The narrator in The Tell-Tale Heart is nervous ("very dreadfully nervous"), paranoid, and physically and mentally ill. He doesn't know the difference between the "real" and the "unreal," and seems to be completely alone and friendless in the world."Ringing ears" or "hyper sensitive ears," is a condition which can cause auditory hallucinations, intense sensitivity to sound, and possibly amplified hearing.Poe doesn't explicitly tell us if the narrator is male or female.He wants to kill the old man simply to be free of the power of his eye.