Tinnitus

Background

• Perception of sound without external stimulation
• Can be constant or pulsatile, high or low pitched, hissing, clicking, or ringing

Causes/Differential Diagnosis

Objective

May be heard by examiner. Less common

• Mechanical: Enlarged eustachian tube, palatal myoclonus, stapedial muscle spasm
• Vascular: often pulsatile
  • AVM, aneurysm
  • Arterial bruits
  • Carotid stenosis or dissection

Subjective

• Excessive noise exposure and/or any cause of sensory hearing loss
• Otitis media, otomycosis, herpes zoster oticus
• Meniere's disease
• Labyrinthitis
• Head trauma, otic barotrauma, decompression sickness
• Hypertension,
• TMJ
• MS
• Acoustic neuroma
• Abducens nerve palsy
• Leukostasis and hyperleukocytosis
• Benign intracranial hypertension
• Ototoxicity/medication effect:
  • Salicylate toxicity: tinnitus is an early symptom
  • Hydrocarbons
  • Caffeine toxicity
  • Oxygen toxicity
  • NSAIDs
  • Loop diuretics (furosemide, bumetanide, ethacrynic acid)
  • Antibiotics: aminoglycosides, erythromycin, vancomycin
  • Chemotherapeutics: cisplatin, carboplatin, vinblastine, vincristine
  • Quinine
  • Fosphenytoin
  • Bupropion

Evaluation

• Evaluate for emergent causes
• Accurate/definitive diagnosis often involves referral to otolaryngology/audiometry

Management

• Stop/minimize exposure to excessive noise and ototoxic agents
• Outpatient management may include masking the tinnitus (e.g. with music or white noise), habituation techniques, or antidepressants

Disposition

• Discharge unless underlying condition requires admission

See Also

• Focal neurologic deficits