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Tinnitus: Etiology, Evaluation, and Management Options

Tinnitus (phantom sound perception) affects 10–15% of adults. It is a symptom, not a disease.

Common Causes

  • Hearing loss (noise-induced, presbycusis) – most common
  • Conductive pathology: cerumen impaction, otitis media, otosclerosis
  • Ménière's disease (triad: tinnitus, vertigo, fluctuating hearing loss)
  • TMJ disorders, cervical spine dysfunction
  • Ototoxic drugs: aminoglycosides, loop diuretics, cisplatin, high-dose ASA/NSAIDs, quinine
  • Vascular: pulsatile tinnitus (AVM, stenosis, glomus tumor, high output states)
  • Neurologic: vestibular schwannoma (unilateral), multiple sclerosis

Red Flags → Urgent ENT/Neuro

  • Unilateral, pulsatile, or asymmetric tinnitus
  • Associated focal neurologic signs, hearing loss, vertigo
  • New onset after head trauma

Management

  • Treat underlying cause (wax removal, hearing aids, medication adjustment)
  • Sound therapy: masking, notching, customized neuromodulation (Lenire, Neuromonics)
  • CBT-t: Cognitive restructuring, habituation training
  • TRT (Tinnitus Retraining Therapy): Directive counseling + sound enrichment
  • No FDA-approved drug; off-label: low-dose benzodiazepines, antidepressants for comorbid distress

Multidisciplinary approach (audiology, otology, psychology) yields best outcomes.

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