Tinnitus is the perception of sound when no corresponding external sound is present. Nearly everyone will experience a faint "normal tinnitus" in a completely quiet room but it is only of concern if it is bothersome or interferes with normal hearing or correlated with other problems. While often described as a ringing, it may also sound like a clicking, buzzing, hiss, or roaring. The sound may be soft or loud, low or high pitched, and often appears to be coming from one or both ears or from the head itself. In some people, the sound may interfere with concentration and in some cases it is associated with anxiety and depression. Tinnitus is usually associated with a degree of hearing loss and with decreased comprehension of speech in noisy environments. It is common, affecting about 10–15% of people. Most, however, tolerate it well, and it is a significant problem in only 1–2% of all people. The word tinnitus comes from the Latintinnire which means "to ring".
Prevention involves avoiding exposure to loud noise for longer periods or chronically. If there is an underlying cause, treating it may lead to improvements. Otherwise, typically, management involves psychoeducation or counseling, such as talk therapy.Sound generators or hearing aids may help. No medication directly targets tinnitus.
Signs and symptoms
Tinnitus may be perceived in various locations, more commonly in one or both ears or more central in the head. The noise can be described in many different ways but is reported as a noise inside a person's head or ear(s) in the absence of auditory stimulation. It often is described as a ringing noise, but in some people, it takes the form of a high-pitched whining, electric buzzing, hissing, humming, tinging, whistling, ticking, clicking, roaring, beeping, sizzling, a pure steady tone such as that heard during a hearing test, or sounds that slightly resemble human voices, tunes, songs, or animal sounds such as "crickets", "tree frogs", or "locusts (cicadas)". Tinnitus may be intermittent or continuous: in the latter case, it may be the cause of great distress. In some individuals, the intensity may be changed by shoulder, neck, head, tongue, jaw, or eye movements, also tinnitus loudness
can vary between patients.
The sound perceived may range from a quiet background noise to one that even is heard over loud external sounds. The specific type of tinnitus called objective tinnitus is characterized by hearing the sounds of one's own muscle contractions or pulse, which is typically a result of sounds that have been created by the movement of muscles near to one's ear, or sounds related to blood flow in the neck or face.
Due to variations in study designs, data on the course of tinnitus showed few consistent results. Generally, the prevalence increased with age in adults, whereas the ratings of annoyance decreased with duration.
Besides being an annoying condition to which most people adapt, persistent tinnitus may cause anxiety and depression in some people. Tinnitus annoyance is more strongly associated with the psychological condition of the person than the loudness or frequency range. Psychological problems such as depression, anxiety, sleep disturbances, and concentration difficulties are common in those with strongly annoying tinnitus. 45% of people with tinnitus have an anxiety disorder at some time in their life.
Psychological research has focussed on the tinnitus distress reaction (TDR) to account for differences in tinnitus severity. These findings suggest that among those people, conditioning at the initial perception of tinnitus, linked tinnitus with negative emotions, such as fear and anxiety from unpleasant stimuli at the time. This enhances activity in the limbic system and autonomic nervous system, thus increasing tinnitus awareness and annoyance.
A common tinnitus classification is into "subjective and objective tinnitus". Tinnitus is usually subjective, meaning that the sounds the person hears are not detectable by means currently available to physicians and hearing technicians. Subjective tinnitus has also been called "tinnitus aurium", "non-auditory" or "non-vibratory" tinnitus. In rare cases, tinnitus can be heard by someone else using a stethoscope. Even more rarely, in some cases it can be measured as a spontaneous otoacoustic emission (SOAE) in the ear canal. This is classified as objective tinnitus, also called "pseudo-tinnitus" or "vibratory" tinnitus.
Subjective tinnitus is the most frequent type of tinnitus. It may have many possible causes, but most commonly it results from hearing loss. When the tinnitus is caused by disorders of the inner ear or auditory nerve it can be called otic (from the Greek word for ear). These otological or neurological conditions include those triggered by infections, drugs, or trauma. A frequent cause is traumatic noise exposure that damages hair cells in the inner ear.
When there does not seem to be a connection with a disorder of the inner ear or auditory nerve, the tinnitus can be called non-otic. (i.e. not otic). In some 30% of tinnitus cases, the tinnitus is influenced by the somatosensory system, for instance, people can increase or decrease their tinnitus by moving their face, head, or neck. This type is called somatic or craniocervical tinnitus, since it is only head or neck movements that have an effect.
