Not all tinnitus is the same. While most people experience subjective tinnitus — sounds only they can hear — a small percentage have objective tinnitus, where the sound can actually be detected by a clinician during examination. Understanding which type you have is important because it directly affects which treatments are most likely to help. Here’s what you need to know about the different types of tinnitus and how accurate diagnosis shapes the path forward.
What Is Subjective Tinnitus?
Subjective tinnitus is by far the most common form, accounting for approximately 95% of all cases. The sound — whether it’s ringing, buzzing, hissing, whooshing or humming — is perceived only by the person experiencing it. There is no external sound source that anyone else can hear or measure.
Subjective tinnitus is most commonly associated with damage to the hair cells in the inner ear (cochlea), age-related hearing changes, noise exposure, or neurological factors. It’s the type most often discussed in the context of tinnitus management and the type that responds best to sound therapy, CBT and hearing aid-based approaches.
What Is Objective Tinnitus?
Objective tinnitus is rare — it accounts for fewer than 5% of cases. Unlike subjective tinnitus, the sound is generated by a physical source within the body and can sometimes be heard by a clinician using a stethoscope or during examination. The most common causes include:
Pulsatile tinnitus — rhythmic tinnitus that pulses in time with your heartbeat, often caused by blood flow changes near the ear.
Muscular tinnitus — involuntary contractions of the muscles in the middle ear or the palate, producing a clicking or rhythmic sound.
Eustachian tube dysfunction — problems with the Eustachian tube, the channel connecting the middle ear to the back of the throat, can cause a range of unusual sounds.
Why Does the Distinction Matter for Treatment?
The reason audiologists and ENT specialists distinguish between these types is that the treatment pathways are fundamentally different:
Treatment for Subjective Tinnitus
Because subjective tinnitus involves the brain’s perception of sound rather than an identifiable physical source, treatment focuses on changing how you respond to the tinnitus:
Sound therapy and tinnitus masking to reduce the prominence of the sound
Cognitive Behavioural Therapy (CBT) to address the emotional impact
Hearing aids with tinnitus programmes to amplify environmental sounds and provide built-in relief
Relaxation techniques and stress management
Treatment for Objective Tinnitus
Because objective tinnitus has an identifiable physical cause, treatment can sometimes address the source directly:
Pulsatile tinnitus may require investigation of blood vessel abnormalities through imaging (MRI or CT scan), and treatment may involve medication or, in some cases, surgery.
Muscular tinnitus may respond to muscle relaxants or, occasionally, Botox injections to the affected muscles.
Eustachian tube problems may be managed with decongestants, nasal sprays, or in persistent cases, surgical intervention.
How Is Tinnitus Diagnosed?
A thorough hearing assessment is usually the starting point. During your appointment, the audiologist will:
Take a detailed history of your tinnitus — when it started, what it sounds like, whether it’s constant or intermittent, and any patterns you’ve noticed
Conduct a full audiometric hearing test to check for any hearing loss
Assess the pitch and loudness of your tinnitus using specialised matching techniques
Check for any signs of objective tinnitus (pulsatile sounds, clicking)
Discuss your medical history, including any medications you’re currently taking
If objective tinnitus is suspected, you may be referred for further investigation — typically to an ENT specialist for imaging or vascular assessment. If your tinnitus is subjective, the audiologist can discuss management options with you during the same appointment.
Pulsatile Tinnitus: A Special Case
Pulsatile tinnitus deserves particular attention because it can sometimes indicate an underlying vascular condition. If your tinnitus has a rhythmic, beating quality that matches your pulse, it’s important to mention this to your GP or audiologist. Most cases of pulsatile tinnitus are benign, but it should always be investigated to rule out anything that needs medical attention. Our guide on ringing in one ear versus both ears covers this topic in more detail.
Frequently Asked Questions
How do I know if my tinnitus is objective or subjective?
If your tinnitus has a rhythmic, pulsing quality or a clicking sound, it may be objective. However, the only way to confirm the type is through professional assessment. An audiologist or ENT specialist can evaluate your tinnitus and determine the most appropriate next steps.
Is objective tinnitus more serious than subjective tinnitus?
Not necessarily more serious, but it can sometimes indicate an underlying condition that needs investigation. Subjective tinnitus, while more common, can also have a significant impact on quality of life and deserves professional attention.
Can subjective tinnitus become objective?
These are generally distinct conditions with different underlying mechanisms. Subjective tinnitus does not typically develop into objective tinnitus. However, it’s possible to have both types simultaneously.
Should pulsatile tinnitus always be investigated?
Yes. While most pulsatile tinnitus is harmless, it can occasionally indicate a vascular condition that benefits from early treatment. Your GP can arrange appropriate imaging if needed.
Can both types of tinnitus be managed effectively?
Yes. Subjective tinnitus responds well to sound therapy, CBT and hearing aids. Objective tinnitus can often be treated by addressing the underlying cause. At Hear With Ish, we’ll help you understand exactly what’s going on and guide you towards the most effective management for your specific type of tinnitus.
What if my tinnitus doesn’t fit neatly into one category?
That’s quite common. Tinnitus can present in many different ways, and some people experience a combination of sounds. The important thing is getting a thorough professional assessment so the management approach is tailored to your actual experience, not a textbook definition.
Not sure what type of tinnitus you have? Book a tinnitus assessment at Hear With Ish and Ishvaree will carry out a thorough evaluation, explain her findings clearly, and recommend the best management approach for your specific situation.
