Tinnitus as an early indicator of permanent hearing loss. Meniere's disease: differential diagnosis and treatment. Philadelphia: Lippincott Williams & Wilkins, 2000:1123–5. Primary care medicine: office evaluation and management of the adult patient. Philadelphia: Saunders, 2003:45–6.Ĭlinical evidence on tinnitus. Louis: Mosby, 1998:90–5.įortune DS, Haynes DS, Hall JW.

Current therapy in otolaryngology: head and neck surgery. Management depends on how the tinnitus affects the patient's quality of life. Hyperlipidemia, thyroid disorder, vitamin B 12 deficiency, anemia Tinnitus of patulous eustachian tube is alleviated by lying down with head in dependent position. Noise-induced or medication-induced hearing loss Low-pitched rumbling pattern suggests Meniere's disease, high-pitched pattern suggests sensorineural hearing loss.Īssociated vertigo, aural fullness, hearing loss Pulsatile tinnitus suggests a vascular origin.Ĭharacteristics (i.e., pitch, complexity)

Episodic tinnitus suggests Meniere's disease. Tinnitus associated with unilateral sensorineural hearing loss is the hallmark of acoustic neuroma.Ĭontinuous tinnitus accompanies hearing loss. Unilateral tinnitus can be caused by cerumen impaction, otitis externa, and otitis media. Precipitous onset can be linked to excessive or loud noise exposure or head trauma. Progressive hearing loss with tinnitus and advancing age suggests presbycusis. In patients who are discomforted by tinnitus and have no remediable cause, auditory masking may provide some relief. Unilateral or pulsatile tinnitus may be caused by more serious pathology and typically merits specialized audiometric testing and radiologic studies. Initial evaluation of tinnitus should include a thorough history, head and neck examination, and audiometric testing to identify an underlying etiology. Objective tinnitus usually is caused by vascular abnormalities of the carotid artery or jugular venous systems. Subjective tinnitus also may be caused by neurologic, metabolic, or psychogenic disorders. Unilateral hearing loss plus tinnitus should increase suspicion for acoustic neuroma. Sensorineural hearing loss may be caused by exposure to excessive loud noise, presbycusis, ototoxic medications, or Meniere's disease. Common causes of conductive hearing loss include external ear infection, cerumen impaction, and middle ear effusion. Otologic problems, especially hearing loss, are the most common causes of subjective tinnitus. Most cases of tinnitus are subjective, but occasionally the tinnitus can be heard by an examiner. Tinnitus is a common disorder with many possible causes.

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