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Tinnitus
Tinnitus is the perception of sound (ringing, buzzing, hissing, pulsating) in the absence of an external source. It ranges from mild annoyance to severe distress, often linked with hearing loss or other otological/neurological conditions.
🧾 Causes of Tinnitus
- 👂 Hearing loss: Presbycusis, noise-induced damage.
- 🕳️ Earwax blockage: Conductive loss and irritation.
- 🦠 Ear infections: Otitis externa/media, transient tinnitus.
- 🦴 Otosclerosis: Abnormal ossicle bone remodelling.
- 🌊 Meniere’s disease: Fluctuating hearing loss, vertigo, tinnitus.
- 🔊 Loud noise exposure: Concerts, industrial settings, headphones.
- 💊 Ototoxic drugs: Aspirin, aminoglycosides, loop diuretics, chemotherapy agents.
- ❤️ Vascular: Pulsatile tinnitus from carotid disease, AVMs, hypertension.
- 🦷 TMJ dysfunction: Jaw pain + tinnitus.
- 🤕 Trauma: Head/neck injury affecting auditory nerves.
- 🧠 Neurological: Acoustic neuroma, MS.
📊 Summary Table
| Cause | Clues | Clinical Tests | Management |
|---|---|---|---|
| Noise-induced hearing loss | History of loud noise, high-pitched tinnitus | Audiometry, OAE | Ear protection, hearing aids, sound therapy |
| Presbycusis | Bilateral gradual hearing loss + tinnitus | Audiometry | Hearing aids, counselling |
| Earwax blockage | Unilateral fullness, conductive loss | Otoscopy | Microsuction, irrigation, ear drops |
| Meniere’s disease | Vertigo + fluctuating loss + aural fullness | Audiometry, ECoG | Low-salt diet, diuretics, vestibular rehab |
| Ototoxic drugs | History of drug use, bilateral tinnitus | Drug history, audiometry | Stop culprit drug, monitor hearing |
| Acoustic neuroma | Unilateral tinnitus + hearing loss | MRI with contrast | ENT referral, surgery/radiotherapy |
| TMJ dysfunction | Jaw pain, clicking, headaches | Exam, imaging | Jaw exercises, bite guards |
| Vascular causes | Pulsatile, heartbeat-synchronous | Doppler US, CT/MR angiography | Manage vascular disease, surgical options |
👁️ Clinical Features
- 🔊 Subjective tinnitus: Heard only by patient, most common.
- ❤️ Pulsatile tinnitus: In sync with heartbeat, think vascular.
- ⏱️ Constant vs intermittent: Helps suggest cause (e.g., constant with hearing loss vs episodic with Meniere’s).
- 🤢 Associated symptoms: Hearing loss, vertigo, ear fullness, otalgia.
- 💤 Impact: Sleep disturbance, poor concentration, anxiety, depression.
🔎 Diagnostic Workup
- 🦻 Audiometry: First-line to assess hearing loss.
- 📈 Tympanometry: Middle ear pathology.
- 🎧 OAEs: Outer hair cell function.
- 🧠 MRI brain/IAMs: For unilateral tinnitus ± hearing loss (rule out acoustic neuroma).
- 🖼️ CT temporal bone/angiography: For pulsatile tinnitus.
- 🩺 Doppler ultrasound: Carotid disease assessment.
🛠️ Management
Treatment depends on cause. The aim is to reduce perception and distress, as complete cure is often not possible.
- 🎯 Underlying causes: Wax removal, treat infections, stop ototoxic drugs, manage hypertension, address TMJ issues.
- 🦻 Hearing aids: Helpful in tinnitus with hearing loss.
- 🎵 Sound therapy: Masking with white noise, hearing aid sound generators.
- 🧠 CBT & Tinnitus Retraining Therapy (TRT): Reduce psychological burden.
- 💊 Medication: No curative drug; antidepressants/anxiolytics may help with associated depression/anxiety.
- ❤️ Vascular treatment: Manage carotid disease, AVM repair if indicated.
⚠️ Red Flags (Need ENT Referral)
- Unilateral tinnitus ± hearing loss (acoustic neuroma suspicion).
- Pulsatile tinnitus (vascular lesion risk).
- Sudden sensorineural hearing loss + tinnitus.
- Associated neurological symptoms (facial numbness, imbalance).
✅ Take-Home Messages
- Tinnitus is common and often linked to hearing loss but may indicate serious disease.
- Distinguish subjective vs pulsatile, and unilateral vs bilateral.
- Use audiometry as first-line; MRI if unilateral or neurological features present.
- Management is usually supportive: hearing aids, sound therapy, CBT.