Tinnitus is hearing a sound, such as ringing, buzzing or hissing, when no outside sound is present. It is a symptom rather than a disease and most often comes with age-related or noise-induced hearing loss.
Key symptoms
- Ringing, buzzing, hissing or roaring in one or both ears
- Worse in quiet rooms or at night
- Trouble sleeping or concentrating
- Hearing loss
- Anxiety or low mood
What you find on exam
- Otoscopy: earwax, infection, perforation
- Tuning fork tests
- Listening over the neck and ear for a bruit in pulsatile tinnitus
- Cranial nerve and balance exam
- Jaw and neck exam for temporomandibular joint problems
Tests
- Audiogram for persistent tinnitus
- Medication review for ototoxic drugs: high-dose aspirin, loop diuretics, aminoglycosides
- MRI if tinnitus is in one ear or hearing loss is asymmetric
- CT angiography or MRI for pulsatile tinnitus
Treatment basics
- Treat the cause: remove earwax, stop ototoxic drugs
- Hearing aids if hearing loss is present
- Sound therapy and background noise
- Cognitive behavioral therapy for distress
- Screen and treat anxiety, depression and insomnia
Red flags
- Pulsatile tinnitus
- Tinnitus in one ear with hearing loss
- Tinnitus with sudden hearing loss, vertigo or neurologic signs
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.