The noise that isn't there

Summary

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Short Wave: "The Noise That Isn't There"

NPR’s Short Wave presents an episode of Vox’s Unexplainable (Sound Barrier series Part II, originally reported by Noam Hassenfeld)
Date: February 21, 2026
Episode Theme: The mysteries of tinnitus: Why do so many people hear ringing or noises that aren't there – and why does science still not fully understand it?

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Episode Overview

This episode dives into the persistent phenomenon of tinnitus—ringing or buzzing in the ears that affects almost 15% of adults, often without any detectable cause or cure. Through personal stories, expert interviews, and new neuroscience insights, host Noam Hassenfeld explores not just what tinnitus is, but why it’s so elusive, how it’s experienced, what’s going wrong in the brain, and why it’s so hard to treat.

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Key Discussion Points & Insights

1. Kelly’s Story: Living With ‘Invisible Noise’

• [01:10–03:36]
  • Kelly, in her late 20s, describes the onset of inexplicable, persistent sounds (“do, do, do…”, then intense “high pitched ringing”), initially brushed off as external noises or stress.
  • Eventually, her tinnitus spreads to both ears and worsens in loud environments, leading to isolation, insomnia, and impacts on mood and social life.
  • Quote: “It’s like you’re just trapped in a room with a crying kid...there’s no way to escape it.” – Kelly [03:06]

2. Defining and Pronouncing Tinnitus

• [04:51–05:05]
  • Stefan Maison: “You’ve got two ways of saying it. Tinnitus is, I believe, the proper way…Most people say tinnitus. Doesn’t matter as long as we understand what we’re talking about.”

3. Meeting the Experts: Dr. Stefan Maison’s Personal and Professional Battle

• [05:14–06:02]
  • Dr. Maison, director of Mass Eye and Ear’s Tinnitus Clinic (and a sufferer himself), founded the clinic after seeing patients dismissed by other providers.
  • Quote: “The vast, vast, vast majority of the patients are being told, there’s nothing I can do for you. Goodbye. I’ve seen some patients who are borderline suicidal.” – Stefan Maison [05:14]

4. What Causes Tinnitus? The ‘Phantom Noise’ Hypothesis

• [06:13–07:40]
  • Audiologists explain how damage to hearing reduces the brain’s auditory input, causing the brain to ‘turn up the volume’ internally (like a thermostat compensating for temperature).
  • Compared to phantom limb pain: even if the sound is ‘missing,’ the brain creates it.

5. The Problem with Standard Hearing Tests

• [08:19–09:49]
  • Most hearing tests only measure the ability to detect soft beeps.
  • Hidden Hearing Loss: Many with tinnitus ‘pass’ these tests but still can’t hear well in loud places; the test misses damage to auditory nerve fibers responsible for loud or complex sounds.
  • Quote: “The gold standard of hearing evaluation...is completely insensitive to the loss of those fibers.” – Stefan Maison [09:31]

6. Hidden Hearing Loss and Its Link to Tinnitus

• [09:49–12:24]
  • Research at Mass Eye and Ear reveals many tinnitus sufferers have ‘hidden’ damage to nerve fibers, undetectable with standard methods but apparent under more complex tests.
  • Electrical readings show “early peaks” (auditory nerve response) are weak, but “later peaks” (brainstem compensation) are amplified for tinnitus patients.
  • Quote: “Tinnitus is not a sound in your ears. Tinnitus is generated at the central nervous system.” – Stefan Maison [13:06]

7. Why Doesn’t Everyone With Hearing Loss Get Tinnitus?

• [13:16–14:00]
  • The science isn’t settled—many with hearing loss never get tinnitus, and some with no apparent damage do. The step from damage to perception of ringing is unknown.

8. Current Treatments: Maskers and Their Limitations

• [14:08–15:18]
  • Kelly tries ‘maskers’ (white, pink, or brown noise) via YouTube or hearing aids.
  • Maison downplays their efficacy: “It’s just a band-aid…I don’t think it’s very useful.” [14:53]
  • The problem: maskers make patients more aware of their tinnitus, potentially worsening it by drawing attention to the noise.

