Essay 3 - The Tinnitus Triptych
- Art of Hearing | Dyon Scheijen
- 2 days ago
- 4 min read
Tinnitus is often described as a sound without an external source. But when we listen to the experience of tinnitus, it soon becomes apparent that this phenomenon cannot be fully understood by looking only at the auditory signal. It arises at the intersection of three dimensions: the sound itself, the brain that gives meaning, and the person living with it.
Where Art Meets Science
The Hearing Triptych
Sound · Brain · Human Experience
Essay 3
The Tinnitus Triptych
Understanding tinnitus through sound, brain and human experience
In the search for an explanation for tinnitus, research has long focused on the auditory system. The question was logical: where does the sound originate?
Researchers have examined damage in the cochlea, changes in neural activity, and reorganization of auditory networks in the brain. These insights have significantly deepened our understanding of tinnitus (Jastreboff, 1990; Roberts et al., 2013).
Nevertheless, a remarkable observation remains.
Two people can have a similar perception of tinnitus, while their distress is completely different.
One person hardly notices the sound.
For the other person, the sound can become a constant source of tension and exhaustion.
This observation suggests that tinnitus cannot be fully understood from the auditory signal alone.
In this essay series, therefore, an integrative perspective is proposed in which tinnitus is approached as an interaction between three dimensions—sound, brain, and human. This perspective is referred to here as The Hearing Triptych framework (Scheijen, 2026).
From signal to experience
When we approach tinnitus exclusively as an auditory disorder, we look primarily at one dimension of the phenomenon.
But tinnitus is more than a signal.
It is an experience.
And experiences rarely arise from a single mechanism. They arise from an interaction between biological, neurological, and psychological processes.
Therefore, models have been developed within various research fields that attempt to explain why some tinnitus perceptions lead to suffering while others do not (Cima et al., 2011).
These models emphasize that tinnitus is not only an auditory phenomenon, but also has a cognitive and emotional dimension.
The tinnitus triptych
To describe this complexity, it can be helpful to view tinnitus as a triptych.
In art, a triptych consists of three panels that together tell a single story. Only when all panels are opened does the complete image emerge.
Tinnitus also seems to unfold at the intersection of three dimensions.
Panel 1 - Sound
The first panel consists of the auditory signal itself.
This includes the physiological processes in the auditory system: the cochlea, auditory nerve pathways, and neural activity in the auditory cortex.
Much tinnitus research has rightly focused on this dimension. The neurophysiological model of tinnitus describes how changes in the auditory system can lead to the development of a tinnitus perception (Jastreboff, 1990).
But this does not yet explain why the same signal has hardly any meaning for one person and becomes a source of suffering for another.
Panel 2 - Brain
The second panel is located in the brain.
Here, the auditory signal acquires meaning.
The brain constantly determines which stimuli deserve attention and which fade into the background. In neuroscience, this process is often described by the concept of salience (Menon, 2015; Uddin, 2015).
When a sound acquires high salience, it remains present in the attention.
It becomes a stimulus that the brain considers important.
This mechanism can explain why some tinnitus perceptions remain persistently present in consciousness.
Panel 3 - Human
The third panel is located in the life of the person experiencing the sound.
Factors such as stress, sleep, emotional significance, behavior, and coping play a role here.
Psychological models such as the fear-avoidance model show how attention, anxiety, and avoidance behavior can reinforce experienced suffering (Vlaeyen & Linton, 2000).
Within cognitive behavioral therapy for tinnitus, therefore, the focus is often on changing the relationship a person has with the sound (Cima et al., 2011).
An integrative perspective
When these three panels are viewed together, an integrative perspective on tinnitus emerges.
Tinnitus can then be understood as a phenomenon that arises at the intersection of:
sound · brain · human
This perspective aligns with various existing models.
The neurophysiological model of tinnitus emphasizes the role of auditory signals and limbic systems (Jastreboff, 1990).
Psychological models show how attention, interpretation, and avoidance can intensify suffering (Vlaeyen & Linton, 2000).
Moreover, within modern neuroscience, increasing attention is being paid to brain networks that determine which stimuli become relevant to the brain (Menon, 2015).
The tinnitus triptych does not attempt to replace these insights, but to bring them together within an understandable framework.
The complete picture
When we approach tinnitus solely from the perspective of the auditory signal, we may miss an important part of the story.
When we look only at psychological factors, we equally miss the biological basis of the phenomenon.
Only when all three panels of the triptych are opened does a more complete picture of tinnitus emerge.
An image in which sound, brain, and human experience are inextricably linked.
From tinnitus to noise nuisance
This perspective may have implications that extend beyond tinnitus alone.
With other forms of noise pollution as well – such as low-frequency sound – we see that the same physical stimulus can produce a completely different experience for different people.
There, too, the full story seems to unfold at the intersection of:
sound · brain · human
In the following essay, we explore how this perspective can help to better understand the complexity of low-frequency sound as well.
Where Art Meets Science
Sound · Brain · Human Experience
Literature
Cima, RFF et al. (2011).
A multidisciplinary cognitive behavioral approach to tinnitus. The Lancet.
Scheijen, D. (2026).
The Hearing Triptych: Sound · Brain · Human Experience.
Jastreboff, PJ (1990).
Phantom auditory perception (tinnitus): mechanisms of generation and perception. Neuroscience Research.
Menon, V. (2015).
Salience Network. Annual Review of Neuroscience.
Uddin, LQ (2015).
Salience processing and insular cortical function. Nature Reviews Neuroscience.
Roberts, LE et al. (2013).
Neural mechanisms of tinnitus. Trends in Cognitive Sciences.
Vlaeyen, JWS, & Linton, SJ (2000).
Fear-avoidance and its consequences in chronic pain. Pain.
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