Otolaryngology Book

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Tinnitus

Aka: Tinnitus, Ear Ringing
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  1. Definition
    1. Ringing in the ears, unrelated to external sounds
  2. Causes
    1. See Ototoxic Medications
    2. Cerumen Impaction
    3. Hearing Loss
    4. Meniere's Disease
    5. Acoustic Neuroma
    6. Head Injury
    7. Multiple Sclerosis
    8. Syphilis
    9. Hypothyroidism
    10. Vitamin B12 Deficiency
    11. Carotid Bruit or other vascular abnormality
    12. Venous Hum
  3. Examination
    1. Otoscopy
    2. Tympanometry
    3. Hearing Testing
    4. Tuning Fork Tests
    5. Auscultate for Carotid Bruit
  4. Labs
    1. Complete Blood Count
    2. Thyroid Stimulating Hormone
    3. Lipid profile
  5. Diagnostic Testing
    1. Formal audiology testing can characterize Tinnitus
  6. Imaging
    1. CT or MRI Head
      1. May be needed as directed by history and exam
  7. Algorithm for approach to Tinnitus
    1. Middle or high frequency ringing
      1. Most common form of Tinnitus
      2. Inner ear etiology
      3. Often results from Ototoxic Drug (e.g. Aspirin)
    2. Low pitched, roaring sounds
      1. Conductive Hearing Loss
    3. Pulsating sounds in synchrony with heart beat
      1. Cardiac murmur
      2. Carotid Bruit
      3. Cerebral Aneurysm
      4. Fistula or AV malformation
    4. Pulsating alone
      1. Increased fluid pressure at middle ear
    5. Pulsating, high pitched, irregular sounds
      1. Otosclerosis
    6. Fluttering Tinnitus
      1. Intermittent spasm of tensor tympani muscle
      2. Associated with eye irritation or acute anxiety
    7. Clicking Tinnitus
      1. Palatal Myoclonus
        1. Rapid rhythmic twitching of ipsilateral Palate
      2. May respond to mild Sedation
    8. Crunching Tinnitus
      1. Temporomandibular Joint arthritis
      2. Foreign body (e.g. hair) rubbing against TM
    9. Tinnitus and unilateral Sensorineural Hearing Loss
      1. Acoustic Neuroma
    10. Roaring Tinnitus, Hearing Loss and Vertigo
      1. Meniere's Disease
    11. Bilateral subjective Tinnitus without Hearing Loss
      1. Endocrine causes (e.g. Hypothyroidism)
      2. Ototoxic Medications
      3. Mood Disorder
  8. Management
    1. Correct underlying medical problem
    2. Eliminate possible Ototoxic Medications
    3. Audiogram
    4. Reassurance
    5. Antidepressants (SSRI)
    6. Noise masking
      1. Soft, monotonous noise (e.g. fan or radio) at night
      2. Hearing Aid amplifies background noise
    7. Avoid ineffective measures
      1. Ginkgo Biloba is not effective
        1. Rejali (2004) Clin Otolaryngol 29:226-31
  9. Resources
    1. American Tinnitus Association
      1. http://www.ata.org
  10. References
    1. Crummer (2004) Am Fam Physician 69(1):120-8

Tinnitus (C0040264)

Definition (NCI) A disorder characterized by noise in the ears, such as ringing, buzzing, roaring or clicking.
Definition (NCI) A noise in the ears, such as ringing, buzzing, roaring, clicking.
Definition (MEDLINEPLUS)

Do you hear a ringing, roaring, clicking or hissing sound in your ears? Do you hear this sound often or all the time? Does the sound bother you? If you answer is yes, you might have tinnitus.

Millions of people in the U.S. have tinnitus. People with severe tinnitus may have trouble hearing, working or even sleeping. Causes of tinnitus include hearing loss, exposure to loud noises or medicines you may be taking for a different problem. Tinnitus may also be a symptom of other health problems, such as allergies, high or low blood pressure, tumors and problems in the heart, blood vessels, jaw and neck.

Treatment depends on the cause. Treatments may include hearing aids, sound-masking devices, medicines and ways to learn how to cope with the noise.

