tinnitus

introduction

most tinnitus originating in the auditory system is due to a sensorineural hearing loss with resulting dysfunction within the auditory system
- mostly this is high pitched
- Ménière's disease is generally low pitched tinnitus
- a whooshing sound is generally regarded as whooshing or pulsatile tinnitus and is often due to vascular noises which may be serious

eustachian tube dysfunction
presbycusis (sensorineural hearing loss with aging)
otosclerosis - conductive hearing loss
patulous Eustachian tube - also have autophony
endolymphatic hydrops including Meniere's disease - generally low pitched; also have vertigo, deafness
acoustic neuroma - also have deafness
superior canal dehiscence syndrome (SCDS) - rare; pulsatile tinnitus
arterial bruits, AVM's, fistulae - mainly while sleeping; no vertigo/deafness;
head and neck paragangliomas of the carotids - may interfere with hearing
venous hums - eg. hypertension; often change with head position
spasm of the tensor tympani or stapedius muscle - pulsatile tinnitus +/- deafness, aural fullness
myoclonus of the palatal muscles - clicking noises or irregular or rapid pulsations; MS, etc
TMJ dysfunction
cervical spine soft tissue injuries
leukostasis - as in myeloproliferative disorders
drugs (may also have deafness if ototoxic)
- salicylate poisoning
- non-steroidal anti-inflammatory drugs (NSAIDs) and COX-2 inhibitors
- aminoglycoside antibiotics such as gentamicin
- vancomycin
- azithromycin
- flouroquinolone antibiotics
- SSRI/SNRI antidepressants
- local anaesthetic agents
- ACE inhibitors
- antimalarials
- benzodiazepines
- calcium channel blockers
- carbamazepine
- sodium valproate (Epilim)
- loop diuretics such as frusemide / furosemide / Lasix
- proton pump inhibitors (PPIs)
- quinidine
- tricyclic antidepressants

if the tinnitus is whoosing or pulsatile then this needs more urgent Ix - see whooshing or pulsatile tinnitus
check for and cease any ototoxic medications
otherwise if it is a constant tinnitus this can generally be managed by the GP:
- referral for audiometry
- referral to an ENT specialist
  - further Ix may be an OP MRI, etc.