9. The Brain Networks of Tinnitus – Mild vs. Severe

• [15:51–17:35]
  • Dr. Dan Pauly (researcher/sufferer) explains that mild tinnitus (like his own) is confined to auditory pathways, while severe cases (like Kelly’s) involve wider brain networks, affecting withdrawal, depression, sleep, and concentration.
  • Quote: “People with really severe tinnitus have…a whole brain problem. Their tinnitus has expanded and it’s incorporated other brain networks.” – Dan Pauly [16:34]
  • In those with severe tinnitus, therapy like mindfulness or CBT may help lessen whole-brain disruption and reduce suffering.

10. Kelly’s Progress: Embracing Sound Again

• [18:19–20:58]
  • One year later, Kelly reports improvement—not by masking, but by openness and gradual exposure to sounds.
  • She’s “chiseling through” her box, sometimes going without hearing protection and reacquainting herself with the world’s sounds, despite her persistent tinnitus.
  • Quote: “It just closes you in this insane box...and you just somehow find a way to chisel through it.” – Kelly [18:47]

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Notable Quotes

• On the isolation of tinnitus:
  “With the lack of sleep, you’re just not in any other mood for anybody. And you can’t show up like you used to…” – Kelly [03:36]
• On the limitations of hearing tests:
  “A hearing test does not tell you the whole story.” – Stefan Maison [08:48]
• On explaining the problem to sufferers:
  “Maybe it’s still not entirely like me me.” – Kelly [19:16]
• On severity and brain involvement:
  “Whatever hyperactivity in my auditory pathway…hasn’t reprogrammed my limbic system to find all sounds horribly aversive and make me depressed.” – Dan Pauly [16:34]
• On recovery:
  “It’s really weird to know the world again.” – Kelly [20:23]

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Major Timestamps

• 01:10 – Kelly introduces her tinnitus experience
• 05:14 – Dr. Stefan Maison on the lack of treatment
• 06:27 – Post-concert “ringing” explained neurologically
• 09:49 – Hidden hearing loss described
• 12:24 – Brainstem hyperactivity found in tinnitus sufferers
• 14:08 – Maskers as treatment; their pros and cons
• 16:14 – Dr. Dan Pauly on brain networks and severity
• 18:19 – Kelly’s progress one year later
• 20:23 – Kelly re-acquaints herself with the world’s sounds

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Episode Tone and Language

Conversational, curious, empathetic, and lightly humorous at moments; the hosts and interviewees speak in accessible language to demystify neuroscience and validate the lived experience of tinnitus sufferers.

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Summary Takeaway

Tinnitus is a real, multi-layered neurological phenomenon—not “just in your head,” but rooted in brain circuitry that sometimes responds to hidden hearing loss in unexpected ways. Effective diagnosis and management will require re-thinking standard hearing tests, addressing overlooked brain mechanisms, and providing compassionate, tailored care. For those suffering, therapy and gradual reconnection to the world of sound may be more helpful than masking or denial.

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Transcript

[Emily Kwong]

This message comes from Rosetta Stone, the trusted leader in language learning. Choose from 25 languages. Receive 50% off a lifetime membership with unlimited access to 25 language courses for life. Visit rosettastone.com NPR hi Short Wavers. Emily Kwong here. And we have a special episode for you from one of the best science podcasts out there, Unexplainable from Vox, Unexplainable digs into scientific mysteries and unanswered questions about everything from dark matter and black holes to what dinosau sores may have sounded like. And last year, host Noam Hassenfeld did a five part series about the way our brains process sound. It's called the Sound Barrier. And their second episode is about tinnitus. That's when you perceive a ringing in your ear, this persistent sound that comes from nowhere. Almost 15% of adults suffer from this and there is no cure. In fact, researchers are only just beginning to understand the cause. Here's that piece and you can check out the rest of the Sound Barrier series on the Unexplainable podcast feed. Enjoy.

[Kelly]

I noticed it around just New Year's time. I just remember there was something on the right side of my ear going on. It's like do, do, do, do, do, do, do, do. And I thought it was just the pipes. I kept asking my fiance if he' something going on in the walls next to me, but he's recorded back nothing.