There is a growing body of evidence suggesting that some tinnitus is a consequence of neuroplastic alterations in the central auditory pathway. These alterations are assumed to result from a disturbed sensory input, caused by hearing loss. Hearing loss could indeed cause a homeostatic response of neurons in the central auditory system, and therefore cause tinnitus.
The most common cause of tinnitus is hearing loss. Hearing loss may have many different causes, but among those with tinnitus, the major cause is cochlear injury.
Ototoxic drugs also may cause subjective tinnitus, as they may cause hearing loss, or increase the damage done by exposure to loud noise. Those damages may occur even at doses that are not considered ototoxic. More than 260 medications have been reported to cause tinnitus as a side effect. In many cases, however, no underlying cause could be identified.
Tinnitus can also occur due to the discontinuation of therapeutic doses of benzodiazepines. It can sometimes be a protracted symptom of benzodiazepine withdrawal and may persist for many months. Medications such as bupropion may also result in tinnitus. In many cases, however, no underlying cause can be identified.
Objective tinnitus can be detected by other people and is sometimes caused by an involuntary twitching of a muscle or a group of muscles (myoclonus) or by a vascular condition. In some cases, tinnitus is generated by muscle spasms around the middle ear.
Spontaneous otoacoustic emissions (SOAEs), which are faint high-frequency tones that are produced in the inner ear and can be measured in the ear canal with a sensitive microphone, may also cause tinnitus. About 8% of those with SOAEs and tinnitus have SOAE-linked tinnitus,[need quotation to verify] while the percentage of all cases of tinnitus caused by SOAEs is estimated at about 4%.
Some people experience a sound that beats in time with their pulse, known as pulsatile tinnitus or vascular tinnitus. Pulsatile tinnitus is usually objective in nature, resulting from altered blood flow, increased blood turbulence near the ear, such as from atherosclerosis or venous hum, but it can also arise as a subjective phenomenon from an increased awareness of blood flow in the ear. Rarely, pulsatile tinnitus may be a symptom of potentially life-threatening conditions such as carotid arteryaneurysm or carotid artery dissection. Pulsatile tinnitus may also indicate vasculitis, or more specifically, giant cell arteritis. Pulsatile tinnitus may also be an indication of idiopathic intracranial hypertension. Pulsatile tinnitus can be a symptom of intracranial vascular abnormalities and should be evaluated for irregular noises of blood flow (bruits).
It may be caused by increased neural activity in the auditory brainstem, where the brain processes sounds, causing some auditory nerve cells to become over-excited. The basis of this theory is that many with tinnitus also have hearing loss.
Three reviews of 2016 emphasized the large range and possible combinations of pathologies involved in tinnitus, which in turn result in a great variety of symptoms demanding specifically adapted therapies.
The diagnostic approach is based on a history of the condition and an examination of the head, neck, and neurological system. Typically an audiogram is done, and occasionally medical imaging or electronystagmography. Treatable conditions may include middle ear infection, acoustic neuroma,
concussion, and otosclerosis.
Evaluation of tinnitus can include a hearing test (audiogram), measurement of acoustic parameters of the tinnitus like pitch and loudness, and psychological assessment of comorbid conditions like depression, anxiety, and stress that are associated with severity of the tinnitus.
One definition of tinnitus, as compared to normal ear noise experience, is lasting five minutes at least twice a week. However, people with tinnitus often experience the noise more frequently than this. Tinnitus can be present constantly or intermittently. Some people with constant tinnitus might not be aware of it all the time, but only for example during the night when there is less environmental noise to mask it. Chronic tinnitus can be defined as tinnitus with duration of six months or more.
Since most persons with tinnitus also have hearing loss, a pure tone hearing test resulting in an audiogram may help diagnose a cause, though some persons with tinnitus do not have hearing loss. An audiogram may also facilitate fitting of a hearing aid in those cases where hearing loss is significant. The pitch of tinnitus is often in the range of the hearing loss.
Acoustic qualification of tinnitus will include measurement of several acoustic parameters like frequency in cases of monotone tinnitus or frequency range and bandwidth in cases of narrow band noise tinnitus, loudness in dB above hearing threshold at the indicated frequency, mixing-point, and minimum masking level. In most cases, tinnitus pitch or frequency range is between 5 kHz and 10 kHz, and loudness between 5 and 15 dB above the hearing threshold.
