Some Causes of Tinnitus
Cause | Suggestive Findings | Diagnostic Approach |
|---|---|---|
Subjective tinnitus* | ||
Acoustic trauma (eg, noise-induced hearing loss) | History of occupational or recreational exposure, hearing loss | Audiogram |
Clear history of exposure to increased air or water pressure | Audiogram | |
Central nervous system tumors (eg, vestibular schwannoma, meningioma) and lesions (eg, caused by multiple sclerosis or stroke) | Unilateral tinnitus and often hearing loss Sometimes other neurologic abnormalities | Gadolinium-enhanced MRI Audiogram |
Onset of bilateral tinnitus coincident with use of drug Except with salicylates, hearing loss also possible Aminoglycosides also possibly associated with bilateral vestibular loss (eg, dizziness, dysequilibrium) | Audiogram | |
Eustachian tube dysfunction | Often prolonged decreased hearing, preceding URIs, problems clearing ears with air travel or other pressure change Severe allergies can worsen symptoms Unilateral or bilateral (often one ear more of a problem than the other) | Tympanometry Audiogram |
Infections (eg, otitis media, labyrinthitis, meningitis, neurosyphilis) | History of infection | Clinical examination alone Sometimes other confirmatory tests (eg, CSF examination for meningitis) Audiogram |
Episodic unilateral hearing loss, tinnitus, fullness in the ear, and severe vertigo Typically, fluctuating and eventually permanent low-frequency hearing loss | Audiogram Gadolinium-enhanced MRI to evaluate unilateral sensorineural hearing loss and rule out vestibular schwannoma | |
Obstruction of ear canal (eg, caused by cerumen, foreign body, or external otitis) | Unilateral, with visible, diagnostic abnormalities on ear examination, including discharge with external otitis | Clinical examination alone |
Presbycusis (with aging) | Progressive hearing loss, often with family history | Audiogram |
Objective tinnitus† | ||
Dural arteriovenous malformations | Unilateral, constant, pulsatile tinnitus Usually no other symptoms May have bruit over skull Physical examination should always include periauricular auscultation | CT, MR, or conventional angiogram |
Myoclonus (palatal muscles, tensor tympani, stapedius) | Irregular clicking or mechanical-sounding noise Possibly other neurologic symptoms (eg, of multiple sclerosis) Movement of the palate, TM, or both seen on examination when symptomatic | MRI Tympanometry |
Turbulent flow in carotid artery or jugular vein | Bruit or venous hum in neck Venous hum possibly ceasing with jugular vein compression or head rotation | Sometimes clinical examination alone Sometimes CT venography and CT angiography |
Vascular middle ear tumors (eg, glomus tympanicum, glomus jugulare) | Unilateral, constant, pulsatile tinnitus Sometimes bruit on auscultation of ear Tumor usually visible behind TM as a very erythematous, sometimes pulsatile mass, which may blanch (on pneumatoscopy) | CT MRI Angiogram (usually done before surgery) Audiogram |
* Typically a constant tone and accompanied by some degree of hearing loss. All patients with subjective tinnitus should have audiometry. † Typically intermittent or pulsatile. CSF = cerebrospinal fluid; TM = tympanic membrane; URI = upper respiratory infection. | ||