Tinnitus

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

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

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

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