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Key Features

  • Perception of abnormal ear or head noises

  • Persistent tinnitus often, though not always, indicates the presence of sensory hearing loss

  • Intermittent periods of mild, high-pitched tinnitus lasting seconds to minutes are common in normal-hearing persons

Clinical Findings

  • Pulsatile tinnitus

    • Often described as listening to one's own heartbeat

    • Should be distinguished from tonal tinnitus

    • Often caused by conductive hearing loss

    • May indicate a vascular abnormality, such as glomus tumor, venous sinus stenosis, carotid vaso-occlusive disease, arteriovenous malformation, or aneurysm

  • A staccato "clicking" tinnitus

    • May result from middle-ear muscle spasm, sometimes associated with palatal myoclonus

    • Patient typically perceives a rapid series of popping noises, lasting seconds to a few minutes, accompanied by a fluttering feeling in the ear

Diagnosis

  • For nonpulsatile tinnitus: Audiometry to rule out associated hearing loss

  • For unilateral tinnitus: MRI should be done to rule out retrocochlear lesion (eg, vestibular schwannoma)

  • For pulsatile tinnitus: Consider MR angiography and venography and temporal bone CT when vascular abnormality or sigmoid sinus abnormality is suspected

Treatment

  • Avoid exposure to excessive noise, ototoxic agents, and other factors that may cause cochlear damage

  • Masking the tinnitus with music or through amplification of normal sounds with a hearing aid may bring relief

  • Oral antidepressants (eg, nortriptyline at an initial dosage of 50 mg at bedtime) often impact tinnitus-induced sleep disorder and depression

  • Habituation techniques, such as tinnitus retraining therapy, may prove beneficial in those with refractory symptoms

  • Transcranial magnetic stimulation of the central auditory system may improve symptoms

  • Progress is being made toward implantable brain stimulators as treatment option

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