Merck Manual

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Some Causes and Features of Tinnitus

Some Causes and Features of Tinnitus

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

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

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.