What is subjective tinnitus vs objective tinnitus?

Subjective tinnitus is the common form of tinnitus. It is a sound only you can hear, and it is not audible to other people or to an examiner. The sound is a perception generated by the hearing system and the brain, often linked with hearing loss, noise exposure, or irritation/injury within the ear, but sometimes no single cause is found.

Objective tinnitus is rare. It is a sound generated by a physical source in or near the ear, and in some cases a clinician can hear it too, for example by listening near the ear. Because there can be an identifiable source, it is assessed a bit differently.

• Who can hear it: subjective tinnitus is heard only by the person, objective tinnitus may be heard by an examiner.
• How common: most tinnitus is subjective, objective tinnitus is uncommon (around 1 percent of tinnitus cases in some primary care references).
• Typical causes of objective tinnitus: blood flow noises (vascular causes), muscle contractions in or around the middle ear or soft palate (myoclonus), or a patulous Eustachian tube where sounds can vary with breathing.

How it is checked: clinicians usually start with a history, ear examination, and hearing tests. If objective tinnitus or pulsatile symptoms are suspected, they may also listen for a sound and consider targeted investigations or specialist assessment to look for a treatable cause.

Seek medical assessment promptly if your tinnitus is new, one-sided, pulsatile (in time with your heartbeat), comes with sudden or rapidly worsening hearing loss, significant vertigo, neurological symptoms, or severe distress.