REFERENCE · CO-OCCURRING CONDITION
Tinnitus Alongside FND
This page covers: Persistent subjective tinnitus: hearing a sound when there is no corresponding external sound.
For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources
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For the Person With FND
Understanding the sound
Tinnitus may sound like ringing, buzzing, hissing or another noise. It can be intrusive even when no one else can hear it. Hearing loss is a common contributor, but not everyone with tinnitus has obvious hearing difficulty. One leading explanation is that changes in hearing input alter activity in auditory pathways; attention and emotion networks can influence how noticeable or distressing the sound becomes. This remains an explanatory model rather than one proven mechanism for everyone. [1]
This offers a useful connection with FND principles: the experience of a sensation depends on nervous-system processing as well as incoming signals. A sound that captures attention can interrupt sleep and conversation; exhaustion can make both tinnitus and existing FND harder to manage. These are practical interactions, not evidence that tinnitus is caused by FND. [1][2]
Recovery may mean less intrusion, better sleep and easier participation even if some sound remains. Reduced distress is a worthwhile result; it is different from reducing the sound’s loudness. [1][3]
Recovery and management options
- Hearing assessment and explanation: audiology can check hearing, explain the tinnitus pattern and help choose appropriate support. Knowing what has been assessed can make the next steps clearer. [3] [Guideline-based practice]
- Hearing aids when hearing loss is present: improving access to outside sound may make communication easier and tinnitus less prominent. Hearing aids are not routinely recommended for tinnitus without hearing loss. [3] [Guideline-based practice]
- Tinnitus-focused CBT: cognitive behavioural therapy explains the relationship between sound, attention, worry and daily responses, then helps reduce the disruption. It treats the burden of tinnitus; it does not ask the person to admit the sound is imaginary. [3] [Research-supported guideline recommendation]
- Comfortable background sound: a fan, quiet music or another gentle sound may make silence less difficult. Choose a comfortable level, not loud masking. Formal sound therapies have uncertain comparative evidence; no particular device or sound programme is a proven cure. [1][3] [Supportive option; uncertain treatment evidence]
- Treat persistent insomnia: if lying awake has become a separate problem, insomnia treatment can help with sleep rather than relying only on masking the tinnitus. See the insomnia page. [4] [Adjacent insomnia evidence]
- Adjust everyday listening and demands: use hearing protection for genuinely hazardous noise, plan quieter conversations and allow breaks. Work toward valued activities with support; do not require loud-sound exposure as an FND exercise. [1][3] [Clinical guidance and individualized adaptation]
When it becomes intrusive: use a comfortable environment and an agreed sleep or coping plan. Seek urgent assessment for sudden hearing loss; new pulse-synchronous tinnitus or persistent one-sided symptoms also need appropriate evaluation rather than automatic attribution to FND. [3]
For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources
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For Family, Friends, and Other Supporters
Ask whether background sound helps before switching it on. Face the person when speaking and reduce competing noise if hearing is difficult. Avoid telling them to “just ignore it”; less attention to tinnitus often develops through successful support, not an act of will.
For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources
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For Clinicians and the Care Team
Record laterality, pulsatility, hearing and vestibular symptoms, distress and sleep effects. Follow tinnitus assessment and referral guidance. Measure impact and participation as well as perceived loudness. Do not describe tinnitus CBT or auditory-gain theories as evidence for an FND diagnosis. [1][3]
For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources
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Research and Sources
Evidence reviewed: September 23, 2026. Tinnitus guidance supports management of tinnitus, not a tinnitus-specific FND rehabilitation protocol. Sound therapy evidence is limited; the relevant CBT outcome is usually distress and functional impact.
Technique labels describe the evidence for the named condition. A treatment working does not confirm an FND diagnosis or prove a shared mechanism.
| No. | Source and stable record | What it supports and limits | Figure |
|---|---|---|---|
| 1 | National Institute on Deafness and Other Communication Disorders. Tinnitus. Patient information. Accessed September 23, 2026. FND-CIT-0202 | Official patient information on auditory pathways and management. Central-processing explanations are theories, not proof of an FND mechanism. | — |
| 2 | Kannan S, Dutta A, Das A. Sleep disorders in functional neurological disorder—a systematic review and meta-analysis. Neurological Sciences. 2025;46(4):1573–1580. https://doi.org/10.1007/s10072-024-07931-9 FND-CIT-0073 | FND sleep systematic review; association and burden, not proof that insomnia treatment resolves FND. | — |
| 3 | National Institute for Health and Care Excellence. Tinnitus: assessment and management. NG155. Recommendations. Accessed September 23, 2026. FND-CIT-0201 | Tinnitus assessment and management guideline; CBT addresses tinnitus-related distress; evidence for standalone sound therapy remains limited. | — |
| 4 | Edinger JD, Arnedt JT, Bertisch SM, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2021;17:255–262. doi:10.5664/jcsm.8986. FND-CIT-0207 | Adult insomnia guideline: strong recommendation for multicomponent CBT-I; sleep hygiene alone is insufficient. Application in complex FND requires individual adaptation. | — |
For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources
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