NIH: National Institute on Deafness and Other Communication Disorders

Definition (NCI) A disorder in which a person hears noises such as buzzing, ringing, clicking, or the sound of a pulse, when no outside sound is causing them. Tinnitus may have many different causes, and may be a symptom of another disease or condition. It may be caused by certain tumors and anticancer drugs.
Definition (MSH) A nonspecific symptom of hearing disorder characterized by the sensation of buzzing, ringing, clicking, pulsations, and other noises in the ear. Objective tinnitus refers to noises generated from within the ear or adjacent structures that can be heard by other individuals. The term subjective tinnitus is used when the sound is audible only to the affected individual. Tinnitus may occur as a manifestation of COCHLEAR DISEASES; VESTIBULOCOCHLEAR NERVE DISEASES; INTRACRANIAL HYPERTENSION; CRANIOCEREBRAL TRAUMA; and other conditions.
Definition (CSP) symptom of hearing disorder characterized by the sensation of buzzing, ringing, clicking, pulsations, roaring or other noises in the ear.
Definition (NCI) A noise in the ears, such as ringing, buzzing, roaring, clicking.
Concepts Finding (T033)
MSH D014012
ICD9 388.30, 388.3
ICD10 H93.1, H93.19
SnomedCT 139624001, 139618007, 139621009, 194392000, 155248003, 162355009, 194393005, 194395003, 60862001, 162349004, 162352007, 300200005
English EAR NOISES, EAR RINGING, EAR RINGING SOUND, RINGING IN EARS, TINNITUS, Tinnitus, NOS, Tinnitus NOS, Tinnitus, unspecified, Unspecified tinnitus, Ringing/buzzing/tinnitus, Tinnitus, Tinnitus Aurium, Tinnitus symptom NOS, tinnitus, ringing in ears (symptom), tinnitus (diagnosis), ringing in the ears (tinnitus), ringing of ears, ringing in ears, Tinnitus symptom NOS (finding), (Tinnitus) or (hearing noises) (disorder), Tinnitus (disorder), Ear noises, Ear ringing, Ringing in ears, Ringing Buzzing Tinnitus, Ringing-Buzzing-Tinnitus, Unspecified tinnitus (finding), Tinnitus NOS (finding), EARS, RINGING IN, Tinnitus, unspecified ear, Tinnitus [Disease/Finding], ear ringing, Noises in;ear, Ringing (in);ear, symptoms tinnitus, tinnitus symptom (non-specific), ear noises, ringing in the ear, ears ring, ear noise, ears noises, ears ringing, Noise in ears, Noises in ear, Noises in head, Ringing in ear, Observation of tinnitus, Noises in ear (finding), Ringing in ear (finding), Tinnitus (finding), Tinnitus, ringing/buzzing ear, ear; murmur, murmur; ear, (Tinnitus) or (hearing noises), Finding of tinnitus (finding), Finding of tinnitus, Hearing noises, noises in ear, ringing in ear
Italian Tinnitus, Rumori nella testa, Ronzio nelle orecchie, Rumori auricolari, Tinnitus, non specificato, Tintinnio/ronzio/tinnito, Tinnito
Dutch oorrinkelen, geluiden in het hoofd, rinkelen in de oren, oorgeluiden, niet-gespecificeerde duizeligheid, Oorsuizen/tinnitus, geruis; oor, oor; geruis, tinnitus, Oorsuizen, Tinnitus
French Bruits dans les oreilles, Tintements d'oreille, non précisés, Tintements d'oreilles, Bruits dans la tête, BOURDONNEMENTS D'OREILLE, BRUITS DIVERS DANS L'OREILLE, Bourdonnement/sifflement/acouph, TINTEMENTS D'OREILLE, Acouphènes, Acouphène, Bourdonnement d'oreille, Bourdonnement d'oreilles, Sifflement d'oreilles, Tintement d'oreilles
German Tinnitus, unspezifisch, Geraeusche im Kopf, Ohrenklingeln, Klingeln im Ohr, Ohrengeraeusche, OHRGERAEUSCHE, OHRKLINGELN, OHRKLINGEN, Ohrenklingen/Ohrensausen/Tinnitus, TINNITUS, Tinnitus, Tinnitus aurium
Portuguese Ruídos nos ouvidos, Campaínhas nos ouvidos, Zumbidos NE, Ruídos na cabeça, Acufeno/ruido/zumbido/assobio, CAMPAINHAS NOS OUVIDOS, RUIDOS NO PAVILHAO AURICULAR, TINITUS, ZUMBIDOS NOS OUVIDOS, Zumbidos, Acufenos, Zumbido, Tinido, Zunido
Spanish Pitido en oídos, Ruidos en oídos, Acúfenos no especificados, Ruidos en la cabeza, Noises in ear, Tinnitus, Hearing noises, (Tinnitus) or (hearing noises), Ringing in ear, ACUFENOS, OIDO, CAMPANILLEO, OIDO, RUIDO, OIDO, TINTINEO, Zumbido/pitido/tinnitus, Acúfenos, Acufenos, Tinnitus symptom NOS, acúfenos (hallazgo), acúfenos no especificados (hallazgo), acúfenos no especificados, acúfenos, SAI (hallazgo), acúfenos, SAI, acúfenos, campanilleo en el oído (hallazgo), campanilleo en el oído, ruidos en oído (hallazgo), ruidos en oído, sonidos en oído, tinitus - hallazgo (hallazgo), tinitus - hallazgo, tinitus no especificado, tinitus, SAI (hallazgo), tinitus, SAI, tinnitus, zumbido en los oídos, Zumbido, Acúfeno, Acufeno
Japanese 詳細不明の耳鳴, ﾐﾐﾅﾘ, ｼｮｳｻｲﾌﾒｲﾉｼﾞﾒｲ, ｼﾞﾒｲ, ｼｮｳｻｲﾌﾒｲﾉﾐﾐﾅﾘ, 耳鳴り, 耳鳴(ジメイ), 耳鳴
Swedish Öronsusning, RINGNING/SUSNING/TINNITUS
Czech tinnitus, Tinnitus, Zvonění v uchu, Blíže neurčený tinitus, Zvuky v uchu, Zvuky v hlavě, Zvonění v uších, ušní šelest, tinitus
Finnish Tinnitus, KORVIEN SOIMINEN/TINNITUS
Russian SHUM V USHAKH, UKHO, SHUMY, УХО, ШУМЫ, ШУМ В УШАХ
Norwegian RINGING/SUSING/TINNITUS
Danish Ringen/susen/tinnitus
Hungarian ful csenges/zugas, Fülzörejek, Tinnitus, Fül csengése, Fülcsengés, Tinnitus, nem meghatározott, Zajok a fejben
Korean 이명(귀울림)
Basque BURRUNBADA/ZIZTUA/AKUFENOA
Hebrew tinitus
Polish Szum w uszach, Szum uszny
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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