Tinnitus

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2] Sabeeh Islam, MBBS[3]

Historical Perspective

• In the early 19th century, Frenchman and Jean Marie Gaspard Itard introduced the concept of masking.  They were the first ones to differentiate between subjective and objective tinnitus.
• Later in the 19th Century, with the introduction of germ theory and anesthesia, surgical therapy such as incudectomy was established.

Causes of subjective tinnitus

Common Causes

Sensorineural hearing loss:

• Ototoxicity
• Presbycusis
• Noise induced hearing loss
• Late onset congenital hearing loss
• Idiopathic

Cochlear injury:

• Ménière disease
• Loop diuretics
• Platinum based chemotherapy
• Antibiotics
• Salicylate
• Trauma

Vascular causes:

• Systemic hypertension
• Sickle cell anemia
• Small vessel disease
• Hypercholesterolemia
• Hypercoagulable state
• Diabetic vasculopathy

CNS causes:

• Pseudotumor cerebri
• Stroke
• Vascular malformations
• Tumor
• Sarcoid
• Multiple sclerosis

Infections:

• Rubella
• Cytomegalovirus
• Chronic otitis media
• Neurosyphilis
• Measles
• Lyme disease
• Meningitis

Bone disease:

• Otosclerosis
• Fibrous dysplasia
• Osteogenesis imperfecta
• Paget disease

Metabolic disorders:

• Hyperparathyroidism
• Chronic renal failure
• Diabetes mellitus
• Thyroid disease

Autoimmune diseases:

• Autoimmune inner ear disease
• SLE
• Rheumatoid arthritis

Medications:

• ACE inhibitors
• Antimalarial medications
• Aminoglycosides
• Dapsone
• Doxazosin
• Calcium channel blockers
• Benzodiazepines
• Cisplatin
• Clarithromycin
• COX-2 inhibitors
• Loop diuretics
• Tricyclic antidepressant
  

Natural History, Complications and Prognosis

• Early clinical features include
• If left untreated, patients may progress to
• Common complications of

Diagnosis

Imaging:

• MRA and CTA are the gold standard diagnostic tests for arteriovenous fistula related tinnitus.
• MRI with contrast is the initial preferred diagnostic test of choice for suspected vascular tinnitus.
• MRI with contrast is followed by CT/CTA and ultimately interventional angiography, if needed.

Other Diagnostic Testing:

• Initial audiometric tests are done to identify asymmetries between the ears and to locate the site of abnormality such as middle ear, cochlea, and brainstem.  These tests include:
  • Pure-tone audiogram
  • Tympanometry
  • Auditory reflex testing
  • Determination of speech discrimination abilities
  • Otoacoustic emissions testing
  • Auditory brainstem response testing (ABR)