Health Resources


Signs & Symptoms

Individuals with tinnitus report a variety of internal sounds, such as ringing, whistling, vacuuming, hammering, buzzing and humming noises, perceived in the ear or head.

About the condition

Tinnitus involves hearing sounds like ringing, hissing, buzzing or insect-like noises in the absence of external sounds. The experience of tinnitus is subjective, varying in sound, volume and pitch, and can be heard in one or both ears, or in the head. 

The majority of tinnitus cases are subjective, meaning only the affected individual can hear these sounds. Causes of subjective tinnitus vary, and the condition can be constant or intermittent, changing in intensity and even presenting multiple sounds simultaneously.

Objective tinnitus, which can perceived by an examiner, is less common. Often linked to vascular issues, this type of tinnitus usually has a pulsating quality in sync with the individual’s heartbeat.

It is important to note that tinnitus is relatively common and not always a source of distress. However, a smaller group of individuals may experience severe tinnitus, significantly affecting sleep, mood and overall quality of life.

Reduced sound tolerance is a broad category encompassing sensitivity to both 
soft and loud sounds. Some individuals may find certain sounds, which are tolerable to others, too loud or physically uncomfortable. Others may develop a fear of sound due to past loud noise trauma. Additionally, specific sounds, such as chewing or sniffing, can be particularly distressing, causing anxiety or irritation.
Diagnosis and Treatment Options

For individuals experiencing severe tinnitus, pulsatile tinnitus, unilateral tinnitus or any form of reduced sound tolerance, a medical evaluation is crucial. This helps to determine if there is an underlying cause that can be medically or surgically resolved. If tinnitus persists post-intervention, management programmes developed by an audiologist specialising in these conditions can help to reduce its impact and improve quality of life.

Medical Management

The first step in any tinnitus and sound tolerance programme is a comprehensive medical examination by an ENT doctor. This includes a complete history, physical examination and tests to evaluate hearing and middle ear function. If active disease processes are discovered, they are treated before proceeding with tinnitus or sound tolerance management. If no diseases are found, or if problems persist post-treatment, audiologic management is the next step.

Audiologic Management

After medical evaluation, patients are referred to an audiologist who assesses the specific needs of each individual with tinnitus or reduced sound tolerance. The audiologist conducts a detailed evaluation, including reviewing a comprehensive questionnaire filled out by the patient, to understand their condition and its impact.

The audiologist provides education about condition, its causes, why it can be management strategies. Directive counselling is given to both the patient and their family members to mitigate the impact of the tinnitus or sound intolerance. Family members are encouraged to accompany patients for support and information.

The audiologist may recommend devices and sound delivery systems based on individual needs. These might include hearing aids, tinnitus instruments/combination units, table-top sound generators, MP3 players, CDs, bluetooth streaming devices to hearing aids, pillows with speakers for use during sleep and other devices. The patient is guided on the use and potential benefits of each device, with personalised instructions provided.


Continual follow-up with the audiologist is crucial for chronic conditions like tinnitus and sound intolerance. Patients are encouraged to maintain regular contact for progress updates, especially in the first six months. The audiologist may also coordinate care with other healthcare providers to address all factors related to the condition.

  • Ms Joanna Tang
Last updated on
Best viewed with Chrome 79.0, Edge 112.0, Firefox 61.0, Safari 11
National University Health System
  • National University Hospital
  • Ng Teng Fong General Hospital
  • Alexandra Hospital
  • Jurong Community Hospital
  • National University Polyclinics
  • Jurong Medical Centre
  • National University Cancer Institute, Singapore
  • National University Heart Centre, Singapore
  • National University Centre for Oral Health, Singapore
  • NUHS Diagnostics
  • NUHS Pharmacy
  • Yong Loo Lin School of Medicine
  • Faculty of Dentistry
  • Saw Swee Hock School of Public Health
Back to Top