Tinnitus is the perception of sound without an external source. It may be a symptom of ear disease but may also occur with systemic disorders such as hypertension. It is common and occurs in 15% of all people. It is more common in the elderly and may be accompanied by hearing loss and dizziness.

It is broadly divided in subjective (only noticeable to the patient) and less common objective (noticeable to the observer as well). It can be described as a hissing, rumbling, whistling or a cricket like sound and may be present in one ear only. If it follows the heartbeat (pulsatile ) it should be investigated to exclude a vascular problem, tumour or a superior canal dehiscence (SCD). Patients often report that it is worse when it is quiet.

There are many causes of which hearing loss is still the most common. An acoustic neuroma is a tumour that may present with tinnitus in one ear. Menière’s disease also causes it and it often changes character during an attack. Vestibular paroxysmia causes it due to vascular compression of the vestibulocochlear nerve. Sometimes the hearing is normal and no cause can be found.

Tinnitus is most often caused by hearing loss

It is well recognized that stress can aggravate it. In some cases patients can get depressed and develop sleeping problems.

There are audiologists trained in the effective management  but a treatable cause should be ruled out first. A hearing test with speech discrimination should always be performed. In some cases a contrast-enhanced magnetic resonance imaging (MRI) of the brain is indicated to exclude an acoustic neuroma.

In patients with hearing loss a hearing aid is likely to improve the tinnitus. Medication is often prescribed for those patients with anxiety and depression. Patients should be careful of so called “wonder drugs”. The same applies for mechanical devices and laser treatment. Tinnitus counseling and retraining therapy (TRT) is often of value.

Tinnitus can be managed very effectively and patients should never give up hope. Never except the advice that you should “live with it”.