1 March 2011 2011 3M. All Rights Reserved By: Elliott H. Berger &

 

1 

March 2011 

© 2011  3M.  All Rights Reserved 

 

By: Elliott H. Berger & 

Laurie L. Wells 

Elliott H. Berger, M.S., is a Division 

Scientist for 3M’s Occupational 

Health & Environmental Safety. 

Laurie L. Wells, Au.D., is Manager 

of Audiology for Associates in 

Acoustics, Inc. 

Tinnitus and Hearing Protection: 

Fiction and Fact  

 

I pulled the trigger. My ears have never been the same since. All I could hear 

was ringing, constant, infuriating ringing, all the time, ringing, ringing, ringing. 

No matter what I did, where I went, who I was with, ringing. That one brief 

instance changed me forever….. 

 

One brief instance, one unprotected gun shot, airbag deployment, or firecracker 

explosion can cause hearing loss, tinnitus, or both, which for some will become a 

permanent and devastating life-changing experience.  

 

Sure, I have ringing in my ears all the time. It seems like I’ve had it all my life. I 

hardly notice it. It does seem to get louder after I have been around a lot of 

background noise.  Once in awhile it keeps me awake at night, but I don’t really 

think about it much.  

 

A much more common story - adapting to life with tinnitus while challenging for some 

is merely a nuisance for others.   Each person’s tinnitus and circumstances are 

unique, but what is true for all those with tinnitus is that having good hearing 

protection options can make life in our noisy world more comfortable. And for those 

who don’t have tinnitus, proper use of hearing protection may be the answer to 

remaining “tinnitus free” for life.   

 

Misinformation and misconceptions about tinnitus and hearing protection are plentiful, 

so an overview of fiction and fact is a good place to start our discussion. While not an 

exhaustive list, Table 1 summarizes some common issues that are further explained 

below. First, a definition: tinnitus is a generic word for the perception of sound that is 

not associated with actual physical acoustic energy.  It seems to come from inside the 

head and lasts for at least a few minutes at a time. It is commonly described as 

 

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ringing, chirping, roaring, buzzing, whooshing, hissing, frying bacon, peeping or 

something similar.  

 

No one understands my tinnitus… 

Actually, tinnitus is more common than you might think. Estimates suggest that from 6 

– 17% of the population, or perhaps as many as 50 million Americans, have tinnitus. 

A much smaller percentage (about 3 - 7% of the general population) is bothered by 

tinnitus enough to seek medical attention.  An even smaller percentage of people 

consider their tinnitus so debilitating that it keeps them from leading a “normal” life.  

 

Chances are good that if you start asking your family members and friends, you will 

discover someone who has tinnitus and who can relate to your experience. People 

who have hearing loss, particularly noise-induced hearing loss, and the elderly 

population, are more likely to have tinnitus. A notable national organization dedicated 

to helping those with tinnitus is the American Tinnitus Association (ATA). Visit 

www.ata.org

 for current resources and to locate a local support network. 

 

Disease or symptom?  

Tinnitus is an indicator of abnormal function, but it is not a disease in and of itself. In 

this way it is similar to headache, elevated blood pressure, or dizziness, each of 

which signals something is wrong with the body, but none is a disease. Although 

tinnitus has been studied extensively, the cause and mechanics of tinnitus are not 

well understood. Because the ear detects sound and the brain processes it, it is 

generally accepted that both the hearing mechanism and the brain are involved with 

the origination of tinnitus. Some believe tinnitus is extra activity of the auditory 

neurons – in the nerve pathways of hearing. Tinnitus is often associated with certain 

medications, but interestingly having tinnitus is not more common among people who 

consume caffeine, nicotine, or alcohol. Things like the condition of one’s health, noise 

exposure, and the degree of hearing loss are all correlated with the presence and the 

severity of tinnitus.  

