The precision and fragility of the human body are particularly evident in the ear. What we commonly call tinnitus actually comprises two fundamentally different types: one is temporary and physiological, while the other is persistent and disease-related.

Temporary tinnitus is usually directly related to lifestyle: the day after staying up late, it feels like cicadas are chirping in the ear; after prolonged use of earphones, a brief buzzing may occur; when stressed, there may be irregular sounds in the ear.

This type of tinnitus is mostly short-lived, typically resolving on its own within a few hours or a day or two, and is not accompanied by significant hearing loss. It is the body reminding you: you need rest!

Pathologic tinnitus is different; it is often an early sign of an ear disorder. This tinnitus may persist for days or even longer, and the sound characteristics vary: a low-frequency buzzing may point to a middle ear problem, while a high-frequency cicada-like ringing may be related to the inner ear or the auditory nerve.

So how do you distinguish between these two types of tinnitus? Judging from the following four dimensions can help you preliminarily identify the nature of the tinnitus:

Duration is an important indicator. Physiological tinnitus is usually transient, whereas pathological tinnitus tends to persist and may gradually worsen. If tinnitus lasts more than three days, one should be on heightened alert.

Accompanying symptoms are also a key distinguishing point. Purely physiological tinnitus usually has no other obvious discomfort. But if tinnitus is accompanied by a feeling of ear fullness, vertigo, nausea and vomiting, or a marked decrease in hearing, it likely points to conditions such as Ménière's disease or sudden sensorineural hearing loss.

The degree of hearing impact directly reflects the severity of the problem. Physiological tinnitus usually does not affect everyday hearing; you can still communicate normally and hear environmental sounds clearly. Pathological tinnitus is often accompanied by hearing loss at specific frequencies, such as inability to hear high tones or difficulty distinguishing sounds in noisy environments.

The characteristics of tinnitus also differ. Physiological tinnitus sounds are relatively simple and low in volume; pathological tinnitus may be complex and louder, and sometimes may pulse in time with the heartbeat, which may be related to vascular issues.

If you are experiencing tinnitus, you can perform the following simple preliminary self-tests:

In a quiet environment, gently press the tragus (the small prominence in front of the external auditory canal) with your finger. If the tinnitus temporarily diminishes or disappears while pressing and returns when you release, this usually represents physiological tinnitus and may be related to a transient eustachian tube dysfunction.

Try recording the time, environment, and possible triggers of tinnitus onset. Keep a continuous log for a week to see if any patterns emerge. Physiological tinnitus is often clearly associated with fatigue, stress, or noise exposure, while pathological tinnitus may have no obvious triggers.

You can also perform a simple hearing self-check: play sounds of different frequencies on your phone and compare whether both ears perceive them equally. Pay special attention to the high-frequency range, such as bird calls and ring tones, because early hearing loss often begins in the high frequencies.

Although most tinnitus is not an emergency, certain situations require immediate medical attention. If your tinnitus meets any of the following characteristics, go to the hospital otolaryngology department immediately:

If tinnitus occurs suddenly and is accompanied by significant hearing loss, this may be a sign of sudden sensorineural hearing loss. There is a 72-hour golden treatment window for this condition; the earlier treatment is started, the better the outcome.

If tinnitus is accompanied by severe vertigo and unsteadiness, especially when the vertigo is related to changes in head position, this may indicate benign paroxysmal positional vertigo or an acute attack of Meniere’s disease, which require professional repositioning maneuvers or pharmacologic treatment.

Unilateral tinnitus accompanied by ipsilateral facial numbness, facial droop, or neurological symptoms such as diplopia or slurred speech should raise concern for vestibular schwannoma or other intracranial lesions and requires prompt imaging evaluation.

Pulsatile tinnitus, meaning the tinnitus rhythm is synchronous with the heartbeat, may indicate vascular abnormalities such as jugular bulb tumor, arterial stenosis, etc.; these conditions carry potential risks and require specialist evaluation.

When you go to the hospital for tinnitus, the usual examination process is as follows to establish a diagnosis:

First is an otoscopic examination: the physician will use specialized equipment to inspect your external auditory canal and tympanic membrane, excluding common problems such as impacted cerumen in the ear canal and otitis media. This examination is painless and quick.

Next is an audiological assessment, including pure-tone audiometry and tympanometry. Pure-tone audiometry can precisely quantify the degree of hearing loss at each frequency; tympanometry evaluates middle ear function. These two tests are the core basis for determining the nature of the tinnitus.

For specific situations, the physician may recommend vestibular function tests, such as electronystagmography, to assess the balance system; or imaging studies, such as inner ear MRI, to exclude space-occupying lesions like vestibular schwannoma. There is no need to fear these examinations—these measures are intended to more accurately determine the source of the problem.

After a definitive diagnosis, treatment also varies according to the type of tinnitus:

For physiologic tinnitus, the primary measures are lifestyle adjustments: ensuring adequate sleep, managing stress, and avoiding prolonged noise exposure. Studies have shown that more than 70% of patients with physiologic tinnitus achieve significant symptom relief through lifestyle modification.

If tinnitus is related to a specific disease, etiologic treatment is required: for example, otitis media with effusion requires improvement of Eustachian tube function; Meniere’s disease requires a low-sodium diet and diuretics; sudden sensorineural hearing loss requires prompt intervention.

Our ears receive external sounds every day and occasionally produce their own sounds. Understanding the language of these sounds is the most basic responsibility for taking care of your health.