The article “Defining Tinnitus: A Socratic and Epistemological Inquiry” takes a philosophical and methodological approach to one of the most basic yet unresolved questions in tinnitus research: what exactly do we mean by “tinnitus”? Rather than offering a definitive answer, the paper deliberately adopts a Socratic method, using structured questioning to expose assumptions, ambiguities, and conceptual gaps that underlie existing definitions. In doing so, it shows that the problem of defining tinnitus is not merely semantic, but foundational to research design, clinical practice, epidemiology, and health policy.

Tinnitus is commonly described as the perception of sound without an external acoustic source. While this formulation is widely used, the article argues that it is conceptually insufficient. Many other experiences also involve internally generated sounds, including auditory hallucinations, dream sounds, involuntary musical imagery, and certain forms of auditory memory. A definition that captures all of these phenomena risks becoming too broad, while one that excludes them often does so on pragmatic rather than principled grounds. The central challenge, therefore, is identifying what tinnitus has in common across cases and what distinguishes it from related experiences.

A major theme in the paper is the difference between description and definition. Descriptions list typical features of tinnitus, such as ringing, buzzing, or hissing, but definitions require identifying the conditions that make an experience tinnitus rather than something else. The article emphasizes that many current definitions rely on clusters of features that are common but not essential, or essential but not unique. This lack of conceptual precision has practical consequences, including wide variation in prevalence estimates and difficulties comparing findings across studies.

The paper places particular emphasis on tinnitus as a first-person experiential phenomenon. In most cases, tinnitus is known only through self-report. There is currently no biomarker that can independently confirm its presence or absence. This raises important epistemological questions: to what extent does tinnitus exist independently of being noticed, recognized, or reported? Can tinnitus be said to occur if it never enters awareness? Rather than resolving these questions, the article argues that they must be acknowledged explicitly in any serious attempt at definition.

Another key issue explored is whether tinnitus should be understood strictly as an auditory percept. Many people describe tinnitus using auditory language, but others report sensations that do not clearly map onto sound in the conventional sense, such as pressure, vibration, or an internal bodily sensation. The paper questions whether tinnitus is inherently auditory, or whether it is an internal experience that is described in auditory terms because available language and conceptual categories are limited. This challenges the assumption that tinnitus neatly fits within traditional models of auditory perception.

Temporal persistence is also examined. Some definitions impose duration thresholds, distinguishing tinnitus from fleeting internal sounds by specifying minimum lengths of time or frequency of occurrence. The article argues that such thresholds are largely arbitrary. Instead, it suggests that persistence may matter less as a fixed duration and more as a form of continuity that allows the experience to cross into conscious recognition and memory. A sound that lasts only briefly may still qualify as tinnitus if it is noticed, remembered, and given significance.

The role of affect and salience receives careful attention. Tinnitus is often assumed to be unpleasant or distressing, but this is not universally true. Some individuals report neutral or minimally intrusive tinnitus, at least initially. The article explores whether some degree of affective salience is necessary for tinnitus to be noticed at all, while also cautioning against equating tinnitus with suffering. Distress may be common, but it is not a defining feature of the phenomenon itself.

A significant portion of the paper is devoted to comparing tinnitus with other internal auditory experiences, such as auditory hallucinations, dream sounds, and musical imagery. Traditional distinctions often rely on factors such as wakeful consciousness, lack of semantic content, or perceived externality. The article shows that these boundaries are porous. Tinnitus-like experiences can occur during sleep, and tinnitus can acquire strong emotional or symbolic meaning over time. Rather than treating these overlaps as problems to be eliminated, the paper treats them as boundary cases that clarify what is at stake in defining tinnitus.

The article also questions the practice of excluding experiences with identifiable internal sources, such as pulsatile tinnitus, from the definition of tinnitus itself. While this may be useful clinically, it risks embedding current limitations of diagnostic knowledge into the definition. As medical technologies evolve, phenomena once considered source-less may later be explained. The paper argues that definitions should therefore focus on the experience as it is lived and recognized, rather than on the current state of causal knowledge.

Methodologically, the Socratic approach serves to keep the definition of tinnitus open and revisable. The goal is not to arrive at a final statement, but to clarify which features are being treated as essential, which are provisional, and which are merely convenient. This openness is presented as a strength rather than a weakness, allowing definitions to evolve alongside advances in phenomenology, neuroscience, and clinical understanding.

The practical implications of definitional ambiguity are emphasized throughout. Inconsistent definitions affect who is counted as having tinnitus, how burden is estimated, how resources are allocated, and how individuals interpret their own experiences. A vague or overly broad definition can inflate prevalence estimates, while an overly narrow one can exclude people who clearly experience tinnitus-related difficulties. Conceptual clarity, therefore, is not an abstract philosophical concern but a prerequisite for coherent research and equitable care.

In its concluding reflections, the article proposes a cautious, working understanding of tinnitus as a persistent internal experience that becomes tinnitus through conscious recognition, while acknowledging that this formulation remains open to challenge and refinement. Rather than closing the question, the paper reframes tinnitus definition as an ongoing inquiry that must remain sensitive to experience, language, and evolving scientific knowledge. In doing so, it invites researchers and clinicians to reflect more carefully on what they assume tinnitus to be, and why those assumptions matter.

Read the full text (PDF) of this Open Access paper here.