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Understanding reactive tinnitus
Understanding Hyperacusis
Reactive tinnitus is a subtype of tinnitus which has been largely neglected in the literature. A study by Greenberg & Carlos (2019) is one of the few focusing on reactive tinnitus, but also what they describe as sound-sensitive tinnitus. They define sound-sensitive tinnitus as cases in which subjective tinnitus perception and/or distress are exacerbated by sound exposure, causing enduring discomfort, auditory sensitivity, and/or pain. How long the tinnitus remains exacerbated varies among patients.
Reactive tinnitus, however, they see to be characterized by modulation from external sound with respect to loudness, pitch, tone, or quality, yet differentiated from sound-sensitive tinnitus in that it does not necessarily represent a persistent exacerbation of tinnitus perception, distress, or related pain once the external sound subsides.
To our knowledge no other researchers currently differentiate between the two types of tinnitus reacting to external sounds.
In a way, reactive tinnitus is the opposite of residual inhibition, where tinnitus is suppressed for a limited time after listening to certain sounds.
A search for the total reactive tinnitus studies on Google Scholar provides a sparse 40 results; sound-sensitive tinnitus gives 15 studies which are even fewer results. In comparison, there are 246 results for tensor tympani syndrome, 230 for loudness hyperacusis, 320 for pain hyperacusis, 22,800 for the umbrella term hyperacusis, and 432,000 for tinnitus.
Hyperacusis and reactive tinnitus seem to be strongly connected. For example, in a study of 32 patients with pain hyperacusis, 88% also reported experiencing reactive tinnitus (Jahn et al., 2025). Similarly, a larger survey found that nearly 82% of the 243 respondents with pain and/or loudness hyperacusis reported having reactive tinnitus (Williams et al., 2021).
Anecdotal reports suggest that patients with reactive, sound-sensitive tinnitus find habituation more difficult because their tinnitus worsens in response to external sounds, such as a fan they might use for masking.
References
Greenberg, B. S., & Carlos, M. C. (2019). The sound-sensitive tinnitus index: Psychometric properties of a scale to assess the impact of tinnitus exacerbated by sound. Noise and Health, 21(100), 98-107.
Jahn, K. N., Kashiwagura, S. T., & Yousuf, M. S. (2025). Clinical phenotype and management of sound-induced pain: Insights from adults with pain hyperacusis. The journal of pain, 27, 104741.
Williams, Z. J., Suzman, E., and Woynaroski, T. G. (2021). “A phenotypic comparison of loudness and pain hyperacusis: Symptoms, comorbidity, and associated features in a multinational patient registry,” Am. J. Audiol. 30, 341–358.