Another relevant parameter of tinnitus is residual inhibition, the temporary suppression or disappearance of tinnitus following a period of masking. The degree of residual inhibition may indicate how effective tinnitus maskers would be as a treatment modality.
An assessment of hyperacusis, a frequent accompaniment of tinnitus, may also be made. Hyperacusis is related to negative reactions to sound and can take many forms. One associated parameter that can be measured is Loudness Discomfort Level (LDL) in dB, the subjective level of acute discomfort at specified frequencies over the frequency range of hearing. This defines a dynamic range between the hearing threshold at that frequency and the loudness discomfort level. A compressed dynamic range over a particular frequency range can be associated with hyperacusis. Normal hearing threshold is generally defined as 0–20 decibels (dB). Normal loudness discomfort levels are 85–90+ dB, with some authorities citing 100 dB. A dynamic range of 55 dB or less is indicative of hyperacusis.
The condition is often rated on a scale from "slight" to "severe" according to the effects it has, such as interference with sleep, quiet activities and normal daily activities.
Assessment of psychological processes related to tinnitus involves measurement of tinnitus severity and distress (i.e., nature and extent of tinnitus-related problems), measured subjectively by validated self-report tinnitus questionnaires. These questionnaires measure the degree of psychological distress and handicap associated with tinnitus, including effects on hearing, lifestyle, health and emotional functioning. A broader assessment of general functioning, such as levels of anxiety, depression, stress, life stressors and sleep difficulties, is also important in the assessment of tinnitus due to higher risk of negative well-being across these areas, which may be affected by or exacerbate the tinnitus symptoms for the individual. Overall, current assessment measures are aimed to identify individual levels of distress and interference, coping responses and perceptions of tinnitus to inform treatment and monitor progress. However, wide variability, inconsistencies and lack of consensus regarding assessment methodology are evidenced in the literature, limiting comparison of treatment effectiveness. Developed to guide diagnosis or classify severity, most tinnitus questionnaires have been shown to be treatment-sensitive outcome measures.
Other potential sources of the sounds normally associated with tinnitus should be ruled out. For instance, two recognized sources of high-pitched sounds might be electromagnetic fields common in modern wiring and various sound signal transmissions. A common and often misdiagnosed condition that mimics tinnitus is radio frequency (RF) hearing, in which subjects have been tested and found to hear high-pitched transmission frequencies that sound similar to tinnitus.
Safety sign from the UK Government Regulations requiring ear protection
Prolonged exposure to loud sound or noise levels can lead to tinnitus. Custom made ear plugs or other measures can help with prevention. Employers may use hearing loss prevention programs to help educate and prevent dangerous levels of exposure to noise. Government organizations set regulations to ensure employees, if following the protocol, should have minimal risk to permanent damage to their hearing.
Motorbike riders are also advised to wear ear plugs when riding to avoid the risk of tinnitus, caused by overexposure to loud noises such as wind noise.
Several medicines have ototoxic effects, and can have a cumulative effect that can increase the damage done by noise. If ototoxic medications must be administered, close attention by the physician to prescription details, such as dose and dosage interval, can reduce the damage done.
The use of sound therapy by either hearing aids or tinnitus maskers may help the brain ignore the specific tinnitus frequency. Whilst these methods are poorly supported by evidence, there are no negative effects. There are several approaches for tinnitus sound therapy. The first is sound modification to compensate for the individual's hearing loss. The second is a signal spectrum notching to eliminate energy close to the tinnitus frequency. There is some tentative evidence supporting tinnitus retraining therapy, which is aimed at reducing tinnitus-related neuronal activity. There are preliminary data on an alternative tinnitus treatment using mobile applications, including various methods: masking, sound therapy, relaxing exercises and other. These applications can work as a separate device or as a hearing aid control system.
Botulinum toxin injection has been tried with some success in some of the rare cases of objective tinnitus from a palatal tremor.
Caroverine is used in a few countries to treat tinnitus. The evidence for its usefulness is very weak.
In 2020, information about recent clinical trials has indicated that bimodal neuromodulation may be a promising treatment for reducing the symptoms of tinnitus. It is a noninvasive technique that involves applying an electrical stimulus to the tongue while also administering sounds. Equipment associated with the treatments is available through physicians. Studies with it and similar devices continue in several research centers.
Ginkgo biloba does not appear to be effective. The American Academy of Otolaryngology recommends against taking melatonin or zinc supplements to relieve symptoms of tinnitus, and reported that evidence for efficacy of many dietary supplements—lipoflavonoids, garlic, homeopathy, traditional Chinese/Korean herbal medicine, honeybee larvae, other various vitamins and minerals—did not exist. A 2016 Cochrane Review also concluded that evidence was not sufficient to support taking zinc supplements to reduce symptoms associated with tinnitus.
