Tinnitus Doctor Nashville: Expert ENT Care for Ringing Ears

By Dr. Steven Enrich, MD — Board-Certified Otolaryngologist

What Is Tinnitus and Who Should Evaluate It?

Tinnitus is the perception of sound — most often ringing, buzzing, clicking, or hissing — in the absence of an external noise source. The sound may be constant or intermittent, affect one ear or both, and range from mildly annoying to severely disruptive.

A board-certified ENT physician is the appropriate specialist for tinnitus evaluation. Audiologists play an important supporting role in hearing assessment, but an otolaryngologist can order imaging, assess middle ear anatomy, and rule out conditions that require medical or surgical management.

Key facts about tinnitus:

The American Tinnitus Association estimates 50 million Americans are affected.
The National Institute on Deafness and Other Communication Disorders (NIDCD) reports that roughly 20 million Americans experience chronic tinnitus.
About 2 million have what the NIDCD classifies as extreme or debilitating tinnitus.
Tinnitus is the most common service-related disability among U.S. veterans, according to the U.S. Department of Veterans Affairs.
Age-related hearing loss (presbycusis) is the single most common cause in adults over 60.

Because tinnitus is a symptom rather than a disease, evaluation focuses on finding the underlying cause. Attempting to manage tinnitus without a proper diagnosis may delay treatment for a correctable condition.

How Does a Tinnitus Doctor Diagnose the Cause?

Diagnosing tinnitus starts with a structured clinical history and physical examination. Dr. Enrich follows an evidence-based approach that gathers information before recommending any intervention.

A typical tinnitus evaluation may include:

Medical history review — onset, character of the sound (pulsatile vs. non-pulsatile), duration, and any associated symptoms such as vertigo or ear fullness.
Otoscopic examination — direct inspection of the ear canal and tympanic membrane to check for cerumen impaction, perforation, or middle ear fluid.
Audiometric testing — pure-tone and speech audiometry administered by a licensed audiologist to quantify any associated hearing loss across frequencies.
Tympanometry — a pressure test that evaluates middle ear function and Eustachian tube patency.
Imaging when indicated — a CT scan or MRI may be ordered if pulsatile tinnitus, sudden unilateral hearing loss, or asymmetric findings suggest a structural or vascular cause requiring further workup.
Laboratory evaluation — blood pressure measurement and, in selected cases, thyroid or metabolic panels, since certain systemic conditions are associated with auditory symptoms.

What Is Pulsatile Tinnitus?

Pulsatile tinnitus — a rhythmic sound that corresponds to the heartbeat — is a distinct presentation that warrants prompt evaluation. The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) recommends imaging for all patients presenting with pulsatile tinnitus because a vascular or structural abnormality may be present.

Non-pulsatile tinnitus is far more common and is most frequently linked to sensorineural hearing loss, noise exposure, or Eustachian tube dysfunction.

Common Causes of Tinnitus an ENT Doctor Evaluates

Tinnitus has more than a dozen recognized causes. Understanding which one is driving the symptom is the only reliable path to appropriate management.

Cause	Prevalence	Key Feature
Sensorineural hearing loss	Most common overall	High-frequency hearing loss on audiogram
Noise-induced hearing loss	Very common	History of loud occupational or recreational noise
Cerumen (earwax) impaction	Common, easily treated	Visible on otoscopy
Eustachian tube dysfunction	Moderate	Ear fullness, muffled hearing, popping
Ototoxic medications	Common in older adults	Temporal link to new drug (e.g., high-dose aspirin, some antibiotics)
Middle ear infections (otitis media)	More common in children	Ear pain, fluid behind drum
Temporomandibular joint (TMJ) disorder	Less common	Jaw pain, clicking
Acoustic neuroma (vestibular schwannoma)	Rare	Unilateral tinnitus, progressive hearing loss
Pulsatile vascular causes	Rare	Rhythmic, heartbeat-synchronized sound

Dr. Enrich evaluates both pediatric and adult patients, which is significant because children sometimes present with tinnitus related to recurrent ear infections, eustachian tube immaturity, or adenoid hypertrophy rather than the noise-exposure causes more typical in adults.

Why Is Choosing a Board-Certified ENT Important for Tinnitus?

