Tinnitus

Key Features

• Phantom noise or sounds

• Persistent tinnitus often, though not always, indicates the presence of 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 (middle ear myoclonus) or sometimes 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 lesion or sigmoid sinus abnormality is suspected

• Specialized forms of tympanometry may formally diagnose staccato "clicking" tinnitus

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

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

• Antidepressant and antipsychotic medications do not treat tinnitus directly but may allow patients to cope with it better

• For staccato "clicking" tinnitus: surgery