While there is no cure, most people with tinnitus get used to it over time; for a minority, it remains a significant problem.
Tinnitus affects 10–15% of people. About a third of North Americans over 55 experience tinnitus. Tinnitus affects one third of adults at some time in their lives, whereas ten to fifteen percent are disturbed enough to seek medical evaluation.
Tinnitus is commonly thought of as a symptom of adulthood, and is often overlooked in children. Children with hearing loss have a high incidence of tinnitus, even though they do not express the condition or its effect on their lives. Children do not generally report tinnitus spontaneously and their complaints may not be taken seriously. Among those children who do complain of tinnitus, there is an increased likelihood of associated otological or neurological pathology such as migraine, juvenile Meniere's disease or chronic suppurative otitis media. Its reported prevalence varies from 12% to 36% in children with normal hearing thresholds and up to 66% in children with a hearing loss and approximately 3–10% of children have been reported to be troubled by tinnitus.
^ abcdLevine, RA; Oron, Y (2015). "Tinnitus". The Human Auditory System – Fundamental Organization and Clinical Disorders. Handbook of Clinical Neurology. Vol. 129. pp. 409–431. doi:10.1016/B978-0-444-62630-1.00023-8. ISBN 978-0444626301. PMID25726282.
^ abcdefghijklmnopqrstuvBaguley, D; McFerran, D; Hall, D (9 November 2013). "Tinnitus" (PDF). The Lancet. 382 (9904): 1600–1607. doi:10.1016/S0140-6736(13)60142-7. PMID23827090. Archived (PDF) from the original on 11 April 2018.
^ abcHan BI, Lee HW, Kim TY, Lim JS, Shin KS (March 2009). "Tinnitus: characteristics, causes, mechanisms, and treatments". Journal of Clinical Neurology. 5 (1): 11–19. doi:10.3988/jcn.2009.5.1.11. PMC2686891. PMID19513328. About 75% of new cases are related to emotional stress as the trigger factor rather than to precipitants involving cochlear lesions.
^ abcdefghLangguth, B; Kreuzer, PM; Kleinjung, T; De Ridder, D (September 2013). "Tinnitus: causes and clinical management". The Lancet Neurology. 12 (9): 920–930. doi:10.1016/S1474-4422(13)70160-1. PMID23948178. S2CID 13402806.
^"Tinnitus – noises in the ears or head". ENT kent. Retrieved 20 January 2021.
^Esmaili, Aaron A; Renton, John (1 April 2018). "A review of tinnitus". Australian Journal of General Practice. 47 (4): 205–208. doi:10.31128/AJGP-12-17-4420. PMID29621860.
^ abcHenry, JA; Dennis, KC; Schechter, MA (October 2005). "General review of tinnitus: prevalence, mechanisms, effects, and management". Journal of Speech, Language, and Hearing Research. 48 (5): 1204–1235. doi:10.1044/1092-4388(2005/084). PMID16411806.
^Stouffer, J.L. and Tyler, R.S., 1990. Characterization of tinnitus by tinnitus patients. Journal of Speech and Hearing Disorders, 55(3), pp. 439–453. Searchfield, G.D., Kobayashi, K., Proudfoot, K., Tevoitdale, H. and Irving, S., 2015. The development and test–retest reliability of a method for matching perceived location of tinnitus. Journal of neuroscience methods, 256, pp. 1–8
^Simmons R, Dambra C, Lobarinas E, Stocking C, Salvi R (2008). "Head, Neck, and Eye Movements That Modulate Tinnitus". Seminars in Hearing. 29 (4): 361–370. doi:10.1055/s-0028-1095895. PMC2633109. PMID19183705.
^ ab"MEM, Tinnitus and Ear Drum Spasms". Tinnitus And You. 18 August 2021. Archived from the original on 20 August 2021. Retrieved 24 May 2022.
^Baguley D; Andersson g; McFerran D; McKenna L (2013). Tinnitus: A Multidisciplinary Approach (2nd ed.). Blackwell Publishing Ltd. pp. 16–17. ISBN 978-1118488706.
