Tinnitus

Tinnitus is the perception of sounds in the ears or head that do not come from an outside source. Around 1 in 10 people will experience an episode of tinnitus at some point in their life. Although sometimes considered a 'minor' symptom of 'ringing in the ears' it can be distressing to patients and may occasionally be a sign of a serious underlying condition.

Causes of tinnitus include:

Positive family history | | Sudden onset sensorineural hearing loss (SSNHL) | The majority of SSNHL cases are diopathic | | Acoustic neuroma | Hearing loss, vertigo, tinnitus Absent corneal reflex is an important sign Associated with neurofibromatosis type 2 | | Hearing loss | Causes include excessive loud noise and presbycusis | | Drugs | Aspirin/NSAIDs Aminoglycosides Loop diuretics Quinine | | Impacted ear wax | Usually obvious on otoscopy |

Assessment

• audiological assessment
  • detect underlying hearing loss
• imaging
  • not all patients will require imaging. Generally, non-pulsatile tinnitus does not require imaging unless it is unilateral or there are other neurological or otological signs. MRI of the internal auditory meatuses (IAM) is first-line
  • pulsatile tinnitus generally requires imaging as there may be an underlying vascular cause. Magnetic resonance angiography (MRA) is often used to investigate pulsatile tinnitus

Management

• investigate and treat any underlying cause
• amplification devices
  • more beneficial if associated hearing loss
• psychological therapy may help a limited group of patients
  • examples include cognitive behavioural therapy
• tinnitus support groups