Table: Some Causes and Features of Tinnitus - Merck Manuals Consumer Version

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)
Acoustic trauma (noise-induced hearing loss Hearing Loss Worldwide, about half a billion people (almost 8% of the world's population) have hearing loss. More than 15% of people in the United States have some degree of hearing loss that affects their... read more )	History of occupational or recreational exposure to noise Hearing loss	Audiogram
Aging ( presbycusis Presbycusis Worldwide, about half a billion people (almost 8% of the world's population) have hearing loss. More than 15% of people in the United States have some degree of hearing loss that affects their... read more )	Progressive hearing loss, often with family history	Audiogram
Barotrauma Barotrauma of the Ear Barotrauma is an injury caused by increased air pressure, such as during airplane flights or scuba diving. Barotrauma can cause ear pain or damage to the eardrum. The eardrum separates the ear... read more (ear damage due to sudden pressure change)	Clear history of exposure to increased air or water pressure	Audiogram
Brain tumors (such as vestibular schwannoma Vestibular Schwannoma A vestibular schwannoma (also known as an acoustic neuroma) is a noncancerous (benign) tumor that originates in the cells that wrap around the vestibular nerve (Schwann cells). These tumors... 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) and symptoms that... 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 (suppurative) 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... read more , meningitis Meningitis , or syphilis Syphilis Syphilis is a sexually transmitted infection caused by the bacteria Treponema pallidum. Syphilis can occur in three stages of symptoms, separated by periods of apparent good health. It... read more )	History of such infection	Audiogram Sometimes other tests (for example, a lumbar puncture if meningitis is suspected)
Meniere disease Meniere Disease Meniere disease is a disorder characterized by recurring attacks of disabling vertigo (a false sensation of moving or spinning), fluctuating hearing loss (in the lower frequencies), and noise... read more	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
Obstruction of ear canal Objects in the Ear Objects in the ear can be removed by flushing the ear canal with sterile water or saline or using suction, forceps, or other tools. If the foreign body cannot easily be removed, a referral to... read more (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 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.