Tinnitus
Tinnitus is the complaint of noises in the ears
in the absence of a sound stimulus. Most patients will report this as
ringing, buzzing, crackling or hissing. It is not a disease but a symptom. Most
people experience transient tinnitus at some time, particularly after exposure
to loud noise. The exact cause is unknown but it is thought to be due to
inappropriate activity in the hair cells of the cochlea. There are multiple
possible causes but most cases are idiopathic . It is especially com- mon in
diseases such as presbycusis which affect hair cell function. It can be a very
unwelcome feature of advancing age. Most tinnitus patients notice that the
noises are worse in quiet surroundings. Tinnitus is aggravated by fatigue,
anxiety and depression.
Local and general causes of tinnitus
Local causes
Tinnitus may be a symptom of
any abnormal condition of the ear and may be associated with any form of
deafness.
• Presbycusis often causes
tinnitus.
• Menière’s disease tinnitus
is usually worse with the acute attacks.
• Noise induced deafness tinnitus may be worse immediately after exposure to noise.
• Aneurysm, vascular
malformation and some vascular intracranial tumours, e.g. glomus jugulare
tumour can cause ‘pulsatile’ tinnitus, which may even be heard by an examiner.
Listen to the side of the head with a stethoscope.
General causes
Tinnitus is often a feature of
general ill-health as in:
• fever;
• cardiovascular disease hypertension, atheroma, cardiac failure;
• blood disease anaemia,
raised viscosity;
• neurological disease multiple sclerosis, neuropathy;
• drug treatment aspirin,
quinine, ototoxic drugs;
• alcohol abuse.
Management:-
Management focuses on excluding treatable causes
and helping patients cope. Tinnitus due to chronic degeneration, such as
presbycusis, ototoxicity or noise-induced deafness, is usually permanent. With
time, the tinnitus will obtrude less as the patient adjusts to it and avoids
circumstances that aggravate it. It very rarely goes away completely.Take the
patient’s fears and complaints seriously. Take a thorough history and examine
the patient properly. Many patients fear that tinnitus indicates serious
disease of the ear or a brain tumour. Always test the hearing. If you find an
abnormality of the ear such as impacted wax or otitis media, treatment will
often cure the tinnitus.
Patients with depression are partcularly susceptible to the effects of
tinnitus. Severe tinnitus may precipitate depression and patients may need
expert help.Drug treatment, such as sedatives and antidepressants, may help the
patient but will not eliminate tinnitus. Anticonvulsant drugs and vasodilators
may be of benefit but their effectiveness cannot be predicted.
If the patient with tinnitus is also deaf, a hearing aid is very helpful not
only to rehabilitate the hearing loss but in ‘masking’ the tinitus.‘Tinnitus
maskers’ or ‘white noise generators’ will also make tinnitus less obtrusive. A
typical device looks like a post-aural or ‘behind the ear’ hearing aid and its
output characteristics can be adjusted to obtain the most effective frequency
and intensity.If the patient is kept awake by tinnitus, a radio with a time
switch may help. Many patients use a ‘pillow masker’ obtainable in most
electrical stores, which emits a constant low intensity sound that helps
patients to focus on a sound other than the tinnitus that is often easier to
tolerate.
Many patients use relaxation techniques, acupuncture and herbal remedies.
Patients will often read of new ‘cures’ for tinnitus in the popular press.Sadly
these will almost always prove useless and cause more distress and
disappointment when it transpires they don’t work.Patients who are very
distressed may find counselling by a skilled hearing therapist helpful.It is
helpful for patients to understand that this is an extremely common problem and
the British Tinnitus Association website (www.tinnitus.org.uk) can be a useful resource.
References
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2. Watkinson JC, Clarke RW, editors. Scott-Brown's
otorhinolaryngology and head and neck surgery. 8th ed. Boca Raton: CRC Press;
2018.
3. Chan Y, Goddard JC, editors. KJ Lee's essential
otolaryngology: head and neck surgery. 12th ed. New York: McGraw Hill; 2019.
4. Loscalzo J, Fauci AS, Kasper DL, Hauser SL,
Longo DL, Jameson JL, editors. Harrison's principles of internal medicine. 21st
ed. New York: McGraw Hill LLC; 2022.
5. UpToDate. Waltham, MA: UpToDate Inc.
uptodate.com (Accessed: July 2026).
6. Medscape Drugs & Diseases. New York: WebMD
LLC. medscape.com (Accessed: July 2026).
7. American Academy of Otolaryngology–Head and Neck
Surgery. Clinical practice guidelines. Alexandria, VA: AAO-HNS. entnet.org
(Accessed: July 2026).
Medical Disclaimer
Important Notice: This article is provided for
educational and informational purposes only and does not constitute medical
advice, diagnosis, or treatment. The content is based on current medical
literature and guidelines but should not replace professional medical
consultation.
