From the Guidelines
Tinnitus diagnosis and treatment involve a comprehensive evaluation, including a targeted history, clinical examination, and audiological examination. The diagnosis of tinnitus is based on the patient's perception of sound in the absence of external stimuli, and it can be categorized as pulsatile or nonpulsatile, primary or secondary, and subjective or objective 1.
Key Points in Diagnosis
- A thorough history and physical examination are crucial in determining the need for imaging and guiding the diagnosis of tinnitus 1.
- Audiological examination is recommended in patients with hearing problems or unilateral persistent tinnitus 1.
- Imaging studies are not recommended for patients with subjective, nonpulsatile tinnitus that does not localize to one ear and is not associated with a focal neurologic abnormality or asymmetric hearing loss 1.
Treatment Approaches
- Targeted therapy depends on the underlying cause of tinnitus, and may include treatment of underlying conditions such as hearing loss, vertigo, or neurological deficits 1.
- Cognitive behavioral therapy and sound therapy may be beneficial in managing symptoms of tinnitus 1.
- Medications such as antidepressants or anti-anxiety medications may be prescribed to manage associated symptoms such as anxiety or depression 1.
Special Considerations
- Pulsatile tinnitus requires evaluation for underlying vascular anomalies or abnormalities, and imaging studies such as CT or MRI may be recommended 1.
- Nonpulsatile tinnitus is almost always subjective and may be associated with presbycusis, medication toxicities, or environmental noise exposures 1.
- Patients with severe anxiety, depression, or psychological disturbances require prompt identification and intervention, as tinnitus can have a significant impact on quality of life and may be associated with an increased risk of suicide 1.
From the Research
Diagnosis of Tinnitus
- Tinnitus is diagnosed mainly through subjective assessments and self-reports, including 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 that may improve with treatment 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.
- Neuroimaging is not part of the standard workup unless the tinnitus is asymmetric or unilateral, pulsatile, associated with focal neurologic abnormalities, or associated with asymmetric hearing loss 3.
Treatment of Tinnitus
- There is currently no golden standard treatment for tinnitus, but counseling, psychotherapy, pharmacological approaches, masking devices, individualized sound stimulation, and cognitive behavioral therapy (CBT) are the most widely used strategies 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 divided into two categories: 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.