From the Guidelines
Tinnitus diagnosis and treatment involve a comprehensive approach, starting with a thorough history, physical examination, and audiometry, as the initial evaluation, before considering any imaging studies.
Diagnosis
- The diagnosis of tinnitus is based on the patient's perception of sound in the absence of external stimuli, with 70% to 80% of cases being subjective 1.
- Tinnitus can be classified as pulsatile or nonpulsatile, with nonpulsatile being the more common variant, and primary or secondary, with primary being idiopathic and secondary being associated with an underlying cause 1.
- A comprehensive otologic examination, audiometric examination, and review of medical history and medications are essential in determining the cause of tinnitus 1.
Treatment
- Imaging studies are not usually necessary for subjective, nonpulsatile tinnitus that does not localize to one ear and is not associated with a focal neurologic abnormality or asymmetric hearing loss 1.
- For pulsatile tinnitus, CT and MRI are useful in evaluating for an underlying vascular anomaly or abnormality 1.
- In cases of asymmetric or unilateral, subjective, nonpulsatile tinnitus, imaging decisions should be guided by the clinical examination findings, rather than the symptom of tinnitus 1.
- Auditory, behavioral, or cognitive therapies may be helpful in mitigating symptoms of primary tinnitus 1.
- Patients with severe anxiety, depression, or psychological disturbances may require prompt identification and intervention 1.
From the Research
Diagnosis of Tinnitus
- Tinnitus is a common hearing disorder with various risk factors, including age, hearing loss, noise exposure, and psychological disorders 2
- The diagnosis of tinnitus mainly relies on subjective assessments and self-reports, such as case history, audiometric tests, detailed tinnitus inquiry, tinnitus matching, and neuropsychological assessment 2
- A standard workup for tinnitus begins with a targeted history and physical examination to identify treatable causes and associated symptoms 3
- A comprehensive audiologic evaluation should be performed for patients who experience unilateral tinnitus, tinnitus that has been present for six months or longer, or that is accompanied by hearing problems 3
Treatment of Tinnitus
- There is currently no golden standard treatment for tinnitus, but various strategies are used, including counseling, psychotherapy, pharmacological approaches, masking devices, individualized sound stimulation, and cognitive behavioral therapy (CBT) 2
- CBT is the only treatment that has been shown to have a definite improvement effect on tinnitus in a large randomized controlled trial 2, 3
- 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
- Treatments for tinnitus can be categorized into two types: those that focus on tinnitus cessation (e.g., cochlear implants, deep brain stimulation) and those that focus on tinnitus reduction or masking (e.g., hearing aids, sound therapy, CBT) 4
Symptoms of Tinnitus
- Tinnitus symptoms are not limited to "ringing in the ears" but can include a wide range of symptoms, such as emotional components (e.g., sleep disturbance, anxiety, depression, irritation, and concentration difficulties) 5
- Patients with tinnitus experience a spectrum of distressing symptoms that impact their quality of life 5
- Tinnitus can be a lifelong disorder and can bring about annoyance, anxiety, depression, insomnia, hyperacusis, concentration difficulty, and, in some extreme cases, suicide 2