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?

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.

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]

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]

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

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.

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.