Is it Possible to Have Tinnitus Without Hearing Loss?

have tinnitus

Tinnitus refers to the phenomenon where people hear noises in one ear, both ears or in their head when there is no physical noise present in the environment. It can come in many forms, including ringing, buzzing, hissing and clicking sounds. Tinnitus can be constant or intermittent, vary in severity and vary in intensity. 

Around one in six Australians suffer from tinnitus, and a small percentage of those people suffer from distressing tinnitus. It is most commonly a symptom of hearing loss. However, people with normal hearing can have tinnitus, and today we will discuss the causes and how to prevent it. 

Tinnitus & Hearing Loss

Although there are many causes of tinnitus, one of the main ones is hearing loss.

The hearing system is quite complex and is made up of many different parts. Our ears are made up of the outer, middle and inner ear.

  • The Outer Ear: Includes the pinna (external ear) and ear canal.
  • The Middle Ear: Includes three tiny bones (malleus, incus and stapes) and the eardrum.
  • The Inner Ear: Includes the organs of hearing (cochlea) and balance. 

Sound waves travel in the air and are picked up by the pinna and sent down the ear canal to the eardrum. They hit the eardrum and set it into motion. The vibration causes the three tiny bones in the middle ear to move, which then displaces the fluid in the inner ear, bending the hair cells. The hair cells’ bending creates electrical impulses sent to the brain along the hearing nerve. The brain then interprets this as sound. Hearing loss can occur due to an issue in either of the three parts. 

Hearing loss-related tinnitus usually arises due to an issue in the inner ear (cochlea). The cochlea is lined with tiny hair cells, essential for hearing. They convert mechanical energy into electrical pulses that are sent to the brain and perceived as sound. When these hair cells are damaged, the brain receives a compromised and reduced sound signal. The brain doesn’t like silence and compensates by generating its own internal noise, known as tinnitus. 

However, it is possible to have tinnitus without hearing loss, and some causes include:  

Loud Noise Exposure 

Loud noise exposure is another of the most common causes of tinnitus and is entirely preventable. 

Tinnitus due to loud noise exposure may occur after a one-off, isolated event or due to a build-up of exposure over time. Loud noise exposure may be due to loud or excessive headphone or earphone use, power tools, heavy equipment and firearms. It can occur in the workplace or be recreational. Sounds that are 85dB or louder can damage the auditory system.

In the cochlea lie the tiny hair cells that are crucial for hearing. When they bend, they translate mechanical vibrations into electrical impulses that are sent to the brain and perceived as sound. These hair cells are delicate and susceptible to damage from things like noise. 

When there is a loud sound, the hair cells are pushed to bend to their extreme, causing damage. This disrupts the signal being sent to the brain. An altered signal is sent to the brain, which is tinnitus. The tinnitus is usually temporary and subsides after some time. However, repeated loud noise exposure can cause the hair cells to break off and cause permanent damage, and therefore, permanent tinnitus. 

Tinnitus due to loud noise exposure is entirely preventable:

  • Wear Hearing Protection: When you are exposed to loud noises that can potentially damage your hearing, it is important to protect your hearing by wearing earplugs, earmuffs or both. 
  • Reduce Listening Volume: If possible, reduce the volume of the noise you are exposed to when listening to earbuds or earphones.
  • Reduce Listening Time: Make sure you limit the time you are exposed to loud noise or give yourself breaks. 

Temporomandibular Joint Disorder

Temporomandibular Joint Disorder 

Temporomandibular Joint Disorder (TMJ) can also cause tinnitus. The temporomandibular joint links the jaw to the skull and is used for talking, chewing and yawning. 

Direct trauma to the joint, putting pressure on it (clenching or grinding your teeth), and even arthritis can cause TMJ. People with TMJ may report pain in the side of the face or jaw, ear pain/ache, stiffness in the jaw and popping or clicking sounds when moving the jaw and tinnitus. 

The joint is positioned just in front of the ear. Injury or damage to this joint can cause swelling and inflammation. Due to its proximity to the ear and hearing system and shared ligaments and muscles, it can cause tinnitus. If you suspect TMJ, it is important to visit your dentist so they can diagnose and manage the TMJ. Once this is under control, the tinnitus should subside. 

Ototoxic Medication 

Some medications can also cause tinnitus, specifically ototoxic medicines. This type of medication can cause tinnitus by damaging the hair cells in the inner ear. In many cases, tinnitus due to ototoxic drugs is temporary and stops once the medication is ceased. In some cases, these medications can cause permanent tinnitus. 

Ototoxic medications include: 

  • Aspirin & Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): The use of which can lead to tinnitus is dosage is high or if used for extended periods. 
  • Certain Antibiotics (Aminoglycosides): These antibiotics are mainly used when treating bacterial infections and can cause tinnitus. 
  • Chemotherapy Medication (Cisplatin). 
  • Diuretics: Used to limit the amount of fluid in the body, these medications can cause tinnitus. 

If you feel that your tinnitus started after you began a new medication, it’s important to discuss it with your doctor. 

Blockage in the Middle Ear

Blockage in the Middle Ear 

It is also possible for middle ear blockages to cause tinnitus. 

  • Wax Build-Up: People often report tinnitus when the wax is impacted in the ear canal. This is because the build-up of wax alters the pressure in the ear and can lead to tinnitus. 
  • Sinus Congestion: When the Eustachian tubes are blocked/not functioning, the pressure in the ear cannot be regulated, which can lead to a build-up of pressure in the ear, causing tinnitus. 
  • Foreign Objects: Foreign objects close to or touching the eardrum can also elicit tinnitus. 
  • Middle Ear Fluid: Tinnitus can occur when the fluid build-up is behind the middle ear. 

In these cases, the tinnitus usually subsides once the blockage has been cleared. However, there is the chance that the tinnitus is permanent if the delicate hearing organs have been compromised. 

In Summary 

Tinnitus or ringing in the ears affects many Australians. One of the leading causes of tinnitus is hearing loss. However, it is possible to have tinnitus without hearing loss. 

As mentioned earlier, loud noise exposure, TMJ, ototoxic medication, and middle ear blockages can also cause tinnitus. 

However, if you have hearing loss and are experiencing tinnitus, it may be best to get a new hearing aid that suits your ear better. At EarDeals, we offer a wide range of hearing aids at affordable prices. Visit our website to browse our range or contact us for more information. 


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