tinnitus

Last edited 03/2020

Tinnitus is the perception of sounds in the ears or head that do not come from an outside source. It is a common condition, with similar prevalence rates in children young people and adults.

The NHS Joint Strategic Needs Assessment Guidance (2019) reports that:

• 10% of the population will have tinnitus at some point
• and it will be moderately annoying in 2.8% of the population; severely annoying in 1.6%; and disrupting a person's ability to live a normal life in 0.5%

Estimated that 3% of adults might require a clinical intervention for tinnitus. The expectation is that a similar number of children will need clinical intervention for tinnitus (1)

• it is derived from a Latin word tinnire, which means "a ringing"
• may range from ringing, hissing, buzzing,and roaring, to clicking, or rough sounds (2)
• some patients experience infrequent, soft sounds while for others it may be unbearable (2)
• may be unilateral or bilateral (1)
  • unilateral tinitus with or without association with unilateral otologic features is more serious (2)
• it is caused by incorrect processing of auditory stimuli due to:
  • structural disease of the auditory apparatus
  • perceptual abnormalities
  • psychological disease
• several classificasions have been put forward
  • subjective tinnitus and objectve tinnitus
    • subjective tinnitus
      • more common
      • heard only by the individual
    • objectve tinnitus
      • the sound is heard by the patient as well as the examiner (3)
      • can be auscultated over the head and neck (near the ear)
  • vibratory tinnitus and nonvibratory tinnitus (3)
• most cases are benign, but since there are serious and treatable causes, it should always be assessed thoroughly
  • generally, pulsatile tinnitus, unilateral tinnitus and tinnitus connected with other unilateral otologic symptoms are considered to be associated with more serious underlying disorder than bilateral tinnitus (3)

Tinnitus can be associated with difficulty in concentrating and listening, and for some people it can be extremely distressing and have a significant impact on their mental wellbeing, family, work and social life

• is a heterogeneous condition that affects people differently both in its severity and its impact
• management of tinnitus is usually tailored according to the person's symptoms
a
• although there is no single effective treatment for tinnitus, there are a variety of approaches that may help people manage their tinnitus or the impact of their tinnitus
• tinnitus is often associated with hearing loss
• for example, 75% of people with hearing loss might experience tinnitus, while only 20% to 30% of people who report tinnitus have normal hearing

Reference:

• (1) NICE (March 2020). Tinnitus:assessment and management
• (2) Crummer RW et al. Diagnostic Approach to Tinnitus. American Family Physician 2004; 69(1)
• (3) Noell CA, Meyerhoff WL. Tinnitus. Diagnosis and treatment of this elusive symptom. Geriatrics. 2003;58(2):28-34