 

Tinnitus and hearing loss 

Hearing loss and tinnitus often occur together, but tinnitus is not a cause of hearing 

loss.  However, tinnitus may be an early indicator of damage to the auditory system, 

showing up before a loss of hearing is obvious.  Certain ear diseases or conditions 

are more likely to exhibit accompanying tinnitus than others. People who have a 

history of loud noise exposure, Meniere’s disease, otosclerosis, age-related hearing 

loss, sudden hearing loss or a benign growth on the hearing or balance nerve are at 

high risk of also having tinnitus.  It is advisable for those with tinnitus and/or hearing 

loss to see a physician and audiologist to diagnose the condition and to explain 

treatment and management options. For those with a sudden onset of tinnitus or 

 

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hearing loss, the sooner you receive medical intervention the better the chances are 

for recovery.  

 

Living with tinnitus 

Most people learn to live with tinnitus without any treatment.  However, for a small 

percentage, tinnitus is such a chronic and unpleasant experience that seeking relief is 

essential. Hearing the message from a healthcare provider, “there is nothing you can 

do about it, just learn to live with it,” can be devastating. True, there is no cure today 

for tinnitus, no magic pills, surgery, or diet to silence the internal, unwanted sounds, 

but there is hope for treatment and/or management of the condition. Initially, an 

evaluation should be conducted to identify the underlying condition causing the 

tinnitus. If this condition can be medically or surgically treated, then the tinnitus may 

be substantially improved or eliminated.  In circumstances where there is no medical 

treatment available, as in the case of tinnitus arising from permanent noise-induced 

hearing loss, there are still options available to help manage the tinnitus.  The two 

basic approaches are: 1) lessen the awareness of the tinnitus and 2) relieve the 

stress and negative emotional reactions that it triggers. Some tinnitus therapies utilize 

both strategies by incorporating counseling, education and the use of competing 

sound intended to distract one from constantly hearing the tinnitus. The overarching 

goal is to return to the pre-tinnitus quality of life.  

 

Unfortunately, many studies have concluded there isn’t one best treatment option.  It 

isn’t uncommon for people who are desperate to find help to fall prey to 

advertisements and false promises. Consulting a professional organization of 

audiologists or physicians with specialty training in tinnitus treatment is 

recommended. See Table 2 for more information. 

 

Tinnitus and hearing protection 

Exposure to loud noise is one of the most common causes of hearing loss and 

chronic tinnitus. Generally speaking, the louder the noise and the longer the time of 

exposure, the greater the risk for hearing damage (noise-induced hearing loss) and its 

common side effect: tinnitus. Proper use of hearing protection when you are exposed 

to loud noise is essential – especially if there is some hearing loss and tinnitus 

already present.  You should use hearing protection whenever it is so loud you must 

shout in order for the person next to you to hear you clearly (roughly 85 dBA), and 

especially in the presence of high-level impulse noise such as that produced by 

gunfire or explosions. Because loud sound can aggravate existing tinnitus, it may be 

advisable to use hearing protection at lower noise levels, for example when you have 

to talk loudly for the person at arms length from you to understand (roughly 80 dBA).  

 

 

 

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Which hearing protector?  

Not all hearing protectors are created equal.  With many options of styles, colors, and 

materials, selection can be a bit overwhelming. Basic types of hearing protectors are 

“roll-down” foam earplugs, push-to-fit foam earplugs, flanged or premolded earplugs, 

custom-made earplugs, “banded” earplugs and earmuffs.  

•

 

Traditional foam earplugs require some skill to insert properly since they must be 

rolled into a small cylinder before they are inserted into your ears.   However, they 

are forgiving and, even when not inserted optimally, can provide a reasonable 

noise-blocking seal. If worn correctly, traditional foam earplugs tend to be the 

most comfortable and effective style of earplug, providing noise reduction that 

rivals high-attenuation earmuffs. 

•

 

Push-to-fit foam earplugs are easier to use than traditional foam since they don’t 

need to be rolled before inserting them into your ears, yet they can provide similar 

levels of comfort and protection.   

•

 

Premolded earplugs are made of an elastic material that can be washed and 

reused for a longer time than foam earplugs.  Although they can seal well, they 

tend to be somewhat less comfortable and less protective than foam earplugs.  

They can’t usually be inserted as deeply as foam earplugs without discomfort, 

and they require repositioning to maintain the acoustic seal in the earcanal.  

