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Merck Manual

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Some Causes and Features of Tinnitus

Some Causes and Features of Tinnitus


Common Features*


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

A doctor's examination‡

Aging (presbycusis)

Progressive hearing loss, often with family history

A doctor's examination‡

Barotrauma (ear damage due to sudden pressure change)

Clear history of ear damage

A doctor's examination‡

Brain tumors (such as acoustic neuroma or meningioma) or disorders such as multiple sclerosis or stroke

Tinnitus and often hearing loss in only one ear

Sometimes other neurologic abnormalities


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

A doctor's examination‡

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)


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

History of such infection

A doctor's examination‡

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

Vestibular testing

Gadolinium-enhanced MRI to rule out acoustic neuroma

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

A doctor's examination‡

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) or 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


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

A doctor's examination

Sometimes CT venogram

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



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 only mentioned in this column if the diagnosis can sometimes be made only by the doctor's examination, without any testing. In other words, additional tests may not be needed.

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

CT = computed tomography; MRI = magnetic resonance imaging.