Tinnitus - Revision history

Danbot: Add verified PubMed references (PMIDs 34060792, 29621860)

2026-03-22T10:53:33Z

Add verified PubMed references (PMIDs 34060792, 29621860)

← Older revision		Revision as of 10:53, 22 March 2026
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	==Background==		==Background==
	*Perception of sound without external stimulation		*Perception of sound without external stimulation<ref>Dalrymple SN, Lewis SH, Philman S. Tinnitus: Diagnosis and Management. Am Fam Physician. 2021 Jun 1;103(11):663-671. PMID 34060792</ref><ref>Esmaili AA, Renton J. A review of tinnitus. Aust J Gen Pract. 2018 Apr;47(4):205-208. PMID 29621860</ref>
	*Can be constant or pulsatile, high or low pitched, hissing, clicking, or ringing		*Can be constant or pulsatile, high or low pitched, hissing, clicking, or ringing
	*Most ED presentations are benign, but key EM role is to identify dangerous causes:		*Most ED presentations are benign, but key EM role is to identify dangerous causes:

Danbot: Strip excess bold

2026-03-22T09:35:08Z

Strip excess bold

Danbot: Expanded with concise EM-focused content: red flags for pulsatile tinnitus, ototoxic meds, sudden SNHL urgency, evaluation, disposition

2026-03-21T00:38:19Z

Expanded with concise EM-focused content: red flags for pulsatile tinnitus, ototoxic meds, sudden SNHL urgency, evaluation, disposition

← Older revision		Revision as of 00:38, 21 March 2026
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	*Perception of sound without external stimulation		*Perception of sound without external stimulation
	*Can be constant or pulsatile, high or low pitched, hissing, clicking, or ringing		*Can be constant or pulsatile, high or low pitched, hissing, clicking, or ringing
			*Most ED presentations are benign, but key EM role is to identify '''dangerous causes''':
			**'''Pulsatile tinnitus''' → vascular lesion (carotid dissection, AVM, dural AV fistula)
			**'''Acute tinnitus with hearing loss''' → sudden sensorineural hearing loss (ENT emergency)
			**'''Tinnitus after medication change''' → ototoxicity (especially [[salicylate toxicity]])

			==Clinical Features==
			*Subjective (only patient hears) vs. objective (examiner can hear — think vascular or mechanical cause)
			*Pulsatile vs. non-pulsatile
			*Unilateral vs. bilateral
			*Associated hearing loss, vertigo, fullness ([[Meniere's disease]])
			*Associated headache, visual changes, papilledema ([[idiopathic intracranial hypertension]])
			*Medication review for ototoxic agents

			===Red Flags===
			*Pulsatile tinnitus (vascular cause until proven otherwise)
			*Unilateral tinnitus with hearing loss (acoustic neuroma, sudden SNHL)
			*Associated neurologic deficits (stroke, dissection)
			*Recent head trauma
			*Suicidal ideation (severe tinnitus is a risk factor)

			==Differential Diagnosis==
			===Objective (May Be Heard by Examiner)===
			*Vascular (often pulsatile): AVM, aneurysm, arterial bruits, [[carotid stenosis]] or [[vertebral and carotid artery dissection\|dissection]], dural AV fistula
			*Mechanical: enlarged eustachian tube, palatal myoclonus, stapedial muscle spasm

