Tinnitus

Tinnitus is a ringing in the ears that is usually constant in pitch and volume and continues for a significant period of time. It can have a wide variety of causes, which requires a very detailed history and head/neck exam.

Differential Diagnosis

• Impacted cerumen
• Eustachian tube dysfunction
  –“Ocean roar” that may wax and wane with respiration
• Acute otitis media
  –Red TM with poor movement, ±fluid
• Chronic otitis media
  –Persistent otitis with poor TM movement
• Noise-induced hearing loss
  –High pitch
• Trauma
  –Airbag, whiplash, barotrauma, etc.
• Temporal-mandibular joint disorder
  –Nonpulsatile tinnitus
• Migraine
• Ototoxicity
  –High pitch
  –Many drugs, including salicylates and aminoglycosides
• Otosclerosis
• Pseudotumor cerebri
• Infections (meningitis, Lyme disease, rubella)
• Acquired AVM, arterial bruit, venous hum (positional change of tinnitus)
• Tumor
  –Glomus tympanicum or jugulare (pulsatile tinnitus with hearing loss)
  –Acoustic neuroma
• Thyroid disease
• Autoimmune inner ear disease
• Idiopathic
  –Low pitch
• Fetal insults
  –Infections, toxins, etc.
• Sickle cell disease, anemia
• Osteogenesis imperfecta
• Symptomatic Chiari malformation
• Late-onset congenital hearing loss
• Less common causes are
  –Hypertension
  –Myoclonus of palatal muscles
  –Multiple sclerosis
  –Small vessel disease
  –Presbycusis (high pitch)

Workup and Diagnosis

• History
  –Pitch of noise, duration, noise exposure, etc.
  –Complete history including problems during
• pregnancy
  –Birth history
  –PMH, medication use
• Physical exam
  –Complete head/neck exam looking for abnormalities
  –Neurologic/systemic exam if indicated by history
• Labs
  –CBC if infectious origin suspected
  –Consider TFTs (occult thyroid disease)
• Studies
  –Tympanometry: OM, eustachian tube dysfunction
  –Full audiology evaluation if suspect sensorineural etiology
• Radiology
  –Head CT if suspect glomus tumor (delineates base of skull involvement)
  –MRI (with enhancement): Chiari malformation, MS, pseudotumor cerebri, acoustic neuroma
  –Angiography: Constant pulsatile tinnitus if no specific vascular or musculoskeletal source
  –MRA if CT and MRI negative and suspect vascular etiology

Treatment

• Treat underlying cause; treat underlying depression and insomnia; benzodiazepines may be helpful in depression
• Refer to ENT or neurotologist for vascular etiology
• Stop ototoxic medications
• Tinnitus retraining therapy can reduce tinnitus by habituation training
• Masking devices: Low-level sound to decrease or eliminate tinnitus
• Biofeedback/stress reduction
• Surgery: Correct conductive defect with outer or middle ear disease, remove tumor
• Hearing aids: Presbycusis; cochlear implants: Severe hearing loss, not benefiting from hearing aids
• Botulinum toxin injection: Myoclonus of palatal muscles
• Many medications treat tinnitus, yet none has proven very effective in double-blind placebo controlled trials without significant side effects

Book Source Details

• Book Title: In A Page: Pediatric Signs and Symptoms
• Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
• Year of Publication: 2007
• Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Hearing loss

Read excerpts from these other book chapters related to Hearing loss:

Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Hearing loss

• Back to symptom: Hearing loss: Introduction (review 259 causes)
• Next Book Extract About Hearing loss: Hearing Loss – Acquired (In A Page: Pediatric Signs and Symptoms)
• All Book Extracts: All Online Book Extracts for Hearing loss

More About This Book: Title: In A Page: Pediatric Signs and Symptoms Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-4051-0427-9

 » Next page: Hearing Loss – Acquired (In A Page: Pediatric Signs and Symptoms)

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• Hearing Loss – Acquired (In A Page: Pediatric Signs and Symptoms)
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• TINNITUS AND DEAFNESS (Differential Diagnosis in Primary Care)
• Tinnitus (Handbook of Signs & Symptoms (Third Edition))
• Hearing loss (Handbook of Signs & Symptoms (Third Edition))

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