tinnitus
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Introduction
An abnormal sound perceived as a ringing, hissing, buzzing, whistling or roaring not originating from an external source.
Etiology
- otologic causes (90%)
- high-frequency sensorineural hearing loss (presbycusis)
- frequency loss 3000-8000 Hz
- unilateral in 50%
- noise-induced hearing loss
- Meniere's disease
- low-pitched
- associated with vertigo
- Herpes zoster oticus (Ramsay Hunt syndrome type 2)
- acoustic neuroma
- otosclerosis
- chronic otitis media
- cerumen impactation
- cholesteoma
- high-frequency sensorineural hearing loss (presbycusis)
- pharmacologic agents (ototoxic agents)[15]
- turbulent blood flow in local blood vessel (pulsatile tinnitus)
- arteriovenous shunts
- arterial bruits
- carotid occlusive disease
- neuromuscular spasms
- temporomandibular joint (TMJ) syndrome
- hypertension, uncontrolled
- head trauma
- hypothyroidism or hyperthyroidism
- hyperlipidemia
- demyelinating diseases - multiple sclerosis
- mental disorders
- insufficient sleep[14]
- other
Epidemiology
- overall prevalence is 10%, 30% over age 55 years[3]; 25% of American[14]
- 40% of children with normal hearing report some form of tinnitus[4]
- affects quality of life in ~10% of affected individuals
Pathology
- cochlear damage, loss of hair cells
Clinical manifestations
- subjective ringing, cracking or whistling in the ears
- pulsatile tinnutus due to a vascular etiology may be objective in that the examiner may be able to hear the stimulus
- normal tinnitus lasts < 5 minutes & occurs < weekly
- hearing loss is common
- vertigo (&/or vestibular dysfunction), asymmetric hearing loss & tinnitus suggests acoustic neuroma
- fluctuating tinnitus, low-frequency hearing loss & episodic vertigo with horizontal nystagmus suggests Meniere's disease[14]
- persistent tinnitus is tinnitus lasting > 6 months[14]
Laboratory
Diagnostic procedures
- audiometric testing
- carotid ultrasound (pulsatile tinnitus)
- cerebral angiography (pulsatile tinnitus)
Radiology
- pulsatile tinnitus (ACR)
- CT angiography of head & neck
- magnetic resonance angiography of head
- MRI of head & internal auditory canal
- asymmetric or unilateral, nonpulsatile tinnitus (ACR)
- MRI head & internal auditory canal, especially if accompanied by hearing loss[2]
- symmetric or bilateral, nonpulsatile tinnitus (ACR)
- imaging generlly not appropriate
Complications
Management
- general
- ear exam
- clean out ear wax (ear irrigation)
- distinguish bothersome from non-bothersome tinnitus[14]
- audiometry[3]
- withdraw offending medications
- avoid stimulants (caffeine & nicotine) which may exacerbate tinnitus
- treat anxiety & depression
- frequently associated with intractable tinnitus
- cognitive behavioral therapy[3][10]
- referral to audiologist for co-existing hearing loss
- hearing aids may improve hearing & mask tinnitus
- pharmacologic agents not effective[2]; not recommended[11]
- alprazolam, nortriptyline, meclizine (used but not effective)
- referral to ENT for pulsatile tinnitus
- competing noise (i.e. music) may help with sleep
- unproven therapies
- transcranial magnetic stimulation not recommended [NGC]
- acupuncture: insufficient evidence to recommend [NGC]
- use of both sound & electrical stimulation to slow firing rates of hyperactive, synchronized neurons causing the phantom ringing or buzzing of tinnitus[12]
- induces long-term depression in fusiform neurons of the dorsal cochlear nucleus in guinea pigs[12]
- no medications, supplements, or herbal remedies have been shown to substantially reduce the severity of tinnitus[13]
- patient education[4]
- tinnitus often diminishes with time
- although disturbing, etiology is generally benign
- avoid exposure to loud noises
- supplements, including Ginkgo biloba, melatonin, zinc, or other dietary supplements of little or no benefit
More general terms
More specific terms
Additional terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 44-46
- ↑ 2.0 2.1 2.2 Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16, 17, 18. American College of Physicians, Philadelphia 1998, 2009, 2012, 2015, 2018.
