaction to loud noise. The combination stopped an impressive 80 percent of noise-induced hearing loss. While the vitamins and magnesium taken alone slightly helped hearing loss, when put together – they were significantly more effective!

Because free radicals continue to form even after exposure to loud noise, taking the nutrient combination as many as three days after the incident can still help reduce hearing damage.

Any longer than that, however, and the damage can’t be reduced. From soldiers who’ve served on the front lines, to employees in noisy factories, to teens who like their music cranked up, this finding has the potential to help the vast number of people who are exposed to loud noises for either work or play.

Folic Acid for Age-Related Hearing Loss

Even if you’ve never worked in a noisy environment or enjoyed listening to loud music, you still may find it getting harder to hear as you age. If so, you aren’t alone—one in three Americans over age 70 live with some degree of hearing loss. Luckily, preventing age-related hearing loss may be as simple as upping your folic acid intake.

Age-related hearing loss can occur in part because of the amino acid homocysteine. This essential amino acid causes hearing difficulty by reducing blood flow to the inner ear.

A University of Sydney study found that men and women with high levels of homocysteine in their blood were an alarming 65 percent more likely to suffer from hearing loss. That’s where folic acid comes in. By helping the body break down homocysteine, folic acid prevents the pesky stuff from diminishing blood flow to the ear.

In a 2010 study, audiologists found that people with low levels of folic acid were significantly more likely to experience high-frequency hearing loss. As a bonus – because too much homocysteine in the blood may also indicate heart disease, stroke and dementia, – you’re doing much more than just helping your hearing when you up your intake of folic acid. You can, of course, find folic acid in supplement form, but you can also squeeze more in your diet by choosing beans, citrus fruits, whole grains and dark, leafy vegetables.


So you see, many nutrients help prevent hearing loss, including vitamins A, C, E, folic acid and magnesium. Age-related hearing loss and noise-induced hearing loss affect millions of people in America. Medical researchers and audiology experts recommend these essentials for optimal hearing health. Now that you understand the importance of dietary supplements for hearing problems, start listening today and improve your hearing!