From the Guidelines
Sudden tinnitus requires prompt medical evaluation as it may indicate an underlying condition requiring treatment. The causes of sudden tinnitus can be varied, including acoustic trauma, Ménière's disease, ear infections, earwax blockage, head or neck injuries, certain medications, blood vessel disorders, or temporomandibular joint dysfunction 1. Management begins with identifying and treating the underlying cause. For acoustic trauma, removing the noise source is essential. Medications that may help include oral steroids, antianxiety medications, or tricyclic antidepressants. Earwax removal by a healthcare provider may resolve symptoms if blockage is present.
Key Management Strategies
- Sound therapy using white noise machines, fans, or smartphone apps can mask the tinnitus
- Hearing aids help if hearing loss is present
- Cognitive behavioral therapy addresses the emotional impact
- Lifestyle modifications include avoiding caffeine, alcohol, and nicotine, managing stress, and protecting ears from loud noises
According to the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNS) guidelines, a targeted history and clinical examination are recommended as the initial evaluation, and a prompt and comprehensive audiological examination is recommended in patients with hearing problems or with unilateral persistent tinnitus 1. The guidelines also suggest that some patients with severe anxiety, depression, or psychological disturbances may need prompt identification and intervention. Seeking medical attention within 48-72 hours of onset provides the best chance for effective treatment, especially if accompanied by hearing loss, dizziness, or severe symptoms. Tinnitus often improves with time as the brain adapts through a process called habituation. The most recent guidelines from 2023 emphasize the importance of a comprehensive evaluation and targeted treatment approach 1.
From the FDA Drug Label
Tinnitus6.610.4
The cause of sudden tinnitus is not directly addressed in the provided drug labels. However, tinnitus is listed as a potential adverse event associated with the use of alprazolam tablets, with an incidence of 6.6% in patients with panic disorder 2.
- Key points:
- Tinnitus is a potential side effect of alprazolam tablets.
- The exact cause of sudden tinnitus is not specified in the provided drug labels.
- Management options for tinnitus are not discussed in the context of alprazolam tablets.
From the Research
Causes of Sudden Tinnitus
- Tinnitus is the sensation of hearing a sound in the absence of an internal or external source and is a common problem encountered in primary care 3
- Risk factors for tinnitus include age, hearing loss, noise exposure, inflammatory diseases or tumors of the ear, ototoxic drugs, head or cervical vertebra trauma, and psychological disorders (e.g., anxiety and depression) 4
- Tinnitus can be caused by abnormal activities in the central nervous system, such as elevated spontaneous neuronal firing rate and increased neuronal synchronization caused by the auditory deprivation, changes in the tonotopic map, auditory cortical reorganization, dysregulation of the limbic system, and the central auditory cortex 4, 5
- Tinnitus is a symptom with a broad differential diagnosis, and understanding how to differentiate between subjective and objective tinnitus is essential to the evaluation and management of these patients 6
Management Options for Sudden Tinnitus
- A standard workup for tinnitus begins with a targeted history and physical examination to identify treatable causes and associated symptoms that may improve with treatment 3
- Cognitive behavior therapy is the only treatment that has been shown to improve quality of life in patients with tinnitus 3, 4, 5, 7
- Sound therapy and tinnitus retraining therapy are treatment options, but evidence is inconclusive 3
- Melatonin, antidepressants, and cognitive training may help with sleep disturbance, mood disorders, and cognitive impairments, respectively 3
- Avoidance of noise exposure may help prevent the development or progression of tinnitus 3
- Counseling, psychotherapy, pharmacological approaches, masking devices, individualized sound stimulation, and cognitive behavioral therapy (CBT) are the most widely used strategies for managing tinnitus 4, 7