Condition: Tinnitus

Rather than being a diagnosis in itself, tinnitus is a symptom, and it’s a term we use for any situation where you are hearing a sound that isn’t coming from an outside source.

In 90% of cases, tinnitus is subjective, meaning you’re hearing a sound even though there’s no external sound actually being made. That means that for up to 10% there may actually be an identifiable cause and it’s important to pick these up.

Listening carefully to the details of the symptoms and performing an examination will help a great deal in picking up any abnormalities.

Important questions

• One or both sides? One sided tinnitus needs investigation more so than when both sides are effective
• What does it sound like? The character of the sound is important. Pulsating tinnitus needs investigation.
• Any other ear symptoms? For example, hearing loss, ear discharge, dizziness. Sometimes this can point to middle or inner ear disease as the cause.
• Any previous trauma or loud noise exposure? A history of loud noise exposure or trauma that might have damaged the hearing mechanism might provide an explanation.

Any medications that cause tinnitus? Salicylates, aminoglycoside antibiotics and loop diuretics can also cause tinnitus

In the small proportion that do need to be investigated further and an objective cause is found, there are a number of different causes, all relatively rare, with their own options for treatment.

Causes include:

• Vestibular schwannoma
• Paragangliomas
• Vascular malformations

• Otosclerosis

• Menieres
• Superior semicircular canal dehiscence
• Middle ear Myoclonus
• Benign intracranial hypertension

Beyond this, it’s very important to establish the overall effect that tinnitus is having on quality of life. Is it interrupting sleep? Is it interfering with your job or daily living? In the vast majority of cases, examination and reassurance is all that’s needed, but there are also a number of different evidence-based management options which are available to help with moderate and severe cases.

• Counselling, sound enrichment
• Hearing aids
• Sound therapy
• Habituatation-based therapy
• Cognitive behavioural therapy
• Self-help groups, Online resources, BTA

Our in-house audiology service will be able to provide guidance on all of these interventions.

Medical involvement

There are a number of scenarios where urgent medical attention is needed for tinnitus:

• Sudden onset of nervous system symptoms such as facial droop or uncontrolled balance difficulties, arm or leg weakness
• Tinnitus after a head injury
• Sudden hearing loss
• Sudden onset pulsating sensation
• Any potentially life-threatening impact on mental health

There are also some scenarios where tinnitus should be evaluated by both an audiologist and an ENT specialist:

• Persistent pulsating tinnitus.
• Persistent one-sided tinnitus
• Tinnitus is associated with any other ear symptom – one-sided hearing loss, discharge, Beyond this, it’s very important to establish the overall effect that tinnitus is having on quality of life. Is it interrupting sleep? Is it interfering with your job or daily living? In the vast majority of cases, examination and reassurance is all that’s needed, but there are also a number of different evidence-based management options which are available to help with moderate and severe cases.

• Counselling, sound enrichment
• Hearing aids
• Sound therapy
• Habituatation-based therapy
• Cognitive behavioural therapy
• Self-help groups, Online resources, BTA

Our in-house audiology service will be able to provide guidance on all of these interventions.

Medical involvement

There are a number of scenarios where urgent medical attention is needed for tinnitus:

• Sudden onset of nervous system symptoms such as facial droop or uncontrolled balance difficulties, arm or leg weakness
• Tinnitus after a head injury
• Sudden hearing loss
• Sudden onset pulsating sensation
• Any potentially life-threatening impact on mental health

There are also some scenarios where tinnitus should be evaluated by both an audiologist and an ENT specialist:

• Persistent pulsating tinnitus.
• Persistent one-sided tinnitus

Tinnitus associated with any other ear symptom – one-sided hearing loss, discharge, pain.