•

 

Custom-made earplugs are much more expensive than non-custom types and, 

contrary to intuition, are usually not the most protective. Even so, for some 

applications and individuals, custom-made  earplugs may be a great choice for 

comfort, ease of use, and adaptability. 

•

 

Banded (also called concha seated and semi-aural) earplugs are primarily 

intended for intermitted-use applications since they easily store around the neck 

while not in use. 

•

 

Earmuffs are easy to use, quick to put on and take off for short-term exposures 

and provide warmth, which is welcome in cold environments. Also, earmuffs are 

an ideal solution for people who object to putting something inside their ears.   

You may have to experiment among different types of earplugs and earmuffs to find 

what is best for you.  The “right choice” is the one which blocks sound, is convenient 

to carry with you, and is comfortable enough to wear consistently.  It isn’t necessary 

to buy the most expensive product because effective protection can be achieved with 

simple, less expensive options. To ensure that you are choosing devices designed to 

reduce your noise exposure, look for the Noise Reduction Rating (NRR) on the 

product packaging. Products with an NRR have been developed, studied, and 

objectively measured using scientifically accepted laboratory procedures.  These 

products are preferable to make-shift devices like cotton balls or wadded-up paper 

that allows hazardous sound to penetrate into the ear. However, don’t get hung up on 

the actual NRR; small differences between NRRs of 4 or 5 decibels (dB) won’t make 

a significant difference in the overall performance. 

 

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Most important for good performance is how well you fit the product to your ear; the 

better the fit, the greater the protection.  A poor fit means less protection due to air 

leaks, or worse, no protection if the earplugs stay in your pocket instead of your ear.  

As a rough guide, you can presume that devices with NRRs of 29 dB and greater are 

capable of providing the highest possible protection.  Those with NRRs of 16 dB and 

lower are likely to provide modest protection.  The lower values of protection are often 

quite sufficient (and even preferred) for common recreational exposures other than 

shooting or the loudest of rock concerts. 

 

Learning to fit your ears with hearing protectors is made easier with demonstrations. 

Visit 

www.e-a-r.com/hearingconservation/video_main.cfm

 for short instructional videos on 

fitting earplugs. An in-depth brochure called Tips and Tools for Fitting and Using 

E•A•R

™

 Foam Earplugs, applicable to all brands and types of roll-down foam earplugs 

is available at 

www.e-a-r.com/hearingconservation/booklet_main.cfm

.  Other types of 

hearing protectors also require correct use. See EARLog 19 for numerous 

suggestions on a broad range of products 

www.e-a-r.com/hearingconservation/earlog_main.cfm

.   

 

Hearing with hearing protection 

Hearing protectors block the external sound from entering the ear but don’t totally 

stop all sound from getting through. Conventional hearing protectors filter out more of 

the high pitches than the low pitches, which alters the sound quality. Furthermore, the 

sounds inside the head seem different to you when you are wearing hearing 

protectors; your voice and body sounds become fuller, boomy, hollow-sounding, and 

muffled.  This is called the occlusion effect.  To experience this, try sealing your 

earcanals with your thumbs and read this sentence aloud while listening to your voice.  

Fitting the hearing protectors more deeply in the earcanals will minimize the occlusion 

effect and the sound will be more natural. 

 

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© 2011  3M.  All Rights Reserved 

More is better?    

Not always. People use hearing protection for many different reasons and in many 

environments: to protect hearing from hazardous occupational noise, while shooting 

firearms, to improve their ability to concentrate on reading in an airport, or perhaps to 

sleep during the day when neighborhood children are playing outside. Some of these 

situations require hearing protection to reduce noise to a safe level, but others simply 

use hearing protection to block out unwanted or annoying sounds. Interestingly, 

people with tinnitus often rely on background noise to interfere with the sound of the 

tinnitus. Limiting the background noise with hearing protection may make the tinnitus 

seem more noticeable. This is likely to be more of a problem in low-noise 

environments or with hearing protectors that provide more noise reduction. When 

noise is loud enough to require hearing protection for safety reasons (greater than 85 

dBA), the hearing protection can block hazardous noise while still allowing enough 

sound to pass to still provide distraction from the tinnitus. Remember, changes to the 

awareness of the tinnitus due to the use of hearing protection are temporary; using 

hearing protection appropriately will prevent long-term noise-induced damage and 

potential worsening of the tinnitus.   

