Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 8-07: Diseases of the Inner Ear + Key Features Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ 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 Download Section PDF Listen +++ ++ 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