Tinnitus Without Earwax: Causes and Evaluation

Tinnitus (perceived sound without external source) frequently occurs without earwax involvement. Common causes:

• Hearing Loss: Noise-induced, age-related (presbycusis) — most common cause.
• Ménière's Disease: Triad of tinnitus, vertigo, fluctuating hearing loss.
• Ototoxic Medications: High-dose NSAIDs, aminoglycosides, loop diuretics, cisplatin, quinine.
• TMJ Disorders: Jaw joint dysfunction → somatic tinnitus.
• Cervical Spine Issues: Somatic modulation via dorsal cochlear nucleus.
• Vascular: Pulsatile tinnitus (glomus tumor, AVM, carotid stenosis).
• Neurologic: Vestibular schwannoma (acoustic neuroma), MS.
• Psychogenic: Stress, anxiety amplify perception.

Evaluation

• Audiogram (baseline)
• If unilateral, pulsatile, or with neurologic signs → MRI/IAM
• Medication review
• TMJ/cervical exam if indicated

Management

• Hearing aids if hearing loss
• Sound therapy (masking, TRT)
• CBT for distress
• Treat underlying condition

See an audiologist/ENT for persistent tinnitus (>6 months) or red flags.