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If your ears are ringing and the audiogram came back normal, you are not crazy. Tinnitus is a brain process. And there is a path forward.
Dr. Steven Resnick, a board-certified neurologist, walks through what tinnitus actually is, why anxiety makes it louder, when it requires a workup, and the framework for reducing the brain’s amplification of the sound.
Tinnitus is the perception of sound without an external source. Roughly ten to fifteen percent of adults experience it. It can sound like ringing, buzzing, whooshing, or clicking. Most cases are subjective, meaning only the patient hears it. The audiogram tells you about the ear. Tinnitus lives in the brain.
We trace the auditory pathway from outer ear to cochlea to brainstem to auditory cortex. We explain that most tinnitus begins with some degree of hearing loss, often gradual, often invisible on a basic audiogram. The auditory cortex amplifies its own activity to compensate. The amplification is the ringing. This is the auditory parallel of phantom limb sensation.
We then look at why anxiety makes tinnitus louder. The threat detector tags the sound as significant. Once tagged, the brain monitors it continuously. Attention amplifies perception. The sound gets louder. The louder it gets, the more anxious the patient becomes. The loop tightens. Two people with the same brain compensation can have completely different experiences depending on whether the nervous system is calm or on alert.
We cover when tinnitus actually needs a physician workup. Pulsatile tinnitus (rhythmic with the heartbeat) suggests vascular causes and needs imaging. Persistent unilateral tinnitus, especially with hearing loss in that ear, sometimes warrants an MRI to rule out an acoustic neuroma. Sudden onset with hearing loss is a medical emergency. Tinnitus paired with vertigo and ear pressure suggests Meniere’s disease. Each pattern has its own evaluation path.
We then walk through what works and what does not. We are direct about the tinnitus products industry: most online cures and supplements marketed for tinnitus do not have evidence behind them. What does work: sound therapy (masking sound, environmental noise), tinnitus retraining therapy, cognitive behavioral therapy, treating underlying anxiety (sometimes with medication when matched appropriately), and hearing aids when hearing loss contributes. Dr. Resnick is clear: this is about matching the right tool to the actual cause, not avoiding any particular tool.
We close with habituation, the brain’s natural process of stopping to attend to a constant signal that is not threatening. Habituation is not surrender. It is the brain doing exactly what it is built to do. The goal is not silencing the sound. The goal is no longer needing to listen for it.
Eleanor (composite, 58) closes the deck. Her audiogram never changed. Her relationship to the sound did.
A note on this content. The Healthy Mind is a place for medical education, not medical advice. Watching this channel does not create a doctor-patient relationship. If something in this video resonates with you, that recognition is meaningful. The next step is a conversation with your own physician, who knows your full clinical history and can address your specific situation. No video can substitute for the care of someone who has examined you. Patient examples shared on this channel are composites or representative clinical patterns; identifying details have been changed. If you are experiencing a medical emergency, call 911 or your local emergency services immediately. Dr. Steven Resnick
CHAPTERS
0:00 If the audiogram is normal, you are not crazy
0:45 Eleanor: 58, sound that would not stop
2:30 What tinnitus actually is
3:45 Auditory pathway from ear to brain
5:00 Why the brain amplifies (and the phantom limb parallel)
6:30 Why anxiety makes it louder
8:00 The vicious cycle
9:00 When tinnitus actually needs a workup
10:30 What works. What does not.
12:30 Habituation. The brain’s natural off-switch.
13:45 Eleanor’s path
14:45 Close
Connect with Dr. Steven Resnick:
Website: https://drstevenresnick.com/
Instagram: https://www.instagram.com/dr.stevenresnick/
Spotify: https://open.spotify.com/show/3B4yD7xFJH5xgSEBuQiZau
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