Board certification by the American Board of Otolaryngology-Head and Neck Surgery (ABOHNS) requires a physician to complete a five-year surgical residency, pass written and oral examinations, and demonstrate ongoing competency through periodic recertification. That credential matters for tinnitus patients for several reasons.

First, tinnitus is frequently a symptom of conditions that require medical or surgical management — middle ear disease, Eustachian tube dysfunction, or, rarely, a benign tumor called a vestibular schwannoma. A board-certified ENT can perform the procedures required if intervention is warranted.

Second, an ENT with fellowship training in head and neck anatomy has a deeper understanding of the structures adjacent to the auditory system. Dr. Enrich's fellowship in Advanced Sinus and Skull Base Surgery is directly relevant when evaluating patients whose tinnitus involves the sinuses, skull base, or Eustachian tube.

Third, experience matters. Dr. Enrich brings more than 20 years of surgical and clinical practice to each evaluation. That depth of experience supports what his practice describes as diagnostic clarity — reaching a confident explanation of what is causing the tinnitus before any treatment plan is proposed.

Patients should be cautious of any provider who recommends a tinnitus supplement, device, or procedure without first completing a thorough diagnostic workup. The AAO-HNS Clinical Practice Guideline on Tinnitus (2014, updated guidance 2020) explicitly discourages routine audiologic or medical interventions without a proper evaluation.

What Treatment Options May Be Available for Tinnitus?

No single treatment eliminates tinnitus in all patients, and Dr. Enrich's practice is grounded in shared decision-making — patients understand every available option before agreeing to any course of action.

Treatment depends entirely on the underlying cause identified during evaluation. Options that a board-certified ENT may discuss include:

Treating the Underlying Cause

If a correctable cause is found — impacted cerumen, middle ear fluid, a perforated eardrum, or Eustachian tube dysfunction — addressing that condition may reduce or resolve tinnitus in some patients. Results vary based on the specific diagnosis and individual factors.

Sound Therapy and Hearing Aids

For patients with sensorineural hearing loss, amplification through properly fitted hearing aids is associated with reduced tinnitus perception in a meaningful subset of patients, according to research published in the Journal of the American Academy of Audiology. Sound masking devices and white-noise generators are also used in sound therapy protocols.

Cognitive Behavioral Therapy (CBT)

CBT delivered by a licensed psychologist or trained audiologist has the strongest evidence base among psychological approaches to tinnitus management. The AAO-HNS guideline rates CBT as the treatment with the highest-quality evidence for reducing tinnitus-related distress.

Tinnitus Retraining Therapy (TRT)

TRT combines low-level sound therapy with directive counseling. Developed by Pawel Jastreboff, PhD at the University of Maryland, TRT aims to shift the brain's classification of tinnitus from a threat signal to a neutral one.

What Is Not Recommended

The AAO-HNS guidelines recommend against routine use of dietary supplements, benzodiazepines, anticonvulsants, or antidepressants solely for tinnitus suppression, citing insufficient evidence. Any medication decision requires a conversation with a licensed provider familiar with the patient's full medical history.

How to See a Tinnitus Doctor in Nashville at Dr. Enrich's Practice

Dr. Steven Enrich, MD practices through Tennessee Breathe Free and is currently accepting new patients from Nashville and throughout Middle Tennessee. Both pediatric and adult patients are welcome.

Preparing for a tinnitus appointment can improve the efficiency and quality of the evaluation. Patients are encouraged to:

Document the tinnitus — note when it started, what the sound resembles, whether it is constant or intermittent, and whether it affects one or both ears.
List all current medications — including over-the-counter drugs, vitamins, and supplements, as ototoxicity is a recognized cause of tinnitus.
Bring prior audiograms — if a hearing test has been performed within the past year, that result can inform the evaluation.
Note associated symptoms — dizziness, ear pressure, ear pain, facial numbness, or sudden changes in hearing are clinically important details.

Dr. Enrich's practice prioritizes a diagnostic-first model: no intervention is recommended until there is a clear understanding of what is causing the symptom. This approach aligns with both the AAO-HNS clinical practice guideline and evidence-based standards recommended by the NIDCD.

