Tinnitus
Tinnitus is the conscious perception of sound without an external source, most often subjective (heard only by the patient) and linked to hearing loss, noise exposure, or an ototoxic drug. Management treats any identified cause first (stop the ototoxic agent, treat hearing loss), since no drug cures tinnitus itself, then adds sound therapy, hearing aids, or cognitive behavioral treatment for persistent symptoms.
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What this article covers
- Overview
Definition: tinnitus is the conscious perception of sound, most commonly buzzing or ringing, without an external acoustic source.
- Epidemiology
Tracks with hearing loss: tinnitus rises with age alongside sensorineural hearing loss, which affects an estimated 50% of adults aged 60 to 69 years in the United States and impairs day-to-day communication.
- Risk factors
Sensorineural hearing loss of any cause: the strongest and most common association with subjective tinnitus.
- Pathophysiology
Subjective tinnitus arises from abnormal neural activity within the auditory pathway (cochlea, cochlear nerve, or central auditory processing) in the absence of an external sound, most often…
- Clinical features
Perceived sound without an external source: ringing, buzzing, or hissing, continuous or intermittent, unilateral or bilateral.
- Differential diagnosis
Vestibular schwannoma (acoustic neuroma): unilateral, progressive sensorineural hearing loss and tinnitus, sometimes disequilibrium rather than vertigo; confirmed on MRI of the internal auditory canal.
- Diagnosis
Tinnitus is confirmed by history, not a laboratory or imaging diagnosis; the task is to characterize it (onset, duration, quality, pulsatile nature, laterality) and identify or exclude an underlying cause.
- Management
First, treat the identified underlying cause, before any symptomatic measure for the tinnitus itself.
- Complications
Missed vascular or intracranial pathology: failing to recognize pulsatile or unilateral tinnitus as a red flag delays diagnosis of a vestibular schwannoma, a vascular lesion, or idiopathic…
- Prognosis
Most subjective tinnitus is chronic but manageable: when no reversible cause is found, the goal shifts from cure to reducing distress with sound therapy, hearing aids, and cognitive behavioral treatment.
- Prevention
Limit noise exposure: use hearing protection during occupational or recreational noise exposure to reduce noise-induced hearing loss and its tinnitus.
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