Did you know that 80-90% of people with tinnitus also experience hearing loss? One of the most common questions we get asked is whether there is a link between the two. Hearing loss, a reduction in the ability to hear, and tinnitus, the perception of a sound without any external cause, are indeed closely related. Many of the causes of damage to the ear are risk factors for developing both hearing loss and tinnitus, for example exposure to loud noise and certain medications. Oto presents the essential facts about tinnitus and hearing loss, and what can be done to address both conditions.

Alexandra Costlow AuD

Medically Reviewed by
Dr Jameel Muzaffar
Audiologist and Tinnitus Specialist
September 3, 2021

Tinnitus and Hearing Loss: Is There A Connection?

Did you know that 80-90% of people with tinnitus also experience hearing loss? One of the most common questions we get asked is whether there is a link between the two.

Hearing loss, a reduction in the ability to hear, and tinnitus, the perception of a sound without any external cause, are indeed closely related.  Many of the causes of damage to the ear are risk factors for developing both hearing loss and tinnitus, for example exposure to loud noise and certain medications.

Oto presents the essential facts about tinnitus and hearing loss, and what can be done to address both conditions.

Overcompensating For Loss Of Sound

tinnitus and hearing loss, tinnitus with hearing loss
When there is a lack of sound coming from the ear to the brain, the brain increases its sensitivity to be able to bring in sound more easily.

Although there are many factors that can exacerbate tinnitus, the most widely accepted theory regarding the cause of tinnitus is that if there is damage to the hearing system, the brain tries to compensate for the reduced sound information by turning up the sensitivity of the system. You can think of this as similar to turning up the sensitivity of a microphone, which increases the likelihood of causing sound distortion.

An example of this could be in someone that has been exposed to harmfully loud noise and develops noise induced hearing loss. Loud noise exposure damages the hair cells of the inner ear.

Undamaged, the hair cells work by detecting pressure waves as they move through the fluid of the inner ear.

The process of sound traveling to the hearing system:

In a well functioning ear these pressure waves are converted into electrical signals which are sent down the neurons that make up the auditory nerve. The signals are then transmitted up through the brainstem and into the brain proper.

In this scenario, even though the location of the injury is the hair cells, the knock on effect is that stimulation rates in the neurons are increased to try and overcome the reduced levels of sound input.

Put simply, when any part of the ear is damaged and can no longer sense sound normally, the brain tries to compensate by becoming more sensitive to sound. At times the brain may even overcompensate and become too sensitive to sound.

There has long been debate about whether tinnitus is in the ear or the brain, but scientists currently think that the answer is more complex, with problems in the ear often being the initiator of tinnitus. This is then perpetuated by changes in the brain.

Tinnitus and Hearing Loss

tinnitus and hearing loss, tinnitus with hearing loss
Hearing aids provide increased access to sound and help to mask or cover the tinnitus.

The overlap between tinnitus and hearing loss is also a reason why some treatments help with both conditions, for example using hearing aids. If someone has both hearing loss and tinnitus, using a hearing aid can improve their access to sound and speech and also decrease the amount of effort required for them to listen to and make sense of speech.

Being able to understand more of the sounds around them and not having the worry or embarrassment of needing to ask other people to repeat themselves can also reduce stress and anxiety, both of which make tinnitus worse. Using a hearing aid also helps to make the sounds of the world louder, which can mask, cover, or blend the sound of their tinnitus.

White noise machines for tinnitus can also help cover or blend the sound of the tinnitus when speech and environmental sounds aren't around. White noise machines and environmental masking is helpful for people with normal hearing levels and tinnitus.

Many people struggle with how to sleep with tinnitus because they feel that the tinnitus is louder at night. The tinnitus isn’t really louder at night, it is more that during the day there tends to be more sound around and more visual distractions.

If there is an underlying cause to the hearing loss and tinnitus, such as an ear infection or a build up of wax in the ear canal, then treating this cause, for example with ear wax removal, may improve may both conditions.

A thorough examination of tinnitus will involve an assessment of hearing because of the close relationship between the two. If you have any concerns with either hearing loss or tinnitus you should make an appointment with your general practitioner or audiologist.

Tinnitus and Noise Induced Hearing Loss  

tinnitus and hearing loss, tinnitus with hearing loss
One very loud exposure can lead to hearing loss and tinnitus. Noise induced hearing loss can be prevented.

Noise induced hearing loss occurs when you are exposed to a harmfully loud sound for long enough to damage the hair cells of the inner ear.

We can think of sound as a 'dose', in that there are two variables: intensity (decibel level) and time of exposure.

Generally, sound is considered potentially dangerous if it exceeds 85dB. The longer the exposure, the greater the risk of hearing damage.

Extremely loud sounds such as a blast or explosion can also damage the ear drum by rupturing it or potentially damaging the bones of the middle ear.

Noise induced hearing loss is preventable in many instances.

You can prevent it with:

Protect Your Hearing To Prevent Hearing Loss

tinnitus and hearing loss, tinnitus with hearing loss
Use hearing protection whenever you may be exposed to harmfully loud noise (>85dB).

Many causes of hearing loss, such as genetic or due to aging, cannot be prevented. But one way you can prevent further hearing loss is to protect the ears from harmfully loud noise.

One of the best ways to protect the ears from noise is to use hearing protection, which can come in many forms such as foam plugs or ear muffs. Another way to limit noise exposure is to take auditory breaks to lessen the amount of time you are exposed to loud sound.

Loud noise exposure can happen at work, at home, or an event. Examples of places and events where hearing protection should be worn include but are not limited to:

  • Concerts
  • Live music at restaurants, bars, or festivals
  • Sporting events
  • Use of power tools, mowing the lawn
  • Recreational or occupational artillery / shooting
  • Riding motorcycles, dirt bikes, and other motorized vehicles
  • Fireworks
  • Rallies or marches, other crowded events especially where loudspeakers may be present
  • Sirens

Living With Tinnitus

Whether or not you have hearing loss, the good news is that there are many effective treatments for tinnitus.

A safe and effective treatment for people with or without hearing loss is CBT for Tinnitus. With Oto, you can access digital CBT wherever and whenever you like with 86% of users seeing improvement in their tinnitus.

The key here is to improve the quality of your life with tinnitus.

It's possible that you may still hear your tinnitus from time to time but the goal is to experience tinnitus less often and to lessen its effect on your ability to live a happy and productive life. Tinnitus can fluctuate but the important thing is to focus on an overall arc of improvement.

Identify the specific goals that you'd like to improve, such as hearing or sleeping better, and then target the treatments that are right for you, to help you reach these goals. It may take a combined approach using multiple forms of tinnitus treatment to achieve success.

Tinnitus May Be A Sign Of Hearing Loss

It's important to determine if the tinnitus you perceive is a sign of hearing loss in order to know how to treat it.

Explore where you can find professional tinnitus help here.

Tinnitus relief made simple with the Oto app digital therapy programme. Download today.

Relieve your tinnitus today with Oto's digital therapy

The Oto app features
Science-based tinnitus therapy programme
The Oto app features
Includes CBT, targeted mindfulness, physical therapy and sound therapy
The Oto app features
Created by a team of doctors, audiologists and tinnitus specialists
Try Oto for free

Start relieving your tinnitus today

Try Oto for free
The Oto app features

Instant access to science based tinnitus therapy

The Oto app features

Includes CBT, targeted mindfulness, relaxation and sound therapy

The Oto app features

Created by a team of doctors and tinnitus experts

Similar Articles