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Some Causes and Features of Tinnitus

Some Causes and Features of Tinnitus

Cause

Common Features*

Diagnosis†

Subjective tinnitus (typically a constant tone and sometimes accompanied by some degree of hearing loss)

Acoustic trauma (noise-induced hearing loss)

History of occupational or recreational exposure to noise

Hearing loss

Doctor’s examination alone‡

Aging (presbycusis)

Progressive hearing loss, often with family history

Doctor’s examination alone‡

Barotrauma (ear damage due to sudden pressure change)

Clear history of ear damage

Doctor’s examination alone‡

Brain tumors (such as vestibular schwannoma or meningioma) or disorders such as multiple sclerosis or stroke

Tinnitus and often hearing loss in only one ear

Sometimes other neurologic abnormalities

Audiometry

Gadolinium-enhanced MRI

Drugs (particularly aspirin, aminoglycoside antibiotics, certain diuretics, and some chemotherapy drugs, including cisplatin)

Tinnitus beginning in both ears shortly after starting use of drug

Except with aspirin, hearing loss also possible

With aminoglycoside antibiotics, possible dizziness and problems with balance

Doctor’s examination alone‡

Eustachian tube dysfunction

Often a long history of decreased hearing and frequent colds, and problems clearing ears with air travel or other pressure change

May be in one or both ears (often one ear more of a problem than the other)

Tympanometry

Infections (such as otitis media, labyrinthitis, meningitis, or syphilis)

History of such infection

Sometimes doctor’s examination alone‡

Sometimes other tests (for example, a lumbar puncture if meningitis is suspected)

Repeated episodes of hearing loss, tinnitus, and/or fullness in one ear and severe vertigo

Vestibular testing

Gadolinium-enhanced MRI to rule out vestibular schwannoma

Obstruction of ear canal (due to wax, foreign object, or external otitis)

Only one ear affected

Visible abnormalities seen during ear examination, including discharge with external otitis

Doctor’s examination alone‡

Objective tinnitus (typically pulsatile or intermittent)

Artery and vein (arteriovenous) malformations of the dura

Constant, pulsatile tinnitus in only one ear

Usually no other symptoms

Possible humming or pulsing noise over the skull heard during examination

Magnetic resonance angiography (MRA), CT angiography CTA), or conventional angiography

Spasm of muscles of the palate or of the middle ear

Irregular clicking or mechanical-sounding noise

Possibly other neurologic symptoms (when the cause of the spasm is a neurologic disease such as multiple sclerosis)

Possible movement of the palate and/or eardrum when symptoms occur

Sometimes MRI

Tympanometry

Turbulent blood flow in carotid artery or jugular vein

Possible humming or pulsing noise heard over the neck during examination

The noise may stop when the doctor pushes on the jugular vein and/or has people turn their head to the side

Sometimes doctor’s examination alone

Sometimes CT venogram and CT angiography

Vascular middle ear tumors (such as glomus tumors)

Constant, pulsatile tinnitus in only one ear

Possible pulsing noise heard over the affected ear during examination

Sometimes doctors can see the tumor behind the eardrum when they look in the ear canal with a light

CT

MRI

Angiography (usually done before surgery)

* Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present.

† Although a doctor's examination is always done, it is mentioned in this column only if the diagnosis can sometimes be made by the doctor's examination alone, without any testing.

‡ Most people should have a full hearing test (audiometry).

CT = computed tomography; MRI = magnetic resonance imaging.