Merck Manual

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Some Causes and Features of Tinnitus

Some Causes and Features of Tinnitus


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


Progressive hearing loss, often with family history


Clear history of exposure to increased air or water pressure


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


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)



History of such infection


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


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


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


Angiography (usually done before surgery)


* 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.