Summary
Tinnitus is the perception of sound without an external source. Most is subjective; objective tinnitus usually has a vascular or muscular source.
Establish pulse synchrony, laterality, associated hearing/neurological symptoms and impact. Exclude treatable and urgent causes before reassurance. NICE NG155
Hyperacusis: reduced tolerance of everyday sound, which may feel excessively loud, uncomfortable or painful; assessed separately from tinnitus. Tinnitus UK
More detail
Hearing loss can trigger altered central auditory activity; distress and awareness also involve attention, sleep and emotional networks. A normal audiogram does not exclude tinnitus or establish a psychological cause.