Tinnitus

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