Cause | Common Features* | Diagnostic Approach |
---|---|---|
Subjective tinnitus (typically a constant tone and sometimes accompanied by some degree of hearing loss) | ||
History of occupational or recreational exposure to noise Hearing loss | Audiogram | |
Progressive hearing loss, often with family history | Audiogram | |
Clear history of exposure to increased air or water pressure | Audiogram | |
Brain tumors (such as vestibular schwannoma Vestibular Schwannoma A vestibular schwannoma (also called an acoustic neuroma) is a noncancerous (benign) tumor that originates in the cells that wrap around the vestibular nerve (Schwann cells). Vestibular schwannomas... read more or meningioma Meningiomas Types of brain tumors (see also table Some Tumors That Originate in or Near the Brain) can vary in their characteristics, such as their location, the people they affect most often, and the symptoms... read more ) or disorders such as multiple sclerosis Multiple Sclerosis (MS) In multiple sclerosis, patches of myelin (the substance that covers most nerve fibers) and underlying nerve fibers in the brain, optic nerves, and spinal cord are damaged or destroyed. The cause... read more or stroke Overview of Stroke A stroke occurs when an artery to the brain becomes blocked or ruptures, resulting in death of an area of brain tissue due to loss of its blood supply (cerebral infarction). Symptoms occur suddenly... read more | Tinnitus and often hearing loss in only one ear Sometimes other neurologic abnormalities | Audiogram 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 | Audiogram |
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 Audiogram |
Infections (such as otitis media Otitis Media (Acute) Acute otitis media is a bacterial or viral infection of the middle ear. Acute otitis media often occurs in people with a cold or allergies. The infected ear is painful. Doctors examine the eardrum... read more , labyrinthitis Purulent Labyrinthitis Purulent labyrinthitis is a bacterial infection of the inner ear that often causes deafness and loss of balance. The labyrinth is the bony cavity that contains the inner ear. The inner ear contains... read more , meningitis Meningitis , or syphilis Syphilis Syphilis is a sexually transmitted infection caused by the bacteria Treponema pallidum. It can occur in three stages of symptoms, separated by periods of apparent good health. Syphilis... read more ) | History of such infection | Audiogram 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 Audiogram | |
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 scan MRI Angiography (usually done before surgery) Audiogram |
* Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present. | ||
CT = computed tomography; MRI = magnetic resonance imaging. |