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Tinnitus

Last updated: August 25, 2019

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Tinnitus is a common condition in which sound (whistling, hissing, buzzing, ringing, pulsating) is perceived in the absence of an external source. It can be unilateral or bilateral, acute or chronic, and intermittent or constant. Tinnitus is not a specific disease but a symptom that can be connected to a wide variety of etiologies, most commonly conditions associated with hearing loss. Evaluation should include a detailed history of the tinnitus, as well as an ENT, neck, cardiac, and neurological examination. Patients should also undergo a complete audiological examination. Imaging is recommended for patients with unilateral tinnitus, asymmetric tinnitus, pulsatile tinnitus, and/or focal neurological deficits. If an underlying cause is identified, appropriate treatment should be initiated. However, most patients receive supportive therapy, which might include sound therapy (i.e., hearing aids, cochlear implants) and supportive counseling. The prognosis is favorable for individuals with acute tinnitus (∼ 80% recovery rate) but is significantly worse for those with chronic symptoms (∼ 25% recovery rate).

  • Prevalence:
    • Most people will experience tinnitus at some point in their lifetime.
    • ∼ 10–15% overall prevalence in the US adult population
    • Increases with age
    • More common in men and smokers
  • Associations: hearing loss, hyperacusis

References:[1][2][3][4][5]

Epidemiological data refers to the US, unless otherwise specified.

  • Tinnitus is a symptom, not a specific disease, and its presence can indicate an underlying abnormality.
  • Objective tinnitus; : tinnitus that can perceived by others; , which is due to sounds created by the body (e.g., carotid artery stenosis, stapedial myoclonus)
  • Subjective tinnitus; : tinnitus that is only perceived by the affected individual; , which can be due to a wide range of etiologies (e.g., otosclerosis, tumor, infections)

References:[1][6]

  • Perceived sound without an external source (whistling, hissing, buzzing, ringing, pulsating, etc.)
  • Symptoms of an underlying disease may be present as well (e.g., hearing loss )

References:[7]

References:[1]

  • After symptom onset, treatment should be started as early as possible to prevent the condition from becoming chronic.
  • Treat any underlying conditions.
  • Supportive treatment: counseling , cognitive behavioral therapy , sound therapy

References:[1][8]

In up to 80% of cases of acute tinnitus, symptom resolution occurs spontaneously or with treatment, whereas resolution occurs in only ∼ 25% of patients with chronic tinnitus.

  1. Benson AG, Meyers AD. Tinnitus. Tinnitus. New York, NY: WebMD. http://emedicine.medscape.com/article/856916. Updated: April 26, 2017. Accessed: July 24, 2017.
  2. What is that Ringing in my Ears?. https://vestibular.org/tinnitus. Updated: January 1, 2007. Accessed: July 24, 2017.
  3. Demographics. https://www.ata.org/understanding-facts/demographics. Updated: January 1, 2016. Accessed: July 24, 2017.
  4. Tinnitus. http://www.entnet.org/content/tinnitus. Updated: January 1, 2017. Accessed: July 27, 2017.
  5. National Health and Nutrition Examination: Survey 2011-2012 Data Documentation, Codebook, and Frequencies: Audiometry. https://wwwn.cdc.gov/nchs/nhanes/2011-2012/AUQ_G.htm. Updated: December 1, 2013. Accessed: July 27, 2017.
  6. Han BI, Lee HW, Kim TY, Lim JS, Shin KS. Tinnitus: characteristics, causes, mechanisms, and treatments. J Clin Neurol. 2009; 5 (1): p.11-19. doi: 10.3988/jcn.2009.5.1.11 . | Open in Read by QxMD
  7. Dinces EA, Deschler DG, Sullivan DJ. Etiology and Diagnosis of Tinnitus. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/etiology-and-diagnosis-of-tinnitus.Last updated: February 25, 2016. Accessed: July 27, 2017.
  8. Grapp M, Hutter E, Argstatter H , Plinkert PK, Bolay HV. Music therapy as an early intervention to prevent chronification of tinnitus. Int J Clin Exp Med. 2013; 6 (7): p.589-593.