Tinnitus can be classified in many ways. Some of the titles have practical application, regarding the treatment program, and others are just traditional titles of this medical condition. In this short article we shall try to review the most important ways to classify tinnitus.

A) The associated symptoms of the tinnitus:
Tinnitus can be mono symptomatic, but it is very rare. When the medical doctor is asking his patient the right questions he can find many associated symptoms such as vertigo, dizziness, hyperacusis, “plugged ears”, mizophonia, anxiety, insomnia, irritability or even depression, Sometimes the other symptoms sounds unrelated to the tinnitus.

What could be the relation between tinnitus and peptic ulcer? Is there any connection between tinnitus and joint pain? Is it possible that elevated blood fats will have connection to tinnitus? All the above questions are a partial list of possibilities.

Dr. Shemesh, a medical doctor who is in the field of tinnitus for 29 years admits that the clinical research was not deep enough, and many important questions are still open.

B) Subjective versus objective:
The tinnitus can be divided to two types: subjective and objective. In most of the patients it is subjective. The minority of patients have objective tinnitus. Other patients have episodes of mixed subjective and objective tinnitus.
The sound of objective tinnitus is heard as pulse in the majority of the sufferers. If there is synchronization with the heart rate it means that the patient is suffering from blood vessel disease.

When there is no synchronization with the heart rate, it means that it is a sound of a muscle contraction, such as palatal myoclonus.

C) Fixed versus unsteady:
The sound of tinnitus can be fixed and continuous or fluctuating. The “ups and downs” can be in cycles of hours, days or weeks. In some of the sufferers the tinnitus is loud few days in a month, but when it comes it is very annoying.

An interesting phenomenon is the change in the loudness or the musicality of the tinnitus after sleeping. Usually the change is prominent when the patient wakes up in the afternoon after a sleep of short duration. No one offered a good theoretical explanation for that observation, and no one suggested a way to use it for clinical purposes.

D) Maskable versus unmaskable:
Maskability is another criteria for classification. A tinnitus that respond to masking sound enables the patient to enjoy temporary relief from his tinnitus.

E) The number of sounds:
The number of sounds is variable. One to three sounds are common. Sometimes there are even hundreds. A lady from New Zealand told me: “in New Zealand there are only 100 snakes, and all of them are inside my head”.

F) Meniere's Disease:
When tinnitus is combined with vertigo, hearing loss and plugged ears, without any other medical condition such as tumor, it means that the patient us suffering from Meniere's Disease.

G) Iatrogenic (caused by medical doctor) tinnitus:
One of the most practical aspects of classification is the iatrogenic tinnitus. Most of the cases of Iatrogenic tinnitus are “Drug induced tinnitus”. The others are the “Post surgical” sufferers. Stapedectomy for Otosclerosis and dental surgery may cause tinnitus. Other surgical procedures are less common.

H) Severe, moderate or mild tinnitus:
Tinnitus can be classified according to the degree of severity. Severe tinnitus is the worst, and many times it is associated with disability at work, insomnia, restlesness, irritability, anxiety, hyperacusis, and some cognitive disabilities. It is important to distinguish between psychiatric disorders that include tinnitus and tinnitus with psychological reaction as an outcome of the tinnitus.

I) Tinnitus with psychological symptoms:
Conversive Disorder (very rare), Compensative Neurosis, aggravants, Post Traumatic Stress Disorder or Malingering are some of the possibilities.
The patient with the conversive disorder (the new term for “hysteria”) is suffering from symptom that appears organic without any evidence to biological defect in the affected organ or system, due to unconscious conflict.

The patient with the compensatory neurosis is aware of his symptoms and is trying to receive payment from the insurance company.

The man with post traumatic stress disorder experienced a severe emotional stress such as explosion, car crush or being inside fire.

The malingerer and the aggravant are trying to perform a clinical picture of a sufferer, while the malingerer does not have tinnitus at all, and the aggravant have low grade tinnitus and he is trying to behave as if he is suffering from severe tinnitus.

The most important symptom that can be found in the population of severe tinnitus patients is suicidal thoughts. Many times the patient is not telling about it spontaneously. It is important to ask the patient directly about such ideation. Experienced clinician knows how to do a professional interview that enables the patient to expose his suicidal thoughts. When the therapist knows about any suicidal risk he should refer his patient to a psychiatrist.

J) Acute versus chronic tinnitus:
Duration of less then 6 months of tinnitus is considered “acute tinnitus”. More then 6 months of tinnitus is “chronic tinnitus”. This terminology was used in the clinic of the IDF (Israel Defense Forces).

The practical aspect is the potential for spontaneous cure in the population of acute patients. In soldiers (Age 18 – 21) the probability of spontaneous cure wa found to be 85%.

K) Help-seekers versus non-help seekers.
Patients with mild or moderate tinnitus are usually “non help seekers”. Most of them say: I can live with it