Permanent ringing in the ears – diagnosis tinnitus

There is a whistling, buzzing, ringing, humming and cracking in the ear, and not only after a night of partying or loud concerts, but constantly and for no apparent reason. If the permanent ringing in the ears does not disappear by itself, an ENT doctor is usually consulted, who then makes the diagnosis of tinnitus. Those affected can suffer for weeks, months or years. But what exactly does “tinnitus” mean? And what can you do if you are affected by it yourself?

What types of tinnitus are there?

Tinnitus can sound very different. Some hear the classic beeping in the ear, but many hear more of a buzzing, or cracking sound. In the vast majority of cases, the ear noise is subjective, meaning only the person can hear it. Only in very rare cases is it audible from the outside, e.g. when the doctor holds a stethoscope to the ear. The tinnitus is then caused by ossifications or abnormalities in the auditory canal.

Acute and chronic tinnitus
Doctors distinguish between three forms: The acute form, the subacute and the chronic form. Acute means that the ringing in the ears has just begun (less than three months). In subacute and chronic forms, it has existed for a longer time (more than three months and more than a year, respectively). This classification is based primarily on the time course of the disease. It says nothing about the treatability of the tinnitus. Even in the case of a chronic course, treatment makes sense.

Interference caused by the tinnitus
If the tinnitus is present but hardly disturbs the affected person, it is discussed as compensated tinnitus. This form is also the target state of the therapy procedures

A decompensated tinnitus, on the other hand, leads to considerable suffering and impairment. It is then constantly perceived and can drive the affected person virtually “insane”. Decompensated and chronic tinnitus can cause many concomitant diseases, including:
– Sleep disturbances
– dizziness
– somatic (physical) complaints,
– tensions
– mental illnesses, such as depression and anxiety disorders

The health of the affected person can be attacked by a tinnitus on many levels. Therefore, a tinnitus is an extremely complex health impairment that must be treated accordingly in a holistic manner.

Where does tinnitus come from?

Often preceded by other hearing problems, such as hypersensitivity to sound (hyperacusis) or a hearing loss. Sometimes a circulatory disorder of the inner ear is also the cause of tinnitus. This can be treated with circulation-enhancing agents.

Rarely purely physically caused
However, if there are no anatomical peculiarities in the auditory canal or circulatory disorders and tumors along the auditory pathway in the brain are also excluded, then tinnitus is a neurological phenomenon with complex causes. The brain generates a sound or the illusion or perception of a sound that does not exist in reality.

If all organic causes have been ruled out and the constant ringing in the ears persists, other causes for the disturbing ear noise must be considered. Here we enter the realm of the psyche and its interaction with the body (see also: psychosomatics).

What does tinnitus have to do with the psyche?

Some people are surprised to hear that tinnitus is treated in psychosomatic clinics and not primarily in ENT clinics. This is because a) it can have psychological causes, b) it favors psychological sequelae, and c) psychotherapeutic methods are very effective for therapy.

Psychological causes
A tinnitus can be a signal for strong overload and is therefore mainly associated with the disease burnout. However, depression, anxiety and compulsive disorders also increase the risk of ringing in the ears. In addition, dealing with tinnitus is influenced by the psychological characteristics (e.g., personality traits) of the affected person. Thus, the healing process is more difficult in very pessimistic or critical people than in optimistic ones.

Psychological consequences
If tinnitus occurs together with mental illness, the famous chicken-and-egg problem arises: which came first? The mental illness or the ringing in the ears? This is sometimes not so easy to answer, if for example a depression was not recognized at all in advance by the affected person himself and his doctors. However, it does not have to be a full-blown mental disorder at all. Negative feelings alone, such as anger, resentment and powerlessness, can intensify the experience of illness and suffering.

The vicious cycle of perpetuation
Additionally, psychological factors also play an enormous role in the perpetuation of tinnitus. For example, the perception of ringing in the ears can be self-reinforcing if it is given a lot of negative evaluation and attention by the affected person.

Important: If one goes to treatment, one recognizes its quality by the fact that psychological causes are also considered from the beginning. Tinnitus is a disease that can have many causes, some of which are interconnected. This makes the disease very complex and should be considered by professionals from the beginning.

Diagnosis of tinnitus: What therapy is available?

One thing in advance: you are not helplessly at the mercy of tinnitus. There are now many clinics and outpatient therapists who specialize in the treatment of psychological consequences and causes. The following therapy methods are often used:

– Relaxation methods: reduce the general stress and burden of tinnitus.
– Cognitive restructuring: change negative evaluation of the ringing in the ears and reduce negative thoughts.
– Acceptance: accept the tinnitus and stop it from becoming the focus of attention
– Psychotherapy: address stressful issues in life and look for ways to solve them.
– Sports therapy: stress reduction through exercise.
– Auditory therapy: experiment with which sounds can possibly mask the disturbing tinnitus (noise-canceling).
– Biofeedback: be able to better assess their own stress response.
– Psychoeducation: with regard to sleep hygiene, dealing with stress, etc.
– Drug support: if in the course or already in the run-up a mental disorder shows, medications are prescribed supportive if necessary.

Another method is the so-called “Reframing”, which should also form the conclusion here. Reframing means to give events or sensations a different framework and thus reinterpret them. In the case of tinnitus, one idea would be to no longer title it as a “disturbing, annoying and suffering” experience, but as a “signal from the body to take better care of itself”. Maybe this little tip will help you to tackle the treatment or to motivate yourself for further treatment.


(1) Czischke, Helga (2004), Tinnitus von A – Z : eine Sammlung von Fragen und Antworten rund um das Thema Tinnitus. Hrsg. Deutsche Tinnitus-Liga e.V.

(2) Wendler, J. (2005). Textbook of phoniatrics and pedaudiology. Georg Thieme Verlag.

Categories: Burnout Depression

Verena Klein
Autor Verena Klein
"Die LIMES Schlosskliniken haben sich auf die Behandlung von psychischen und psychosomatischen Erkrankungen spezialisiert. Mit Hilfe des Blogs möchten wir als Klinikgruppe die verschiedenen psychischen Erkrankungen näher beleuchten und verschiedene Therapien sowie aktuelle Themen vorstellen."

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