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Tinnitus
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Tinnitus

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Contributors: Eve Tranchito, Paul C. Bryson MD
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Synopsis

Tinnitus, or ringing in the ear, is the perception of sound that has no objective source external to the patient's body. It is a common disorder affecting 10%-25% of people. It is often described as a humming, hissing, static, or roaring sound, which can be present bilaterally or unilaterally.

There are two broad categories of tinnitus: objective and subjective. Objective tinnitus comes from a source within the body that can technically be perceived by someone other than the patient. Subjective tinnitus, the more common of the two, can only be perceived by the patient. Tinnitus can also be distinguished via pulsatile or nonpulsatile symptoms. Although many people with tinnitus acclimate to the perceived sound over time, it severely impacts quality of life in 1%-7% of the population.

Risk factors for tinnitus include hearing loss, older age, and male sex. Those with occupational noise exposure are at a greater risk. Although the prevalence is higher in older populations, the condition can occur in younger patients. Studies have demonstrated that tinnitus is more common in those with hearing loss and can similarly resolve with hearing restoration. Of note, the disease process is highly variable and can worsen, improve, or even resolve entirely with time.

Codes

ICD10CM:
H93.19 – Tinnitus, unspecified ear

SNOMEDCT:
60862001 – Tinnitus

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Meniere disease – look for concomitant vertigo, hearing loss, and ear pain
  • Acoustic neuroma – may be ruled out by MRI
  • Glomus tumor – may be ruled out by CT
  • Dehiscent jugular bulb – visible on MR angiography
  • Otosclerosis – audiometry will demonstrate conductive hearing loss
  • Infection, inflammation, allergic etiology – can be evaluated on otoscopic examination
  • Migraine-associated vertigo
  • Stapedial or tensor tympani muscle spasm
  • Patulous Eustachian tube – otomicroscopy shows movement of tympanic membrane on respiration
  • Medication-induced ototoxicity – commonly caused by aminoglycosides, cisplatin, furosemide, aspirin (salicylate overdose)
  • Multiple sclerosis – MRI with gadolinium; white matter lesions
  • Cerebrovascular disease – duplex ultrasound or CT showing aberrant carotid artery
  • Arteriovenous malformation – seen on MRI and magnetic resonance angiography (MRA)
  • Head injury (see traumatic brain injury)
  • Thyroid disorder
  • Depression, anxiety

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed: 04/23/2019
Last Updated: 04/29/2019
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Tinnitus
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Tinnitus : Hearing impairment, Ringing ears
Copyright © 2019 VisualDx®. All rights reserved.