If you have seen a doctor about your tinnitus, you might have been told about the distinction between “objective” and “subjective” tinnitus. Objective tinnitus is caused by mechanical means that can be measured physically. Subjective tinnitus, on the other hand, seems to have no physical cause.

Although this distinction is useful for classifying tinnitus and helping to find the right treatment, it may give you and others the wrong idea about your tinnitus.

Objective Tinnitus: Causes and Types

Objective tinnitus is caused by measurable physical phenomena. It’s usually divided into three types: pulsatile, muscular, and spontaneous.

Pulsatile tinnitus is caused by turbulent blood flow, like what happens if you partly kink a garden hose. This kind often surges and recedes with your heartbeat.
Muscular tinnitus is caused by clenching of certain muscles. Two of the most common culprits are tiny muscles in the ear that are supposed to stabilize ear bones to reduce ongoing sound. Others are the muscles in the palate, especially in a condition called palatal myoclonus. Palatal myoclonus is rhythmic contractions of the muscles at one or both sides of the back and top of the roof of your mouth. It’s also possible that TMJ -related muscle spasms could fit in this category.

Spontaneous tinnitus is linked to vibrations of the outer hair cells of the cochlea, which translates vibrations into nerve signals.

Subjective Tinnitus

Subjective tinnitus, on the other hand, is caused by something other than a mechanical stimulus. We don’t know exactly what causes this type of tinnitus, though some people get it after listening to loud music or noises. The sounds are usually high-pitched, but they’ve been compared to many types of sounds, including ringing, hissing, cicadas, and wind.

The problem with calling this type of tinnitus “subjective” is that it implies that it’s not real. After all, subjective things are all judgment calls, only real when seen from a certain perspective.

But subjective tinnitus is actually real, and measurable. Brain scans of people with tinnitus show brain activity associated with the sounds they hear. Although the causes aren’t easily visible, this type of tinnitus is ultimately as real as the other kind.

Perhaps a better division would be between “mechanical” tinnitus and “neural” tinnitus. Mechanical tinnitus is caused by identifiable mechanical effects, and neural tinnitus is caused by something in the nerves or brain.

This new division would not only validate all tinnitus sufferers equally, it is genuinely descriptive and helps get us closer to appropriate treatment.