10 Minute consultation: Tinnitus
An elderly widower complains of ringing in his ears. He denies any associated symptoms. He takes atenolol for hypertension. Tired and anxious, he wants to know what is wrong.
Tinnitus—the sensation of noises in the ears or head not attributable to any perceivable external sound—is common. Is the tinnitus subjective? Uncommon objective tinnitus can be heard by others. The temporomandibular joint, eustachian tube, palate, and carotid artery can produce usually innocent somatosounds.
Character of sound—Ringing, hissing, or buzzing suggest inner ear or central pathology. Popping, clicking, or banging suggest problems in the external or middle ear or palatal problems. Pulsatile sounds may indicate anxiety or acute inflammatory ear conditions but also vascular causes, including tumours (glomus, carotid body), carotid stenosis, arteriovenous malformations, intracranial aneurysms, and high cardiac output states. “Voices” need psychiatric referral.
Balance—Bilateral tinnitus is usually innocuous; unilateral tinnitus may herald acoustic neuroma.
Change over time—Determine intensity and frequency