Middle Tennessee residents dealing with chronic ear ringing, buzzing, or related hearing concerns do not have to manage those symptoms without answers. A structured ENT evaluation is the most direct path to understanding what the tinnitus signifies and what, if anything, can be done about it.

Frequently Asked Questions

What kind of doctor should I see for tinnitus in Nashville?

A board-certified otolaryngologist (ENT physician) is the appropriate specialist for tinnitus evaluation. ENT doctors can examine the ear canal, order audiometric testing and imaging, and identify whether the tinnitus stems from hearing loss, Eustachian tube dysfunction, a middle ear condition, or another cause. In Nashville, Dr. Steven Enrich, MD — a board-certified ENT with over 20 years of clinical experience — evaluates tinnitus patients of all ages at his Tennessee Breathe Free practice.

Can tinnitus be cured?

Tinnitus does not have a universal cure. Management outcomes depend heavily on the underlying cause. For patients whose tinnitus is linked to a correctable condition — such as cerumen impaction, middle ear fluid, or Eustachian tube dysfunction — treating that condition may reduce or resolve symptoms in some cases. For chronic sensorineural tinnitus, evidence-based therapies such as sound therapy, properly fitted hearing aids, and Cognitive Behavioral Therapy (CBT) are associated with meaningful reductions in distress in a significant subset of patients, according to the American Academy of Otolaryngology-Head and Neck Surgery.

Is tinnitus a sign of something serious?

Most tinnitus is not life-threatening, but certain presentations warrant prompt medical evaluation. Pulsatile tinnitus (a rhythmic sound synchronized with the heartbeat), sudden one-sided hearing loss, tinnitus accompanied by vertigo or facial numbness, and progressive asymmetric hearing loss all require timely workup by an ENT physician. The American Academy of Otolaryngology-Head and Neck Surgery recommends imaging for patients with pulsatile tinnitus because a vascular or structural cause may be present.

How long does a tinnitus evaluation take?

A thorough tinnitus evaluation typically requires one to two appointments. The first visit includes a medical history review, otoscopic examination, and in-office assessment. Audiometric testing may occur on the same day or be scheduled with a licensed audiologist at a follow-up visit. If imaging is indicated based on initial findings, results are reviewed at a subsequent appointment. Dr. Enrich's practice follows a diagnostic-first model, which means the goal of the initial evaluation is to reach a clear understanding of the cause before any treatment is discussed.

Does stress make tinnitus worse?

According to research published in peer-reviewed audiology literature, psychological stress does not cause tinnitus but is consistently associated with increased perceived tinnitus severity. The limbic system's threat-detection response can amplify the brain's attention to the tinnitus signal. This is part of the rationale for Cognitive Behavioral Therapy and Tinnitus Retraining Therapy, both of which address the emotional and attentional components of tinnitus perception. Managing stress as part of an overall tinnitus care plan is supported by the AAO-HNS clinical practice guidelines.

Does Dr. Steven Enrich see pediatric patients with tinnitus?

Yes. Dr. Enrich's practice welcomes both pediatric and adult patients. Tinnitus in children often has different underlying causes than in adults — recurrent otitis media, Eustachian tube immaturity, and adenoid hypertrophy are more common contributors in younger patients. Dr. Enrich is a fellowship-trained, board-certified ENT with experience treating ear, nose, and throat conditions across all age groups in the Nashville and Middle Tennessee area.

Conclusion

Tinnitus is one of the most common — and most misunderstood — symptoms in otolaryngology. The path forward starts with an accurate diagnosis from a board-certified ENT physician who can distinguish between dozens of potential causes and explain what the evaluation reveals in plain terms.

Dr. Steven Enrich, MD brings more than 20 years of surgical and clinical experience, fellowship training in Advanced Sinus and Skull Base Surgery, and a genuine commitment to shared decision-making to every patient encounter at Tennessee Breathe Free in Nashville. He is currently accepting new patients from Nashville and throughout Middle Tennessee — adults and children alike.

If ringing, buzzing, or hissing in your ears is affecting your sleep, concentration, or quality of life, a structured ENT evaluation is a reasonable first step. Reach out to Dr. Enrich's office to schedule an appointment and get the clarity you deserve.