 

The amount of noise reduction needed depends on both the purpose for using 

hearing protection and the background noise level. To decide if “more is better” think 

about the reason you are using hearing protection and choose a product that works 

for that specific environment.  Many noise exposures only require about 10 dB of 

noise reduction for adequate protection from noise damage. So, unless you simply 

prefer the extra quieting that maximum noise reduction will provide, you can choose a 

product with lower noise reduction and not be troubled by being isolated from the 

sounds around you. 

 

An excellent choice for taking the edge off of annoying sounds while still allowing 

easy communication is the ER-15 Musicians Earplugs™ (see 

www.etymotic.com

).  

Although more expensive, at over $100/pair, this custom molded earplug is 

comfortable to wear and sounds more natural because it reduces all pitches of sound 

equally and avoids the muffling effect so common with conventional products. An 

alternative, much less expensive product (about $15/pair), is a “one-size-fits-most” 

flanged earplug that can be purchased off the shelf – E•A•R™ Hi-Fi earplugs (also 

called ER-20 earplugs).   Like the custom ER-15, the Hi-Fi earplugs are intended for 

adequate and not maximum protection and thus are ideal for music exposures and 

many public entertainment events. 

 

Another popular approach to controlling unwanted noise is active noise reduction 

(ANR; sometimes also called noise cancellation).  This method depends on 

electronics to process the sound that travels through the hearing protector. The sound 

 

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is modified and reintroduced through a small earphone that partially cancels the 

incoming sound.  This technology works well for low-frequency sound below about 

400 Hz, such as the loud rumbling engine noise inside aircraft or military vehicles. It 

has many commercial and military applications. For consumers who want enhanced 

listening experiences, ANR is most often used in earphones or earplugs that can be 

coupled to listening devices.  Such devices are useful for enjoying music or sound 

tracks while reducing unwanted noise in an aircraft cabin or subway car.  If a high 

degree of noise protection is needed, less-expensive non-electronic insert earphones 

(i.e., earplugs) that seal well in the earcanal can be used instead of an ANR device. 

 

Life can be loud… 

Make sure you are getting the protection you need.  If immediately following a noise 

exposure you experience increased or sudden onset of tinnitus, or if your hearing 

seems muffled or fuzzy, the noise was too loud.   Regular exposures like that will 

probably lead to hearing loss and/or permanent or increased tinnitus. Since you can’t 

always predict when you will be exposed to noise, keep your hearing protection 

handy, just like you might carry a pair of sunglasses.  Having appropriate hearing 

protection options for different listening situations is also helpful. Earplugs are small, 

lightweight, and easy to store in a pocket or travel bag. You can even bring an extra 

pair or two for someone else who is caught unprepared. After all, the fact is replacing 

earplugs is easy, but replacing hearing is still fiction.  

 

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© 2011  3M.  All Rights Reserved 

 

Table 1 – Tinnitus: fiction and fact 

FICTION FACT 

No one can understand how bad my 

tinnitus is. 

Tinnitus is more common than you think. 

Start talking to others and you are likely to 

find someone close to you who has a 

similar experience.   

Tinnitus is a disease. 

Tinnitus is a symptom.  

Tinnitus causes hearing loss. 

Tinnitus commonly accompanies hearing 

loss, but is not the cause of hearing loss.  

Nothing can be done about tinnitus. One 

just has to learn to live with it.  

There is no tinnitus cure, but something 

can be done. Sometimes the underlying 

condition causing the tinnitus can be 

medically treated. Or, as is the case for 

noise damage, there are a variety of 

management approaches that can provide 

tinnitus relief.

 

I already have tinnitus, so I don’t need to 

protect my hearing.   

Using hearing protection can prevent the 

onset or aggravation of tinnitus and 

hearing loss. 

All hearing protection is the same.  

There are many different types of hearing 

protection, and the “best” one may be 

different for each person.  

The higher the number on the hearing 

protection package, the better. 