[Noam Hassenfeld]

Kelly started hearing things almost four years ago, just a couple months after her 25th birthday. At first she wasn't sure what was going on. She did the WebMD thing. She googled all her symptoms. She got worried when she told her family. They told her to relax. But the sound didn't stop. And pretty soon she started hearing something in her other ear.

[Kelly]

It's like the high pitched ringing you usually hear in your ear every now and then. But it's like more intense and it's just there the whole time.

[Noam Hassenfeld]

Wow. So different sounds. Right and left ear.

[Kelly]

Yeah.

[Noam Hassenfeld]

Eventually, Kelly decided she needed to get her hearing checked.

[Kelly]

They've done so many tests on me and I don't have anything wrong with my hearing.

[Noam Hassenfeld]

Almost 15% of all adults have had tinnitus, and 100 million of them have severe tinnitus. Like Kelly, they hear persistent noises, ringing, buzzing, sirens, even construction or drilling sounds which seriously impact their life. But when a lot of them get their hearing checked, the test comes back fine. It's one of the things that makes tinnitus so maddening. Why would so many people keep hearing noises like these? If the test says there's nothing wrong with them. And it's not like most of the people Kelly was talking to were any more help. They didn't take her seriously because they had no idea what living with tinnitus actually feels like.

[Kelly]

I mean, it's. It's like you're just trapped in a room with a crying kid. You can't stop crying or anything. You don't know how to just make it stop. It's like no way to escape it. Yeah, I'm sorry.

[Noam Hassenfeld]

Kelly's tinnitus got worse in louder environments, so she had to leave her job. She stopped seeing her friends. She couldn't sleep.

[Kelly]

I would isolate myself and everything. I've grown so distant from my friends because with the lack of sleep, you're just not in any other mood for anybody. And you can't show up like you used to for any of the things that you've done.

[Noam Hassenfeld]

The thing that makes tinnitus so hard to pin down is that it isn't a sound out there in the world. It is literally just in your head, but it's also real, especially for people like Kelly. I'm Noam Hassenfeld, and this is the second episode of the Sound Barrier, a series from Unexplainable about the limits of hearing and the ways we can break through. On today's episode, how can our brain make us hear sounds that don't exist? Okay, before you go into this, just a question. How do you pronounce this word tinnitus?

[Stefan Maison]

So you've got two ways of saying it. Tinnitus is, I believe, the proper way of saying it. Most people say tinnitus doesn't matter as long as we understand what we're talking about.

[Noam Hassenfeld]

A couple weeks ago, I met Stephane Maison at Mass Eye and Ear, a hospital in Boston, and Stefan's the director of the tinnitus clinic there, which he launched last year.

[Stefan Maison]

The vast, vast, vast majority of the patients are being told, there's nothing I can do for you. Goodbye. I've seen some patients who are, like, borderline suicidal. And so I was interested in being able to provide some beginning of an answer to those patients and to provide support to those patients. And that's why we opened the TNT clinic.

[Noam Hassenfeld]

It was also a way to potentially help his own hearing.

[Stefan Maison]

I have Tinfoise. You do? Yeah.

[Noam Hassenfeld]

What does it sound like?

[Stefan Maison]

High pitch.

[Noam Hassenfeld]

Since when?

[Stefan Maison]

I've tinned Fuse for the past, like, 12 years. Something like that. I haven't been in a club in many, many years or even decades, but I can Tell you that I abuse my ears.

[Noam Hassenfeld]

So do you hear a pitch right now? Yep. You've probably also had at least a brief moment of tinnitus before.

[Stefan Maison]

Some people will go to a concert. They feel that as they leave the concert, the hearing is not quite the same. You feel that your hearing is a little bit muffled. You can even experience that ringing in your ears.

[Noam Hassenfeld]

Basically, your hearing gets damaged, which means one part of your brain is getting less auditory information than it expects. So another part starts to overcompensate.

[Stefan Maison]

As you no longer receive some information in one particular area, the adjacent area is going to start to become hyperactive.

[Noam Hassenfeld]

It's kind of like a climate control system. You have it set to 70 degrees or something, and if it gets too cold, the heat will kick on. So when the brain suddenly isn't getting the same level of sound it's expecting from the outside world, it turns up the volume in your head.

