Tinnitus: When Nothing Is Broken—but Everything Feels Wrong

By Dr. Jennifer J. Gans

Tinnitus occupies a uniquely uncomfortable place in modern medicine. Patients come into the doctor’s office with a clear, credible complaint—ringing, buzzing, hissing, or electrical noise that won’t stop—yet exam after exam often shows nothing “wrong.” The ears look healthy. The scans are normal. The hearing test may even come back within normal limits.

And still, the suffering is real.

Medicine is extraordinarily good at treating conditions where something is clearly damaged or diseased. Infections are eradicated. Bones are repaired. Tumors are removed. A problem is identified, treated, and resolved. Tinnitus does not cooperate with this framework.

Tinnitus is not imagined. It is not exaggerated. It is not a failure of resilience. It is a genuine sensory perception generated by the brain. Tinnitus emerges when auditory input has been reduced---hearing loss ranges from subtle or even undetectable (on a hearing test or audiogram) to profound. The loss can be sudden or gradual. For those with subtle hearing loss frequency ranges can be absent beyond what standard hearing tests measure. The brain searches for the sound it expects to hear, and that search is perceived as sound.

Nothing is broken. But something has changed.

When clinicians cannot identify a fixable cause, uncertainty enters the encounter. This may lead to prescriptions that offer limited relief, excessive testing that heightens fear, or dismissive reassurance that leaves patients feeling unheard. These responses are not born of indifference, but of a medical system with few tools for brain-based perceptual conditions.

Tinnitus feels deeply unsettling because sound is expected to come from the outside world. When it does not, the brain treats the experience as potentially threatening. Attention narrows. Monitoring increases. The sound gets stuck in our awareness feeling louder and more intrusive—not because it is worsening, but because it has been elevated in the brain’s triage system.

Relief does not come from silencing the sound at all costs. It comes from changing the brain’s relationship to it. When tinnitus is understood as a benign, predictable response to altered auditory input, the nervous system settles. The brain’s ability to filter irrelevant signals returns. Once tinnitus is disconnected from fear, the habituation process can begin. Tinnitus can become ‘boring’ to the brain, not worthy of attention.

The sound may still be present—but it no longer dominates awareness.

Tinnitus asks for a different kind of medicine. One grounded in education rather than eradication. When nothing is broken, the work is not to fix the body, but to help the brain understand that it is safe.

And when the brain no longer feels threatened, everything begins to feel different—even if the sound remains.