	~~==Causes/Differential Diagnosis==~~
	~~===Objective===~~
	~~''May be heard by examiner. Less common''~~
	*Mechanical: Enlarged eustachian tube, palatal myoclonus, stapedial muscle spasm
	*Vascular: often pulsatile
	**[[AVM]], aneurysm
	**Arterial bruits
	**[[Carotid stenosis]] or [[vertebral and carotid artery dissection\|dissection]]
	===Subjective===		===Subjective===
	*~~Excessive noise exposure and/or any cause of sensory~~ hearing loss		*Noise-induced hearing loss (most common cause overall)
	*[[Otitis media]], [[otomycosis]], [[herpes zoster oticus]]		*[[Otitis media]], [[otomycosis]], [[herpes zoster oticus]]
	*[[Meniere's disease]]		*[[Meniere's disease]]
	*[[Labyrinthitis]]		*[[Labyrinthitis]]
	*[[Head trauma]], [[otic barotrauma]], [[decompression sickness]]		*[[Head trauma]], [[otic barotrauma]], [[decompression sickness]]
	*[[Hypertension]],		*[[TMJ]] dysfunction
	*[[TMJ]]		*[[Acoustic neuroma]] (vestibular schwannoma)
	*[[MS]]
	*[[Acoustic neuroma]]
	*[[Abducens nerve palsy]]
	*[[Leukostasis and hyperleukocytosis]]
	*[[Idiopathic intracranial hypertension]]		*[[Idiopathic intracranial hypertension]]
	*Ototoxicity/medication effect:		*[[MS]], [[stroke]]
	**[[~~Salicylate toxicity~~]]~~: tinnitus is an early symptom~~
	**[[~~Hydrocarbons~~]]		===Ototoxic Medications===
	**[[Caffeine toxicity]]		*'''[[Salicylate toxicity]]''': tinnitus is an early symptom — check salicylate level
	**[[~~Oxygen~~ toxicity]]		*Loop [[diuretics]] ([[furosemide]], [[bumetanide]], ethacrynic acid)
	**[[NSAIDs]]		*[[Aminoglycosides]], [[erythromycin]], [[vancomycin]]
	**Loop [[diuretics]] ([[furosemide]], [[bumetanide]], ethacrynic acid)		*Chemotherapeutics: cisplatin, carboplatin
	**Antibiotics: [[~~aminoglycosides~~]], [[erythromycin]], [[vancomycin]]		*[[NSAIDs]], [[quinine]], [[bupropion]]
	**Chemotherapeutics: cisplatin, carboplatin, ~~vinblastine~~, ~~vincristine~~		*[[Caffeine]], [[hydrocarbons]]
	**[[~~Quinine~~]]
	**[[~~Fosphenytoin~~]]
	**[[~~Bupropion~~]]

	==Evaluation==		==Evaluation==
	*~~Evaluate~~ for ~~emergent causes~~		*Otoscopic exam (cerumen impaction, otitis media, TM perforation)
	*~~Accurate~~/~~definitive diagnosis often involves referral~~ to ~~otolaryngology/~~audiometry		*Auscultate over periauricular area, orbits, and neck for bruits (objective tinnitus)
			*Cranial nerve exam, hearing (Weber/Rinne), cerebellar function
			*'''Pulsatile tinnitus''': CT/CTA or MRI/MRA to evaluate for vascular cause
			*'''Acute unilateral hearing loss + tinnitus''': audiometry referral urgently (sudden SNHL)
			*'''Salicylate level''' if aspirin use or toxicity suspected
			*Other workup guided by history (BMP, TSH, CBC, head CT if trauma or neurologic deficits)

	==Management==		==Management==
	*Stop/minimize ~~exposure to excessive noise and~~ ototoxic agents		*Identify and treat reversible causes
	*Outpatient ~~management may include~~ masking ~~the tinnitus~~ (~~e.g. with music or~~ white noise), habituation ~~techniques~~, or antidepressants		*Stop/minimize ototoxic agents
			*'''Salicylate toxicity''': treat per [[salicylate toxicity]] protocol
			*'''Sudden sensorineural hearing loss''': urgent ENT referral (may benefit from systemic or intratympanic steroids if started within 2 weeks)
			*'''Cerumen impaction''': removal often provides relief
			*Outpatient: masking techniques (white noise), habituation therapy, consider antidepressants for severe cases
			*Reassurance for most patients

	==Disposition==		==Disposition==
	*Discharge unless underlying condition requires admission		*Discharge unless underlying condition requires admission
			*Urgent ENT referral for: sudden hearing loss, pulsatile tinnitus, unilateral tinnitus concerning for acoustic neuroma
			*Return precautions: hearing loss, new neurologic symptoms, vertigo, worsening

	==See Also==		==See Also==
			*[[Hearing loss]]
			*[[Meniere's disease]]
			*[[Salicylate toxicity]]
	*[[Focal neurologic deficits]]		*[[Focal neurologic deficits]]