[Stefan Maison]

So now you start to perceive a sound that is not there.

[Noam Hassenfeld]

Usually this kind of post concert ringing sound goes away, but chronic tinnitus is when that ringing doesn't stop. Stefan told me it's sort of like phantom limb pain in people who've lost a leg.

[Stefan Maison]

The leg is gone, but you start to feel pain where it's missing. Your brain is artificially increasing the perception. So in the case of touch, if you touch you with my finger like this, you're going to feel my finger. If I increase the perception, that's going to turn into pain.

[Noam Hassenfeld]

Sometimes people with tinnitus can pinpoint what caused it. I spoke to one researcher who told me his tinnitus was caused by sitting too close to a bagpipe band at his friend's wedding. But often tinnitus seems like it comes out of nowhere. Like with Kelly, people just wake up one day and hear this phantom ringing. And just like Kelly did, a lot of them go get a hearing test, and it often tells them their hearing is fine. So what's going on?

[Stefan Maison]

If tinnitus is the result of the hyperactivity of the brain because something is missing, then people with normal hearing tests should not have tinnitus.

[Noam Hassenfeld]

So let's talk about that hearing test, the kind that tinnitus patients like Kelly get all the time. You sit in a soundproof booth, you put on headphones, the audiologist plays you a pure tone, and they say, raise

[Stefan Maison]

your hand whenever you can hear a beep.

[Noam Hassenfeld]

The audiologist keeps playing the same sound softer and softer until you stop raising your hand. And then they do the same thing for a whole bunch of different pitches. This is the gold standard for hearing tests.

[Stefan Maison]

But a hearing test does not tell you the whole story.

[Noam Hassenfeld]

Our ears can do so much more than just listen to beeps.

[Stefan Maison]

There's something I like to tell my patient. If everything is fine, you should be able to hear a pin drop, or you should be able to hear an explosion. If you think about it, that's a gigantic dynamic range.

[Noam Hassenfeld]

Our ears can do this because they have different types of auditory nerve fibers, these wires that carry sound signals from the inner ear to the brain. Some of them pick up soft sounds, and other ones pick up loud sounds. But the hearing evaluation only tests for soft sounds.

[Stefan Maison]

And if the fibers that respond to loud sounds are missing, this is not going to affect whatsoever your hearing test. So the gold standard of hearing evaluation around the world to this day is completely insensitive to the loss of those fibers.

[Noam Hassenfeld]

This is how someone like Kelly can have hearing problems while still having a perfectly normal hearing test. It's called hidden hearing loss, and it was only discovered a few years ago when researchers at Mass Eye and ear realized just how easy it was to damage those louder nerve fibers.

[Stefan Maison]

The fibers that are the most susceptible to aging and noise exposure are the fibers that could fall loud sounds.

[Noam Hassenfeld]

The idea is that if you have tinnitus at some point in the past, you probably damaged your hearing. Specifically, you damaged those louder fibers. But your symptoms might have gone away. And because normal hearing tests don't focus on loud fibers, that damage stayed hidden. And if your loud fibers get damaged, you're not going to have any issues having a conversation in a quiet room. You're not going to have any issues on your hearing test. But if you go somewhere, like a bar or a restaurant, you might find that you suddenly can't make out what your friend is saying.

[Stefan Maison]

And if you look at most people, that's something very, very common. They feel like they don't have any issues in a quiet environment, but as soon as they go to a bar or a restaurant, they start to struggle.

[Noam Hassenfeld]

So Stefan took his patients with normal hearing test scores, and instead of giving them that classic hearing test again, he gave them a different one, focused on

[Stefan Maison]

loud fibers Instead of testing them in quiet. It's as if someone was speaking super fast with a little bit of reverberation, like he suspected.

[Noam Hassenfeld]

A lot of them really struggled with the louder, echoey conversations because they had hidden hearing loss. They had damage to their loud fibers. And Stefan had a feeling that hidden hearing loss could be the thing causing his patients that had normal hearing test scores to have Tinnitus. So he ran a different test. He placed tiny electrodes inside their ear canals, and he played them a sound, a click. He recorded the electrical responses from that sound.

[Stefan Maison]

He and that's going to show you different types of waveforms.

