We need you! Join our contributor community and become a WikEM editor through our open and transparent promotion process.
Tinnitus
From WikEM
Contents
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
- Idiopathic 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
