Tinnitus

last authored August 2009, David LaPierre

Introduction

Tinnitus is a ringing, rushing, or roaring noise that can be real or imagined. Perhaps 10% of people experience tinnitus, although over 90% of people hear something in a soundproofed room (Heller and Bergman, 1953). Tinnitus following nerve damage can be compared to phantom limb pain.

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Differential Diagnosis

Tinnitus is most common in people exposed to long-term, loud noise.

Subjective tinnitus, or noise only the patient can hear, can be caused by many conditions and diseases. Some of these include:

noise-induced hearing loss
prebycusis
Meniere's disease
otosclerosis
middle ear effusion
trauma
ototoxic drugs (aminoglycosides, loop diuretics)
labyrinthitis
acoustic neuroma
wax buildup

Objective tinnitus which can also be heard by an observer, can be caused by

temperomandibular joint or palatal musculature
vascular: normal carotid artery, glomus jugulare, AV malformations, carotid body tumours

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History and Physical Exam

history
physical exam

History

Tinnitus is extremely, usually benign, and history and physical exam are often sufficient to make a diagnosis.

clicking or popping noises are usually caused by the middle ear
high-pitched hissing or rushing usually caused by inner ear or brain
pulsatile: blood flow, musculoskeletal

Physical Exam

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Investigations

Tinnitus does not usually require further investigation.

However, red flags include unilateral symptoms, especially if accompanied by hearing loss.

lab investigations
diagnostic imaging

Lab Investigations

Diagnostic Imaging

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Management

The psychological impact of tinnitus can be profound, particularly if patients are worried about malignancy. Reassurance is paramount and can often lessen the subjective experience of tinnitus.

Hearing loss should be identified and treated.

Noise machines can cover up tinnitus and can help a proportion of patients.

Psychotherapy and group meetings can be helpful for the group of patients overwhelmed with their condition.

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