[Noam Hassenfeld]

It's basically a squiggly line that shows neurons firing as a sound signal gets processed by the brain. And when he looked at the early peaks, which show the auditory nerve in the inner ear, he saw way less firing than normal. The patients were getting less sound input because they had hidden hearing loss. But then he looked at the later peaks on the squiggle, the ones that showed what happened as the sound signal winds its way into the brain.

[Stefan Maison]

So now you're looking at the brainstem response. And interestingly, the participant with tinnitus had response as big as those who never had tinnitus.

[Noam Hassenfeld]

For tinnitus patients, the peak at the brainstem was larger than at the nerve. Something was making up for the hidden hearing loss and turning the volume up.

[Stefan Maison]

Somehow the brain is able to catch up.

[Noam Hassenfeld]

Stefan was basically seeing the seeds of tinnitus on this squiggle graph. This thing that didn't show up in normal hearing tests, this thing that so many patients had been told wasn't real. He saw it happening.

[Stefan Maison]

Tinnitus is not a sound in your ears. Tinnitus is generated at the central nervous system.

[Noam Hassenfeld]

The idea that hidden hearing loss is directly related to tinnitus, it's a big step forward. But there's still so much we don't know. Like, we know the basics, that tinnitus usually starts with hearing loss, which can be caused by things like listening to loud music or a virus or aging. But not everyone with hearing loss hears this constant ringing. Scientists still don't really understand what takes someone from hearing damage to tinnitus, why this happens for some people and not others. Have I not told you that what you mistake for madness is but over

[Stefan Maison]

acuteness of the senses?

[Noam Hassenfeld]

Once she got diagnosed with tinnitus, Kelly started doing all kinds of research online. She was trying to find anything that could help her feel better.

[Kelly]

I found this YouTuber who makes these, like, white noises, or he calls them pink noise, brown noises. There's so many different ones.

[Dan Pauly]

This is the 15khz tinnitus audio noise masker, right around 15,000hz.

[Noam Hassenfeld]

This kind of thing is called a masker because it masks the sound of tinnitus. And Kelly eventually went to her audiologist to get hearing aids that played these sounds for her all the time. But because the hearing aids also Amplify sounds. She had to wear earmuffs over them, too, which isn't great when you're in your 20s and just trying to go outside. So, all in all, it's been helpful, but it's far from perfect. And Stefan isn't really a huge fan of stuff like this to begin with.

[Stefan Maison]

It's just a band aid. I don't think it's very useful.

[Noam Hassenfeld]

Stefan says that even though a masker is designed to blend the tinnitus noise in with the background, it ends up becoming the majority of what people are actually hearing. In his experience, masking noise just ends up reminding patients all the time that they still have tinnitus. And the more you think about tinnitus, the worse it can get.

[Stefan Maison]

We're talking about this right now, so I can hear it much louder thanks to you.

[Noam Hassenfeld]

Sorry,

[Stefan Maison]

but I know it's because I'm paying attention to it.

[Noam Hassenfeld]

For some people with mild tinnitus, a band aid like this can be useful from time to time. But for people like Kelly with severe tinnitus, it's a lot more complicated. I wanted to be able to go back to Kelly with some useful information, but I wasn't really sure what I was going to be able to tell her until I talked to Dan. Pauly.

[Dan Pauly]

I have tinnitus, and whenever I want to, I can hear that beautiful symphony of that pure tone.

[Noam Hassenfeld]

Dan's a tinnitus researcher who also has tinnitus like Stefan, and apparently a whole bunch of tinnitus researchers. As I found out, Dan also works at mass eye and ear, and he focuses on how different parts of the brain work together to generate the tinnitus sound.

[Dan Pauly]

Because the brain doesn't have direct contact with the physical world, everything that we perceive as consciousness is constructed from the activity of the brain.

[Noam Hassenfeld]

Dan told me there's a pretty fundamental difference between the mild tinnitus he has and. And the severe tinnitus that people like Kelly have.

