Tinnitus

It is 3 a.m. You wake up and notice a high pitched sound in one ear. You wait for it to fade, but it does not. You are not imagining it. This is called tinnitus (or 'acouphène' in French).

While tinnitus can feel alarming, in most cases it is not dangerous. The good news is that even when the sound does not completely disappear, its impact can be significantly reduced.

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What Is Tinnitus?

Tinnitus is the perception of sound when there is no actual external source present. Because it is a deeply personal experience, people describe it in many ways, such as a constant ringing, beeping, or humming. For others, it feels like a hissing, buzzing, or a whooshing sensation that may move in rhythm with the heartbeat.

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The way people first notice tinnitus varies. Some find it appears suddenly, while others realise they have lived with it for years, only noticing it more recently because it has become bothersome. It is also common for this to overlap with hyperacusis, which is an increased sensitivity to everyday sounds.

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In my praxis, I help patients see that tinnitus often follows a path of sensory sensitisation similar to PPPD. You can think of it as the brain’s 'volume control' being turned up too high. Just as the balance system in PPPD over processes movement, the auditory system becomes hypersensitive to internal sounds that should normally be filtered out. My goal is to help your nervous system recalibrate so these sounds can eventually fade back into the background.

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How Common Is It?

Tinnitus is much more common than most people realise. Around 15% of adults experience persistent tinnitus. While it can interfere with sleep, concentration, and mood, only a small percentage of people find it severely distressing. In those cases, professional support is an essential part of finding relief.

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Is Tinnitus Dangerous?

In the vast majority of cases, tinnitus is not a sign of a serious disease. However, a medical evaluation is recommended if you experience tinnitus in only one ear, a pulsating sound, sudden hearing loss, or associated dizziness. Most examinations turn out completely normal, which is a reassuring sign that the brain and ears are structurally healthy.

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What Causes Tinnitus?

Tinnitus often begins with a modification in your hearing system. When the inner ear transmits less information to the brain, whether due to loud noise exposure, the natural ageing process, or even a minor loss of hearing, the brain does not simply become quieter. Instead, it attempts to compensate for this missing information by increasing its own internal activity.

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You can think of this as the brain turning up its internal gain or sensitivity to search for the signals it expects to hear. This increased neural activity is what we eventually perceive as sound. For this reason, we now view tinnitus primarily as a change in how the brain processes sound, rather than simply a problem with the ears. In some patients, the brain also receives 'misfired' signals from the neck and jaw muscles. Because the nerves in the upper spine and jaw are physically connected to the auditory centers in the brain, physical tension can sometimes influence the sound you hear.

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Importantly, the sound itself is not the main issue; it is the way the brain reacts to the sound. When tinnitus triggers the limbic system (the brain’s 'alarm system'), it increases your attention to the sound, making it seem louder and more intrusive. Understanding this mechanism is the first step toward retraining the brain.

 

 

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How Can Physiotherapy Help?

While not all tinnitus is caused by physical tension, physiotherapy is a valuable tool for a specific group of patients. For those with somatosensory tinnitus, addressing issues in the neck or jaw can help reduce the intensity of the sound. Treatment for this group may involve manual therapy of the cervical spine, jaw (TMJ) work, and postural correction.

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For patients where a physical cause is less prominent, physiotherapy remains an important part of the journey by calming the nervous system. By focusing on breathing, relaxation techniques, and reducing the body’s 'fight or flight' response, we can decrease hypervigilance and improve sleep. Whether the sound changes physically or the brain simply learns to ignore it more effectively, the goal is to help your body feel safe again.​