Otolaryngology Book

Hearing Disorders

  • Tinnitus

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Vestibular Disorders

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TinnitusAka: 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
  9. Resources
    1. American Tinnitus Association
      1. http://www.ata.org
  10. References
    1. Crummer (2004) Am Fam Physician 69(1):120

Tinnitus (C0040264)

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.
Definition (NCI)A noise in the ears, such as ringing, buzzing, roaring, clicking.
ConceptsSign or Symptom (T184)
ICD9388.3, 388.30
BasqueBURRUNBADA/ZIZTUA/AKUFENOA
DanishRingen/susen/tinnitus
DutchOorsuizen/tinnitus
EnglishEAR NOISES, Finding of tinnitus, Hearing noises, Noise in ears, Noises in ear, Noises in head, Observation of tinnitus, Ringing Buzzing Tinnitus, Ringing in ears, Ringing/buzzing/tinnitus, Tinnitus, Tinnitus Aurium, Unspecified tinnitus
FinnishKORVIEN SOIMINEN/TINNITUS
FrenchBourdonnement/sifflement/acouph
GermanOhrenklingen/Ohrensausen/Tinnitus
Hebrewtinitus
Hungarianful csenges/zugas
ItalianTintinnio/ronzio/tinnito
NorwegianRINGING/SUSING/TINNITUS
PortugueseAcufeno/ruido/zumbido/assobio
Spanishacúfenos, acúfenos no especificados, acufenos, acufenos no especificados, ruidos en oído, ruidos en oido, sonidos en oído, sonidos en oido, tinitus no especificado, tinnitus, zumbido en los oídos, zumbido en los oidos, Zumbido/pitido/tinnitus
SwedishRINGNING/SUSNING/TINNITUS
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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