[Dan Pauly]

People with really severe tinnitus have, like, a whole brain problem. Their tinnitus has expanded and it's incorporated, like, other brain networks and whatever hyperactivity in my auditory pathway that's causing me to perceive a sound that isn't there. It hasn't changed the ability of my executive control to concentrate or it hasn't reprogrammed my limbic system to find all sounds horribly aversive and make me depressed.

[Noam Hassenfeld]

You're saying when some people are obsessed and can't function because they're tinnitus, it's not because they just hate the Sound. It's because that sound has gotten into their brain system and, like, infected their brain.

[Dan Pauly]

Yeah. It isn't actually that their tinnitus is louder. That hyperactivity spilled over and recruited other brain systems that have nothing to do with hearing per se, but with your ability to concentrate, to sleep, to, like, regulate mood and emotion. They have a more widespread network of dysregulation in their brain than I do.

[Noam Hassenfeld]

For people with severe tinnitus, Dan says things like mindfulness therapy or cognitive behavioral therapy can act on these other brain areas and hopefully tamp down the tinnitus.

[Dan Pauly]

They can take you from, like, I have tinnitus disorder. I'm not sleeping. I'm depressed. I'm socially withdrawn. And they can turn you into somebody like me who, like, it's, like, a little bit annoying. But if you can take the 1 in 10 who's severely debilitated by their tennis and turn them into, like, the other nine, I'd still take that as something useful.

[Noam Hassenfeld]

Yeah. So it's been almost a year since we talked. How are you doing?

[Kelly]

I've been doing a lot better, I would say. Honestly, like, I've been happy. I guess I've just been trying to be more open about it because I realized that I never shared it to anyone at my job. Now I'm just, like, trying to just put myself out there again. It just closes you in this insane box. You know, you have nowhere to go, and you just somehow find a way to chisel through it, and you feel

[Noam Hassenfeld]

like you're slowly chiseling through it.

[Kelly]

Chiseling, yeah. Still making my way out.

[Noam Hassenfeld]

I told Kelly what Dan had said about people with severe tinnitus, how it's not like they're just being weak, that they might have a whole brain problem, that their tinnitus has basically expanded across their brain networks and hooked into the parts of their brain that influence other things, like their emotions. That's.

[Kelly]

I feel like that just feels like a better explanation because I've always had a hard time describing it, but it kind of makes me feel a little at ease again, where I'm like, okay, maybe it's still not entirely like me me.

[Noam Hassenfeld]

Like, you know, it's going to be a long process. But Kelly told me she's been trying to slowly phase out her maskers and her hearing aids, and she's trying to learn how to listen to the world again.

[Kelly]

I'm actually just spending days in my apartment, only just without my hearing aids and just trying to take in all the sounds like, I'll have the windows open because the maintenance guys are working or the gardeners. And I'm even trying to, like, vacuum without any type of, like, hearing protection and just recognizing that sound, too. It just.

[Noam Hassenfeld]

Yeah, she still hears that tinnitus sound all the time. But as hard as it is, she's trying to stop blocking everything out. She's just trying to hear all the other sounds along with it.

[Kelly]

I mean, we saw a fireworks show for the first time in years, and it was scary each time one went off. But eventually my body would stop jolting when they would, because I was like, this is what we used to do. Like, it's literally just. It's really weird to. To know the world again.

[Noam Hassenfeld]

This episode was reported and produced by me, Noam Hassenfeld. I also did the music. It was edited by Joanna Solotarov, with help from Jorge. Just mixing and sound design from Christian Ayala, with a ringing endorsement from Sally Helm. Meredith Hoddenott runs the show. Julia Longoria is our editorial director. Unexplainable is part of the Vox Media podcast network. This message comes from BetterHelp. February is full of relationship talk, making it feel like everyone has it all together in their love lives. But most people are still figuring it out. Therapy can take that pressure off. Visit betterhelp.com NPR for 10% off. This message comes from Capital One. Capital One offers checking accounts with no fees or minimums. What's in your wallet terms apply. See capitalone.combank for details. Capital One NA Member FDIC. This is Ira Glass. On this American Life. We look for stories that are surprising that you won't hear anywhere else. Like, for example, this one astronaut. He went to the moon. You know what? He's not into space. Was it cool to float around weightless? No, no, no. This American Life. Unexpected stories. Wherever you get your podcasts.