Etiology and diagnosis of tinnitus
- Elizabeth A Dinces, MD
Elizabeth A Dinces, MD
- Associate Professor of Clinical Otolaryngology
- Albert Einstein College of Medicine
Tinnitus is a perception of sound in proximity to the head in the absence of an external source. It can be perceived as being within one or both ears, within or around the head, or as an outside distant noise. The sound is often a buzzing, ringing, or hissing, although it can also sound like other noises.
Tinnitus can be continuous (a never ending sound) or occur intermittently. Although both may have a significant impact on the patient, the latter is not usually related to a serious underlying medical problem. The sound may be pulsatile or non-pulsatile. Pulsatile tinnitus raises more concern for underlying significant pathology, though non-pulsatile tinnitus may also be associated with underlying disease.
The epidemiology, pathogenesis, and diagnosis of tinnitus will be reviewed here. The treatment of tinnitus is discussed separately. (See "Treatment of tinnitus".)
According to the American Tinnitus Association, an estimated 50 million people in the United States have chronic tinnitus, persisting for greater than six months . For 12 million, it is severe enough to interfere with daily activities. These people are effectively disabled by their tinnitus to varying degrees.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Shargorodsky J, Curhan GC, Farwell WR. Prevalence and characteristics of tinnitus among US adults. Am J Med 2010; 123:711.
- Shetye A, Kennedy V. Tinnitus in children: an uncommon symptom? Arch Dis Child 2010; 95:645.
- Adams PF, Hendershot GE, Marano MA, Centers for Disease Control and Prevention/National Center for Health Statistics. Current estimates from the National Health Interview Survey, 1996. Vital Health Stat 10 1999; :1.
- Ahmad N, Seidman M. Tinnitus in the older adult: epidemiology, pathophysiology and treatment options. Drugs Aging 2004; 21:297.
- Stouffer JL, Tyler RS. Characterization of tinnitus by tinnitus patients. J Speech Hear Disord 1990; 55:439.
- Newman CW, Sandridge SA, Jacobson GP. Psychometric adequacy of the Tinnitus Handicap Inventory (THI) for evaluating treatment outcome. J Am Acad Audiol 1998; 9:153.
- Wilson PH, Henry J, Bowen M, Haralambous G. Tinnitus reaction questionnaire: psychometric properties of a measure of distress associated with tinnitus. J Speech Hear Res 1991; 34:197.
- Folmer RL, Griest SE, Meikle MB, Martin WH. Tinnitus severity, loudness, and depression. Otolaryngol Head Neck Surg 1999; 121:48.
- Minen MT, Camprodon J, Nehme R, Chemali Z. The neuropsychiatry of tinnitus: a circuit-based approach to the causes and treatments available. J Neurol Neurosurg Psychiatry 2014; 85:1138.
- Qiu C, Salvi R, Ding D, Burkard R. Inner hair cell loss leads to enhanced response amplitudes in auditory cortex of unanesthetized chinchillas: evidence for increased system gain. Hear Res 2000; 139:153.
- Melcher JR, Sigalovsky IS, Guinan JJ Jr, Levine RA. Lateralized tinnitus studied with functional magnetic resonance imaging: abnormal inferior colliculus activation. J Neurophysiol 2000; 83:1058.
- Lockwood AH, Salvi RJ, Coad ML, et al. The functional neuroanatomy of tinnitus: evidence for limbic system links and neural plasticity. Neurology 1998; 50:114.
- Lockwood AH, Salvi RJ, Burkard RF, et al. Neuroanatomy of tinnitus. Scand Audiol Suppl 1999; 51:47.
- Møller AR. Similarities between chronic pain and tinnitus. Am J Otol 1997; 18:577.
- Mühlnickel W, Elbert T, Taub E, Flor H. Reorganization of auditory cortex in tinnitus. Proc Natl Acad Sci U S A 1998; 95:10340.
- Shulman A, Goldstein B. Medical Significance of Tinnitus. Int Tinnitus J 1997; 3:45.