The degree of sound reduction varies, 

depending on many things, including how 

well the hearing protector fits the ear. The 

number on the package is not the only 

thing to consider when choosing the best 

protector for you.   

Using hearing protection will make my 

tinnitus worse.  

Tinnitus may temporarily be more 

apparent while wearing hearing 

protection, especially with hearing 

protectors that provide higher noise 

reduction and/or in lower ambient noise.  

But hearing protectors may help prevent 

the noise from permanently making the 

tinnitus worse with time. 

More noise reduction is always better. 

The hearing protection choice depends on 

the purpose for using it and the 

background noise level. 

 

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© 2011  3M.  All Rights Reserved 

 

Table 2 - Tinnitus and hearing protection resources 

American Academy of 

Audiology 

www.howsyourhearing.org

 

American Speech-

Language-Hearing 

Association 

www.asha.org/public/hearing/Tinnitus-Management

 

 

American Tinnitus 

Association 

www.ata.org

 

American Academy of 

Otolaryngology-Head and 

Neck Surgery 

www.entnet.org/HealthInformation/tinnitus.cfm

 

 

3M hearing conservation 

and hearing protection 

fitting information 

www.e-a-r.com/hearingconservation

 

 

Etymotic Research, Inc. 

(high fidelity earplugs) 

www.etymotic.com/ephp/er20.aspx

 

 

National Institutes of 

Health 

www.nidcd.nih.gov/health/hearing/tinnitus

 

National Hearing 

Conservation Association 

www.hearingconservation.org

 

 

Oregon Hearing & 

Science University 

Tinnitus Clinic 

www.ohsu.edu/xd/health/services/ent/services/tinnitus-

clinic/index.cfm

 

 

 

References 

Dobie, R. A. (2004).  “Overview: Suffering from Tinnitus.” in Tinnitus: Theory and 

Management, editor James B. Snow,  BC Decker Inc., Hamilton, London 1-8.. 

 

Hoffman, H. J. and Reed, G.W. (2004).  “Epidemiology of Tinnitus, in Tinnitus: Theory 

and Management, editor James B. Snow, BC Decker Inc., Hamilton, London, 16 – 41. 

 

Jastreboff, P. J. and Jastreboff, M. M (2003). “Tinnitus and Hyperacusis,” in 

Ballenger’s Otorhinolaryngology Head and Neck Surgery 16

th

 Edition, editor James B. 

Snow,  BC Decker Inc., Hamilton, London 456 – 475. 

 

 

 

 

 

 

 

 

March 2011 

 

© 2011  3M.  All Rights Reserved 

About the Authors: 

 

Elliott H. Berger, M.S., is a Division Scientist for 3M’s Occupational Health & 

Environmental Safety Division.  For over 30 years he has studied noise and hearing 

conservation with an emphasis on hearing protection.  Elliott chairs the ANSI working 

group on hearing protectors, has been lead editor for two highly-regarded texts in 

noise and hearing conservation, served on a National Academy of Science committee 

evaluating hearing loss in the military, and has presented his research in numerous 

text book chapters and over 60 published articles. 

 

Laurie L. Wells, Au.D., is Manager of Audiology for Associates in Acoustics, Inc., a 

professional consulting firm specializing in hearing loss prevention through 

occupational audiology, noise measurement and noise control efforts. Laurie 

oversees audiometric monitoring programs for companies and corporations across 

the United States and is an active presenter and teacher on hearing loss prevention 

topics. She currently represents the American Academy of Audiology on the Council 

for Accreditation in Occupational Hearing Conservation and is past president of the 

National Hearing Conservation Association.  

 

Visit

 

http://www.3M.com/Hearing

 

to register for training, download files, or other 

materials. 

 

 

Become a fan at 

http://www.Facebook.com/3MHearingProtection

 

 

 

 

3M Occupational Health & Environmental Safety Division 

 

3M offers comprehensive product solutions providing respiratory protection, hearing 

protection, fall protection, visibility and protective clothing, eyewear, head and face 

protection, welding helmets, and other adjacent products and solutions such as 

tactical safety equipment, detection and monitoring, compliance management and 

spill management.  Visit 

www.3M.com/OccSafety