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) |
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Acoustic trauma (noise-induced hearing loss) |
History of occupational or recreational exposure to noise Hearing loss |
Doctor’s examination alone‡ |
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Aging (presbycusis) |
Progressive hearing loss, often with family history |
Doctor’s examination alone‡ |
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Barotrauma (ear damage due to sudden pressure change) |
Clear history of ear damage |
Doctor’s examination alone‡ |
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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 |
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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‡ |
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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 |
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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) |
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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 |
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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) |
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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 |
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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 |
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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 |
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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) |
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* Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present. |
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† 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. |
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‡ Most people should have a full hearing test (audiometry). |
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CT = computed tomography; MRI = magnetic resonance imaging. |
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