	~~==External Links==~~

	==References==		==References==
	<references/>		<references/>

	[[Category:Symptoms]] [[Category:ENT]]		[[Category:Symptoms]]
			[[Category:ENT]]

ClaireLewis at 15:29, 26 October 2019

2019-10-26T15:29:28Z

← Older revision		Revision as of 15:29, 26 October 2019
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	*[[TMJ]]		*[[TMJ]]
	*[[MS]]		*[[MS]]
	*Acoustic neuroma		*[[Acoustic neuroma]]
	*[[Abducens nerve palsy]]		*[[Abducens nerve palsy]]
	*[[Leukostasis and hyperleukocytosis]]		*[[Leukostasis and hyperleukocytosis]]

ClaireLewis: /* Subjective */

2016-12-27T00:07:31Z

Subjective

← Older revision		Revision as of 00:07, 27 December 2016
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	*[[Abducens nerve palsy]]		*[[Abducens nerve palsy]]
	*[[Leukostasis and hyperleukocytosis]]		*[[Leukostasis and hyperleukocytosis]]
	*[[~~Benign~~ intracranial hypertension]]		*[[Idiopathic intracranial hypertension]]
	*Ototoxicity/medication effect:		*Ototoxicity/medication effect:
	**[[Salicylate toxicity]]: tinnitus is an early symptom		**[[Salicylate toxicity]]: tinnitus is an early symptom

ClaireLewis: Created page with "==Background== Perception of sound without external stimulation Can be constant or pulsatile, high or low pitched, hissing, clicking, or ringing ==Causes/Differential Diagn..."

2016-12-27T00:06:43Z

Created page with "==Background== *Perception of sound without external stimulation *Can be constant or pulsatile, high or low pitched, hissing, clicking, or ringing ==Causes/Differential Diagn..."

New page

==Background==
*Perception of sound without external stimulation
*Can be constant or pulsatile, high or low pitched, hissing, clicking, or ringing

==Causes/Differential Diagnosis==
===Objective===
''May be heard by examiner. Less common''
*Mechanical: Enlarged eustachian tube, palatal myoclonus, stapedial muscle spasm
*Vascular: often pulsatile
**[[AVM]], aneurysm
**Arterial bruits
**[[Carotid stenosis]] or [[vertebral and carotid artery dissection|dissection]]
===Subjective===
*Excessive noise exposure and/or any cause of sensory hearing loss
*[[Otitis media]], [[otomycosis]], [[herpes zoster oticus]]
*[[Meniere's disease]]
*[[Labyrinthitis]]
*[[Head trauma]], [[otic barotrauma]], [[decompression sickness]]
*[[Hypertension]],
*[[TMJ]]
*[[MS]]
*Acoustic neuroma
*[[Abducens nerve palsy]]
*[[Leukostasis and hyperleukocytosis]]
*[[Benign intracranial hypertension]]
*Ototoxicity/medication effect:
**[[Salicylate toxicity]]: tinnitus is an early symptom
**[[Hydrocarbons]]
**[[Caffeine toxicity]]
**[[Oxygen toxicity]]
**[[NSAIDs]]
**Loop [[diuretics]] ([[furosemide]], [[bumetanide]], ethacrynic acid)
**Antibiotics: [[aminoglycosides]], [[erythromycin]], [[vancomycin]]
**Chemotherapeutics: cisplatin, carboplatin, vinblastine, vincristine
**[[Quinine]]
**[[Fosphenytoin]]
**[[Bupropion]]

==Evaluation==
*Evaluate for emergent causes
*Accurate/definitive diagnosis often involves referral to otolaryngology/audiometry

==Management==
*Stop/minimize exposure to excessive noise and ototoxic agents
*Outpatient management may include masking the tinnitus (e.g. with music or white noise), habituation techniques, or antidepressants

==Disposition==
*Discharge unless underlying condition requires admission

==See Also==
*[[Focal neurologic deficits]]

==External Links==

==References==
<references/>

[[Category:Symptoms]] [[Category:ENT]]

