Subjective experiences are those shaped by your individual feelings, beliefs, and perceptions. When tinnitus has no identifiable physical cause, and you’re the only one who can hear it, it’s referred to as “subjective tinnitus”.

Tinnitus occurs when you “hear” a sound that doesn’t have an external source. When there is no known physical cause of your tinnitus, and the sound can’t be heard by your doctor with advanced listening devices, it’s known as “subjective tinnitus.”

Subjective tinnitus can only be heard by you, and it can happen in brief episodes, or it can become recurrent and chronic. Although ringing is a common description of subjective tinnitus, some people hear whistling, buzzing, humming, and a variety of other non-rhythmic phantom sounds.

Tinnitus is common, and almost everyone experiences an episode at least once during their lifetime.

While general estimates of occurrence range up to 25% in adults, a global prevalence study from 2022 found that 14% of adults report tinnitus of any level, and of those, 2% experience severe tinnitus.

The symptoms of subjective tinnitus can vary significantly from person to person. Its core feature is a phantom sound with no identifiable physical cause or external source. People have described subjective tinnitus sounds as:

  • ringing
  • roaring
  • whistling
  • humming
  • clicking
  • hissing
  • chirping
  • squealing
  • whirring
  • whooshing

The sound you hear can be of any intensity, from soft to loud, and it can be constant or might come and go. A 2024 U.S. population-level analysis found that 41.2% of people with tinnitus heard their phantom sound constantly, and 28.3% had symptoms lasting longer than 15 years.

The pitch and clarity of the sound can also change depending on your environment and activity, improving or worsening with background noise or different head movements. Your subjective tinnitus might improve with time, go away, or occasionally worsen.

Subjective tinnitus can affect one ear (unilateral), both ears (bilateral), or can be perceived as a sound within your head rather than within your ears.

Subjective tinnitus vs. objective tinnitus

Only you can hear subjective tinnitus, but for some people, tinnitus can be heard by others.

When your doctor can hear tinnitus, or when tinnitus has an identifiable physical cause, it’s known as objective tinnitus. This means something inside of your body is directly contributing to the sound you hear.

Objective tinnitus is often rhythmic in nature. It might match your heartbeat, for example, or align with certain muscle contractions.

Common causes can include:

  • vascular changes
  • tumors
  • middle ear spasms
  • increased pressure inside the skull
  • disorders of the jawbone and skull joint (temporomandibular joint)

Objective tinnitus may improve or resolve fully with medical treatments addressing the underlying cause.

The exact reason people experience tinnitus isn’t clear, but experts believe dysfunction in the nerves transmitting signals from your auditory networks to other parts of your brain underlies the condition for most people.

How that dysfunction develops can be different for everyone. It’s not always possible to pinpoint why you’re experiencing tinnitus.

Research suggests noise trauma is one of the most common causes. Noise trauma, also known as acoustic trauma, occurs when you’re exposed to extremely loud sounds (like an explosion) or too loud sounds for a prolonged period of time (like attending a concert).

The result is damage to the sensitive organs within your ear that can lead to altered auditory perception.

Common scenarios that can cause noise trauma include:

  • fireworks
  • gunshots
  • loud music
  • noisy work environment

Subjective tinnitus can have many other causes beyond noise exposure. Other contributing factors can include:

Subjective tinnitus is difficult to treat because your doctor isn’t able to hear what you’re hearing during an evaluation.

A treatment plan is developed based on your detailed medical history and an account of events leading up to when you first developed tinnitus. If there is a likely contributing factor, like loud noise exposure, your doctor may consider hearing rehabilitation with surgery or devices like hearing aids, depending on the damage to your ear.

Other therapies used to treat subjective tinnitus include:

  • Audiology devices (neuromodulation): This uses strategic sound exposure to try to reverse the neurological changes contributing to tinnitus.
  • Masking devices: Wearable or tabletop devices can generate pleasant sounds to help drown out or muffle tinnitus.
  • Hearing aids: Small worn devices that amplify sounds in the environment can help make tinnitus less noticeable and disruptive.
  • Cognitive behavioral therapy (CBT): A framework of psychotherapy can help you learn to restructure negative thoughts contributing to tinnitus distress.
  • Tinnitus retraining: A combination of CBT and sound therapies may help train your brain to ignore tinnitus.
  • Medications: No medications specifically treat tinnitus, but your doctor may recommend prescriptions to manage secondary symptoms like anxiety or depression.

Several exploratory therapies that may help restore dysfunctional neurological pathways in tinnitus are being investigated, including:

These treatments are still in development. If you live with tinnitus and haven’t found relief through traditional treatments, a clinical trial for an emerging therapy may be an option.

Does insurance or Medicare cover subjective tinnitus?

Private insurance companies may cover medical expenses related to subjective tinnitus. Policies vary by carrier, however, as will your out-of-pocket costs and coverage criteria. You can find out if your private insurance company covers tinnitus by contacting them; use the ICD-10 diagnostic code: H93.19 to look up tinnitus coverage.

If you’re receiving Medicare, most aspects of your subjective tinnitus evaluation and diagnosis are covered under Medicare Part B. Original Medicare does not cover subjective tinnitus treatment. However, some Medicare Advantage (Medicare Part C) plans may offer more extensive coverage.

Subjective tinnitus refers to tinnitus without an identifiable physical cause that only you can perceive. It’s the most common type of tinnitus, and experiences can vary widely from person to person.

While there’s no cure for subjective tinnitus, treatment may help. Starting tinnitus or cognitive therapies, masking tinnitus with other sounds, and using audiology devices to help restore or improve neurological function are all possible treatment options.