- Sanchez TG, Balbani AP, Bittar RS, et al. Lidocaine test in patients with tinnitus: rationale of accomplishment and relation to the treatment with carbamazepine. Auris Nasus Larynx 1999; 26:411.
- Shiomi Y, Nagamine T, Fujiki N, et al. Tinnitus remission by lidocaine demonstrated by auditory-evoked magnetoencephalogram. A preliminary report. Acta Otolaryngol 1997; 117:31.
- Portmann M, Cazals Y, Negrevergne M, Aran JM. Temporary tinnitus suppression in man through electrical stimulation of the cochlea. Acta Otolaryngol 1979; 87:294.
- Matsushima JI, Fujimura H, Sakai N, et al. A study of electrical promontory stimulation in tinnitus patients. Auris Nasus Larynx 1994; 21:17.
- Ito J. Tinnitus suppression in cochlear implant patients. Otolaryngol Head Neck Surg 1997; 117:701.
- Miyamoto RT, Bichey BG. Cochlear implantation for tinnitus suppression. Otolaryngol Clin North Am 2003; 36:345.
- Holgers KM, Zöger S, Svedlund K. Predictive factors for development of severe tinnitus suffering-further characterisation. Int J Audiol 2005; 44:584.
- Simpson JJ, Davies WE. A review of evidence in support of a role for 5-HT in the perception of tinnitus. Hear Res 2000; 145:1.
- Thompson GC, Thompson AM, Garrett KM, Britton BH. Serotonin and serotonin receptors in the central auditory system. Otolaryngol Head Neck Surg 1994; 110:93.
- Woods CI, Azeredo WJ. Noradrenergic and serotonergic projections to the superior olive: potential for modulation of olivocochlear neurons. Brain Res 1999; 836:9.
- Waldvogel D, Mattle HP, Sturzenegger M, Schroth G. Pulsatile tinnitus--a review of 84 patients. J Neurol 1998; 245:137.
- Fortune DS, Haynes DS, Hall JW 3rd. Tinnitus. Current evaluation and management. Med Clin North Am 1999; 83:153.
- Ren YF, Isberg A. Tinnitus in patients with temporomandibular joint internal derangement. Cranio 1995; 13:75.
- Levine RA. Somatic (craniocervical) tinnitus and the dorsal cochlear nucleus hypothesis. Am J Otolaryngol 1999; 20:351.
- Montazem A. Secondary tinnitus as a symptom of instability of the upper cervical spine: operative management. Int Tinnitus J 2000; 6:130.
- Griest SE, Bishop PM. Tinnitus as an early indicator of permanent hearing loss. A 15 year longitudinal study of noise exposed workers. AAOHN J 1998; 46:325.
- Albers FW, Ingels KJ. Otoneurological manifestations in Chiari-I malformation. J Laryngol Otol 1993; 107:441.
- Mundada P, Singh A, Lingam RK. CT arteriography and venography in the evaluation of Pulsatile tinnitus with normal otoscopic examination. Laryngoscope 2015; 125:979.
- Dietz RR, Davis WL, Harnsberger HR, et al. MR imaging and MR angiography in the evaluation of pulsatile tinnitus. AJNR Am J Neuroradiol 1994; 15:879.
- Forsting M. CTA of the ICA bifurcation and intracranial vessels. Eur Radiol 2005; 15 Suppl 4:D25.
- Tunkel DE, Bauer CA, Sun GH, et al. Clinical practice guideline: tinnitus executive summary. Otolaryngol Head Neck Surg 2014; 151:533.
- CLINICAL IMPACT
- Vascular disorders
- - Arterial bruits
- - Arteriovenous shunts
- - Paraganglioma
- - Venous hums
- Neurologic disorders
- Eustachian tube dysfunction
- Other somatic disorders
- Tinnitus originating from the auditory system
- - Ototoxic medications
- - Presbycusis
- - Otosclerosis
- - Vestibular schwannoma
- - Chiari malformations
- - Other etiologies
- Physical examination
- Specialized testing
- - Suspected vascular tinnitus
- - Suspected auditory system tinnitus
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS