About tinnitus

You hear ringing or hissing, but nobody around you hears it. How does that happen? We explain how tinnitus arises, why it keeps drawing your attention, and what approaches researchers are studying.

Tinnitus means hearing a sound without a sound source around you. We often call it ringing in the ears, though it can also sound like a whistle, hum, or hiss. An estimated ten to fifteen percent of adults hear it regularly. One person mainly notices it in a quiet room. For another, it disrupts sleep or makes concentration difficult. How much it affects daily life varies greatly from person to person.

For a long time, attention focused mainly on the ear, where sound enters. But your brain turns those signals into what you hear, and it plays a role in tinnitus too. That is why exercises focus on how your brain responds: the sound can bother you less even when you still hear it.

From ear to brain

To understand tinnitus, first follow the path sound takes: through your ear and auditory nerve to your brain.

Sound comes in
Vibrations in the air reach the eardrum through the outer ear. In the cochlea, thousands of hair cells turn those vibrations into electrical signals.
The auditory nerve passes it on
The auditory nerve carries those signals to the auditory regions of the brain. Only there does a signal become a sound you consciously hear.
The brain fills in
When fewer signals arrive, for instance through hearing loss, the brain works harder and fills the silence itself. That is how a sound can arise from within: a phantom sound.
The alarm goes off
An unfamiliar sound can feel threatening. The amygdala sounds the alarm and the hippocampus stores the experience, including the fright. The sound can then keep drawing your attention, even when nothing threatening is happening.

What happens in your head

In tinnitus, two parts of the brain are especially active: the part that processes sound and the part that regulates emotion. Together they keep the sound in the spotlight.

The auditory system

The auditory cortex turns sound into conscious perception. In tinnitus this region reorganizes itself in an unwanted way. Research shows this can partly be reversed, and that visual feedback can help.

The emotional brain

The limbic system regulates emotion, attention and memory. In tinnitus it responds as if there were acute danger. Thoughts like 'this is driving me crazy' feed that response, so the brain passes the signal on even more clearly.

Amygdala and hippocampus

The amygdala, no bigger than an almond, sounds the alarm. The hippocampus keeps the memory of the moment, the place and the fright. That is how the sound becomes tied to stress, long after the first moment has passed.

Phantom sound

In phantom pain, someone feels pain in a limb that is no longer there: the brain fills in missing information by itself. In tinnitus something similar happens with sound. The same brain regions are overactive, which is why the literature also calls tinnitus a phantom sound.

What helps

The sound itself is difficult to remove. Much of tinnitus care therefore focuses on how it affects you. Freequency follows that approach.

Exposure therapy

You deliberately seek out your tinnitus sound, but in a context that is not threatening. By experiencing that the feared scenario does not come true, the hippocampus stores new memories with less emotional charge. The European guideline for tinnitus recommends this approach.

In Freequency

In Freequency, your recreated tone comes from a bird you can locate in your own room.

Auditory training

Research suggests that actively searching for and recognizing sound sources, with full attention and active participation, can reduce the perception of tinnitus. Your brain learns to place the sound anew: as something from outside, not as an alarm.

In Freequency

Catch the Tone is exactly that: listening for where the sound is, finding the bird and setting it free.

A mirror for your tinnitus

Mirror therapy has helped with phantom pain since 1996: a mirror shows the brain a limb that is no longer there, and the regained sense of control reduces the pain. If phantom pain and tinnitus look so alike in the brain, a mirror for sound may play the same role.

In Freequency

Freequency makes your tone visible and tangible, so you gain influence over it.

From virtual to augmented reality

In 2010 this approach was worked out theoretically using virtual reality. In 2016 research followed, with demonstrably positive effects on tinnitus loudness and on its impact on daily life. Crucially, the sound has to resemble the person's own tinnitus and the setting has to feel real.

In Freequency

Freequency uses augmented reality on your phone, in the room you are in. You do not need a VR headset.

Misconceptions

Many persistent ideas exist about tinnitus. Some of them unintentionally make the burden heavier.

Tinnitus is in my ear.: The ear can be the trigger, for instance with hearing loss, but the sound arises in the brain. That is why an approach aimed at the brain works.
Nothing can be done about it.: Even if the sound stays, it can bother you less. Exposure, attention training, and acceptance focus on how your brain responds to tinnitus.
Chronic means forever.: Chronic only means it has been present for more than three months. It says nothing about whether it can decrease or fade into the background.
I should ignore the sound.: Forcing yourself to ignore it costs energy and keeps the alarm sharp. Deliberately and calmly seeking out the sound, in a safe context, works better.
Silence is best.: In complete silence tinnitus stands out more. A calm background often helps, as does controlled practice with a tone that resembles your own.
It means something is seriously wrong.: Usually not. Tinnitus is very common and rarely a sign of a serious condition. In doubt, or did it start suddenly on one side? See your doctor or audiologist.