12
THE BULLETIN
FEATURE
TINNITUS IS THE PERCEPTION OF SOUND THAT DOES NOT
HAVE AN EXTERNAL SOURCE.
This description does not include
voices, songs, or melodies which are categorized as auditory hallu-
cinations. The most common tinnitus sounds are ringing (or pure
tone), buzzing, hissing, sizzling, roaring, or chirps that patients
perceive in their ears or head. Most of us occasionally perceive
a high-pitched tone that lasts for 5 to 60 seconds in one ear. This
temporary tinnitus is probably caused by subtle changes in blood
flow or neural activity associated with inner ear structures. Acute
tinnitus, which can last days or weeks, may be caused by ear infec-
tion, medications, head or neck injury, excessive sound exposure,
impacted earwax, and changes in blood pressure or metabolism.
With appropriate evaluation, such underlying conditions usually
can be identified and treated, often with resultant resolution of
tinnitus. Chronic tinnitus (persistence for 6 months or more) can
also result from these conditions and is more likely to occur in
people who have hearing loss. In fact, any condition that contrib-
utes to hearing loss or auditory system degen-
eration (including aging, loud noise exposure,
head or neck injury, neoplasm, cerebrovascular
accident, genetics, otosclerosis, and Meniere’s
Disease) increases the likelihood that patients
will perceive tinnitus. The graph to the right
(from Hoffman & Reed
1
) illustrates the relation-
ship between hearing loss and prevalence of
tinnitus. For all age groups (including children),
the prevalence of tinnitus increases with the pres-
ence and severity of hearing loss (higher pure
tone average audiometric thresholds).
Since hearing loss typically increases with age,
tinnitus is more common within older popula-
tions. The prevalence of tinnitus is somewhat
HELP FOR
TINNITUS
PATIENTS
higher in men compared to women because men tend to acquire
more hearing loss due to occupational, recreational, and mili-
tary noise exposure. While chronic tinnitus is perceived by 10–15
percent of the adult population
1
, only 20 percent of people who
perceive tinnitus consider it to be a “clinically significant” problem.
2
When a patient complains about tinnitus, thorough hearing,
health, tinnitus, and psychosocial histories should be collected.
Hearing history
If possible, determine the presence and type of hearing loss
(congenital, sudden, sensorineural, conductive, or mixed). Note
the patient’s history of ear infections, surgeries, noise exposure
(occupational or recreational), otalgia, otorrhea, and vertigo or
other balance problems. Ask whether immediate family members
have experienced hearing loss or tinnitus.
By Robert L. Folmer, Ph.D., Associate Professor of
Otolaryngology, Oregon Health & Science University (OHSU);
Research Investigator, VA National Center for Rehabilitative
Auditory Research (NCRAR), VA Portland Medical Center
