What happens in your brain when you have tinnitus?

Updated

In tinnitus, the auditory cortex generates phantom sound, the amygdala tags it as threatening, the prefrontal cortex struggles to suppress attention, and the insula signals internal distress.

Auditory Cortex, Amygdala, Prefrontal Cortex, Insula lit up on the Brain Atlas 3D brain: what happens in your brain when you have tinnitus
Figure. The brain regions that light up when you have tinnitus, in order: Auditory Cortex (phantom sound), then Amygdala (threat tag), then Prefrontal Cortex (failed suppression), then Insula (internal distress).

Watch it light up on the 3D brain

Brain regions that light up

OrderRegionWhat it does here
1Auditory CortexAuditory cortex fires spontaneously, creating a sound percept without external input.
2AmygdalaAmygdala reacts to the phantom sound as if it were a real threat.
3Prefrontal CortexPrefrontal cortex tries to ignore the sound but gets caught in attention loop.
4InsulaInsula registers the body's stress response to the persistent noise.

1. Auditory Cortex: phantom sound

Step 1 of what happens in your brain when you have tinnitus: Auditory Cortex lit on the Brain Atlas 3D brain
Figure 1. Auditory Cortex, phantom sound: Auditory cortex fires spontaneously, creating a sound percept without external input.

Damage to the inner ear reduces normal input, leading to increased spontaneous activity in the auditory cortex. This neural noise is interpreted as sound, the hallmark of tinnitus. The auditory cortex is a key site where the phantom percept is generated and maintained.

2. Amygdala: threat tag

Step 2 of what happens in your brain when you have tinnitus: Auditory Cortex, Amygdala lit on the Brain Atlas 3D brain
Figure 2. Amygdala, threat tag: Amygdala reacts to the phantom sound as if it were a real threat.

The amygdala evaluates the sound's emotional significance and often labels it as alarming. This limbic tagging makes the tinnitus more intrusive and stressful. Over time, the amygdala's response can become exaggerated, reinforcing the perception of distress.

3. Prefrontal Cortex: failed suppression

Step 3 of what happens in your brain when you have tinnitus: Auditory Cortex, Amygdala, Prefrontal Cortex lit on the Brain Atlas 3D brain
Figure 3. Prefrontal Cortex, failed suppression: Prefrontal cortex tries to ignore the sound but gets caught in attention loop.

The prefrontal cortex attempts to suppress the phantom sound, but its efforts are often unsuccessful. This failure leads to frustration and the tinnitus becomes a constant distraction. The prefrontal cortex's role is in attentional control, and its inability to disengage maintains the perception.

4. Insula: internal distress

Step 4 of what happens in your brain when you have tinnitus: Auditory Cortex, Amygdala, Prefrontal Cortex, Insula lit on the Brain Atlas 3D brain
Figure 4. Insula, internal distress: Insula registers the body's stress response to the persistent noise.

The insula monitors internal bodily states and signals the discomfort of living with tinnitus. It integrates the emotional and physiological arousal, contributing to the conscious experience of suffering. The insula's activation correlates with the severity of tinnitus distress.

Good to know

  • Tinnitus is associated with reduced inhibition in the central auditory system, leading to hyperactivity.
  • Many people with tinnitus have measurable hearing loss, even if they are not aware of it.
  • The limbic system's involvement explains why tinnitus can cause anxiety and depression.

Tinnitus vs. Real Sound

When you hear a real sound, the auditory cortex processes input from the ear. In tinnitus, the auditory cortex is active without any external stimulus, driven by internal neural noise. This difference is crucial: the brain is generating a percept that has no basis in the outside world.

Test yourself

  1. Which brain region is primarily responsible for generating the phantom sound in tinnitus?

  2. What is the role of the amygdala in tinnitus?

  3. How does the prefrontal cortex contribute to the annoyance of tinnitus?

0 of 3 answered · 0 correct

Simplified: many regions work together at once, and this shows the main players in the order they act. For learning only, not medical advice.