Fast Five Quiz: Annoying Medical Conditions

Richard H. Sinert, DO


April 25, 2022

Tinnitus, the perception of sound in the head or the ears, is a common condition that affects as many as 25% of Americans and as much as 30% of the population worldwide. Tinnitus is often associated with a sensorineural hearing loss; however, tinnitus types such as pulsatile tinnitus, tinnitus with vertigo, fluctuating tinnitus, or unilateral tinnitus must be thoroughly investigated. It can have a detrimental effect on quality of life, and chronic cases are rarely cured.

Fluctuating subjective tinnitus, tinnitus accompanied by dizziness, or dizziness and hearing loss may suggest Ménière disease. A low-pitched rumbling pattern also suggests Ménière disease, whereas a high-pitched pattern suggests sensorineural hearing loss.

Caffeine use itself has not been established as a cause of tinnitus, but lack of sleep may cause or worsen tinnitus. Some evidence has suggested that alcohol consumption may be more helpful than harmful in regard to tinnitus.

According to guidelines from the American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS), imaging studies of the head and neck should not be obtained in patients with tinnitus unless the tinnitus is unilateral or pulsatile, focal neurologic abnormalities are present, or asymmetric hearing loss is noted. Persistent tinnitus is that which has lasted 6 months or longer. A comprehensive audiologic evaluation is recommended in patients with tinnitus that is unilateral, persistent, or associated with hearing difficulties. This is because glomus jugulare tumors originate in the skull or middle ear, and symptoms can include partial or complete hearing loss, a ringing or pulsing sound, ear pain, and/or dizziness.

AAO-HNS guidelines do not routinely recommend antidepressants, anticonvulsants, anxiolytics, or intratympanic medications for a primary indication of treating persistent, bothersome tinnitus. The guidelines also state that clinicians should not recommend transcranial magnetic stimulation for the routine treatment of patients with persistent, bothersome tinnitus.

Learn more about tinnitus.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.