Tinnitus: Causes, Evaluation, and Evidence-Based Management

Tinnitus — the perception of sound without an external source — affects 10–15% of adults. It is a symptom, not a disease, with diverse underlying causes.

Common Etiologies

• Noise-induced hearing loss and presbycusis (age-related hearing loss) are leading contributors.
• Ototoxic medications: NSAIDs, aminoglycosides, chemotherapy agents.
• Mechanical/structural issues: Cerumen impaction, temporomandibular joint (TMJ) disorders, Eustachian tube dysfunction.
• Vascular causes: Pulsatile tinnitus may signal arteriovenous malformation or venous stenosis.
• Neurologic: Vestibular schwannoma (acoustic neuroma) typically presents with asymmetric tinnitus.

Diagnostic Evaluation

Comprehensive assessment includes audiometry, tympanometry, and neuroimaging (MRI/CT) when tinnitus is unilateral, pulsatile, or accompanied by neurologic deficits.

Management Approaches

• Hearing aids: Amplification reduces central auditory gain, often suppressing tinnitus.
• Sound therapy: Masking, notched music, or customized sound generators.
• Cognitive behavioral therapy (CBT): Addresses distress, anxiety, and catastrophizing.
• Treat underlying causes: Cerumen removal, TMJ therapy, vascular intervention.
• Pharmacotherapy: No FDA-approved drug exists; avoid ototoxins.

Most individuals habituate over time. Persistent, bothersome tinnitus warrants referral to an audiologist and ENT specialist for tailored management.