← Older revision		Revision as of 09:35, 22 March 2026
Line 2:		Line 2:
	*Perception of sound without external stimulation		*Perception of sound without external stimulation
	*Can be constant or pulsatile, high or low pitched, hissing, clicking, or ringing		*Can be constant or pulsatile, high or low pitched, hissing, clicking, or ringing
	*Most ED presentations are benign, but key EM role is to identify ~~'''~~dangerous causes~~'''~~:		*Most ED presentations are benign, but key EM role is to identify dangerous causes:
	**~~'''~~Pulsatile tinnitus~~'''~~ → vascular lesion (carotid dissection, AVM, dural AV fistula)		**Pulsatile tinnitus → vascular lesion (carotid dissection, AVM, dural AV fistula)
	**'''Acute tinnitus with hearing loss''' → sudden sensorineural hearing loss (ENT emergency)		**'''Acute tinnitus with hearing loss''' → sudden sensorineural hearing loss (ENT emergency)
	**~~'''~~Tinnitus after medication change~~'''~~ → ototoxicity (especially [[salicylate toxicity]])		**Tinnitus after medication change → ototoxicity (especially [[salicylate toxicity]])

	==Clinical Features==		==Clinical Features==
Line 39:		Line 39:

	===Ototoxic Medications===		===Ototoxic Medications===
	*~~'''~~[[Salicylate toxicity]]~~'''~~: tinnitus is an early symptom — check salicylate level		*[[Salicylate toxicity]]: tinnitus is an early symptom — check salicylate level
	*Loop [[diuretics]] ([[furosemide]], [[bumetanide]], ethacrynic acid)		*Loop [[diuretics]] ([[furosemide]], [[bumetanide]], ethacrynic acid)
	*[[Aminoglycosides]], [[erythromycin]], [[vancomycin]]		*[[Aminoglycosides]], [[erythromycin]], [[vancomycin]]
Line 50:		Line 50:
	*Auscultate over periauricular area, orbits, and neck for bruits (objective tinnitus)		*Auscultate over periauricular area, orbits, and neck for bruits (objective tinnitus)
	*Cranial nerve exam, hearing (Weber/Rinne), cerebellar function		*Cranial nerve exam, hearing (Weber/Rinne), cerebellar function
	*~~'''~~Pulsatile tinnitus~~'''~~: CT/CTA or MRI/MRA to evaluate for vascular cause		*Pulsatile tinnitus: CT/CTA or MRI/MRA to evaluate for vascular cause
	*~~'''~~Acute unilateral hearing loss + tinnitus~~'''~~: audiometry referral urgently (sudden SNHL)		*Acute unilateral hearing loss + tinnitus: audiometry referral urgently (sudden SNHL)
	*~~'''~~Salicylate level~~'''~~ if aspirin use or toxicity suspected		*Salicylate level if aspirin use or toxicity suspected
	*Other workup guided by history (BMP, TSH, CBC, head CT if trauma or neurologic deficits)		*Other workup guided by history (BMP, TSH, CBC, head CT if trauma or neurologic deficits)

Line 58:		Line 58:
	*Identify and treat reversible causes		*Identify and treat reversible causes
	*Stop/minimize ototoxic agents		*Stop/minimize ototoxic agents
	*~~'''~~Salicylate toxicity~~'''~~: treat per [[salicylate toxicity]] protocol		*Salicylate toxicity: treat per [[salicylate toxicity]] protocol
	*~~'''~~Sudden sensorineural hearing loss~~'''~~: urgent ENT referral (may benefit from systemic or intratympanic steroids if started within 2 weeks)		*Sudden sensorineural hearing loss: urgent ENT referral (may benefit from systemic or intratympanic steroids if started within 2 weeks)
	*~~'''~~Cerumen impaction~~'''~~: removal often provides relief		*Cerumen impaction: removal often provides relief
	*Outpatient: masking techniques (white noise), habituation therapy, consider antidepressants for severe cases		*Outpatient: masking techniques (white noise), habituation therapy, consider antidepressants for severe cases
	*Reassurance for most patients		*Reassurance for most patients