- ↑ 3.0 3.1 3.2 3.3 3.4 Prescriber's Letter 17(9): 2010 Tinnitus Treatments: What's the Buzz? Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=260915&pb=PRL Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=261014&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 4.0 4.1 4.2 Juul J et al. Tinnitus and hearing in 7-year-old children. Arch Dis Child 2012 Jan; 97:28. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22100742
- ↑ Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
- ↑ Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society
- ↑ 7.0 7.1 Tinnitus & Hyperacusis Center Jastreboff PJ Emory University http://www.tinnitus-pjj.com
- ↑ 8.0 8.1 Cima RFF et al Specialised treatment based on cognitive behaviour therapy versus usual care for tinnitus: a randomised controlled trial The Lancet, 379(9830):1951-1959, May 26, 2012 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22633033 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2960469-3/fulltext
Langguth B Tinnitus: the end of therapeutic nihilism The Lancet, 379(9830):1926-1928, May 26, 2012 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22633023 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2960561-3/fulltext - ↑ Hobson J, Chisholm E, El Refaie A. Sound therapy (masking) in the management of tinnitus in adults. Cochrane Database Syst Rev. 2010 Dec 8;(12):CD006371. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21154366
- ↑ 10.0 10.1 Tunkel DE et al Clinical Practice Guideline. Tinnitus Otolaryngol Head Neck Surg. October 2014. 151(2) suppl S1-S40 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25274374 <Internet> http://oto.sagepub.com/content/151/2_suppl/S1.full
- ↑ 11.0 11.1 Bhatt JM, Lin HW, Bhattacharyy N Prevalence, Severity, Exposures, and Treatment Patterns of Tinnitus in the United States. JAMA Otolaryngol Head Neck Surg. Published online July 21, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27441392 <Internet> http://archotol.jamanetwork.com/article.aspx?articleid=2533660
- ↑ 12.0 12.1 12.2 Voelker R. Experimental Device Could Offer Hope for Millions With Tinnitus. JAMA. Published online March 14, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29541776 https://jamanetwork.com/journals/jama/fullarticle/2675187
Marks KL, Martel DT, Wu C et al Auditory-somatosensory bimodal stimulation desynchronizes brain circuitry to reduce tinnitus in guinea pigs and humans. Sci Transl Med. 2018 Jan 3;10(422). pii: eaal3175 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29298868 <Internet> http://stm.sciencemag.org/content/10/422/eaal3175.short - ↑ 13.0 13.1 Bauer CA Tinnitus. N Engl J Med 2018; 378:1224-1231. March 29, 2018 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29601255 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMcp1506631
- ↑ 14.0 14.1 14.2 14.3 14.4 14.5 14.6 14.7 Meyers AD. Fast Five Quiz: Tinnitus Medscape - Apr 07, 2021. https://reference.medscape.com/viewarticle/948493
- ↑ 15.0 15.1 15.2 Windle ML Rapid Rx Quiz: Headache Medications Medscape. Sept 12, 2022 https://reference.medscape.com/viewarticle/980181
- ↑ 16.0 16.1 Cantuaria ML et al Transportation Noise and Risk of Tinnitus: A Nationwide Cohort Study from Denmark Environ Health Perspect. 2023 Feb;131(2):27001 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36722980 Free article https://ehp.niehs.nih.gov/doi/10.1289/EHP11248
- ↑ American Tinnitus Association Prescription Medications, Drugs, Herbs & Chemicals Associated with Tinnitus https://www.ata.org/sites/default/files/Drugs%20Associated%20with%20Tinnitus%202013_Updated2017.pdf
- ↑ American Tinnitus Association P.O. Box 5 Portland, OR 97207 http://www.ata.org/