From the Guidelines
Tinnitus is a symptom defined by the perception of sound in the absence of external stimuli, affecting over 50 million Americans and impacting psychosocial well-being and quality of life.
Definition and Classification
Tinnitus can be classified into different types, including primary or secondary, subjective or objective, and pulsatile or nonpulsatile tinnitus [ 1 ].
- Primary tinnitus is idiopathic, whereas secondary tinnitus is associated with an underlying cause.
- Subjective tinnitus is perceived by the patient only and comprises 70% to 80% of cases.
- Objective tinnitus can be detected on examination by the clinician.
- Pulsatile tinnitus (PT) relates to rhythmic noise with the patient’s heartbeat or pulse and can be either subjective or objective.
Etiology and Symptoms
Patients with tinnitus describe hearing various sounds ranging from hissing, buzzing, ringing, pulsations, and clicking to a roaring kind of noise [ 1 ].
- Tinnitus may coexist with other symptoms such as hearing loss, vertigo, previous head trauma, and neurological deficits.
- The American Academy of Otolaryngology and Head and Neck Surgery Foundation (AAO-HNS) guidelines recommend targeted history and clinical examination as the initial evaluation [ 1 ].
Diagnosis and Management
The AAO-HNS guidelines recommend a prompt and comprehensive audiological examination in patients with hearing problems or with unilateral persistent tinnitus.
- Imaging studies of the head and neck are not recommended for patients with nonpulsatile tinnitus that does not localize to one ear and is not associated with focal neurological abnormalities or asymmetric hearing loss [ 1 ].
- Treatment approaches depend on identifying any underlying causes and may include addressing hearing loss with hearing aids, sound therapy to mask the noise, cognitive behavioral therapy to help cope with the condition, or medications to reduce severity of symptoms in some cases.
From the Research
Definition of Tinnitus
- Tinnitus is a perception of an auditory sensation without the presence of an external sound 2, 3, 4, 5, 6
- It is characterized by a subjective noise sensation, often described as ringing, heard in one or both ears 6
- Tinnitus can be benign and idiopathic, but it can also be a symptom of an underlying condition, such as sensorineural hearing loss 3
Prevalence and Impact of Tinnitus
- Tinnitus is a common disorder, affecting 10-15% of the population 4
- It can severely impair the quality of life of 1-2% of all people 4
- Tinnitus can be associated with hearing loss, anxiety, depression, and sleep disruption 5
Mechanisms and Causes of Tinnitus
- The exact cause of tinnitus is not known, but it is related to physiological changes in the auditory system 6
- Tinnitus is thought to be related to increased neuronal firing rate, enhanced neuronal synchrony, and changes in the tonotopic organisation in central auditory pathways 4
- The limbic system may also play a role in the development of tinnitus 5
Management and Treatment of Tinnitus
- There is no cure for tinnitus, but various strategies are available to support individuals to manage the condition on a daily basis 6
- Cognitive behavioral therapy (CBT) is the only treatment that has been shown to improve quality of life in patients with tinnitus 3
- Other treatment options include sound therapy, tinnitus retraining therapy, and counseling 2, 3