^Gopinath B, McMahon CM, Rochtchina E, Karpa MJ, Mitchell P (2010). "Incidence, persistence, and progression of tinnitus symptoms in older adults: the Blue Mountains Hearing Study". Ear and Hearing. 31 (3): 407–412. doi:10.1097/AUD.0b013e3181cdb2a2. PMID20124901. S2CID 23601127.
^Shargorodsky J, Curhan GC, Farwell WR (2010). "Prevalence and characteristics of tinnitus among US adults". The American Journal of Medicine. 123 (8): 711–718. doi:10.1016/j.amjmed.2010.02.015. PMID20670725.
^Andersson G (2002). "Psychological aspects of tinnitus and the application of cognitive-behavioral therapy". Clinical Psychology Review. 22 (7): 977–990. doi:10.1016/s0272-7358(01)00124-6. PMID12238249.
^Reiss M, Reiss G (1999). "Some psychological aspects of tinnitus". Perceptual and Motor Skills. 88 (3 Pt 1): 790–792. doi:10.2466/pms.1918.104.22.1680. PMID10407886. S2CID 41610361.
^Baguley DM (2002). "Mechanisms of tinnitus". British Medical Bulletin. 63: 195–212. doi:10.1093/bmb/63.1.195. PMID12324394.
^Henry JA, Meikele MB (1999). "Pulsed versus continuous tones for evaluating the loudness of tinnitus". Journal of the American Academy of Audiology. 10 (5): 261–272. PMID10331618.
^ abcHenry JA, Dennis KC, Schechter MA (2005). "General review of tinnitus: Prevalence, mechanisms, effects, and management". Journal of Speech, Language, and Hearing Research. 48 (5): 1204–1235. doi:10.1044/1092-4388(2005/084). PMID16411806.
^Davies A, Rafie EA (2000). "Epidemiology of Tinnitus". In Tyler, RS (ed.). Tinnitus Handbook. San Diego: Singular. pp. 1–23. OCLC 42771695.
^Pattyn T, Van Den Eede F, Vanneste S, Cassiers L, Veltman DJ, Van De Heyning P, Sabbe BC (2015). "Tinnitus and anxiety disorders: A review". Hearing Research. 333: 255–265. doi:10.1016/j.heares.2015.08.014. hdl:10067/1273140151162165141. PMID26342399. S2CID 205103174.
^Henry JA, Wilson P (2000). "Psychological management of tinnitus". In R.S. Tyler (ed.). Tinnitus Handbook. San Diego: Singular. pp. 263–279. OCLC 42771695.
^Andersson G, Westin V (2008). "Understanding tinnitus distress: Introducing the concepts of moderators and mediators". International Journal of Audiology. 47 (Suppl. 2): S106–111. doi:10.1080/14992020802301670. PMID19012118. S2CID 19389202.
^Weise C, Hesser H, Andersson G, Nyenhuis N, Zastrutzki S, Kröner-Herwig B, Jäger B (2013). "The role of catastrophizing in recent onset tinnitus: its nature and association with tinnitus distress and medical utilization". International Journal of Audiology. 52 (3): 177–188. doi:10.3109/14992027.2012.752111. PMID23301660. S2CID 24297897.
^Jastreboff, PJ; Hazell, JWP (2004). Tinnitus Retraining Therapy: Implementing the neurophysiological model. Cambridge: Cambridge University Press. OCLC 237191959.
^ abRobert Aaron Levine (1999). "Somatic (craniocervical) tinnitus and the dorsal cochlear nucleus hypothesis". American Journal of Otolaryngology. 20 (6): 351–362. CiteSeerX10.1.1.22.2488. doi:10.1016/S0196-0709(99)90074-1. PMID10609479.
^Chan Y (2009). "Tinnitus: etiology, classification, characteristics, and treatment". Discovery Medicine. 8 (42): 133–136. PMID19833060.
^Barbara Rubinstein; et al. (1990). "Prevalence of Signs and Symptoms of Craniomandibular Disorders in Tinnitus Patients". Journal of Craniomandibular Disorders. 4 (3): 186–192. PMID2098394.
^ abSchecklmann, Martin; Vielsmeier, Veronika; Steffens, Thomas; Landgrebe, Michael; Langguth, Berthold; Kleinjung, Tobias; Andersson, Gerhard (18 April 2012). "Relationship between Audiometric Slope and Tinnitus Pitch in Tinnitus Patients: Insights into the Mechanisms of Tinnitus Generation". PLOS ONE. 7 (4): e34878. Bibcode:2012PLoSO...734878S. doi:10.1371/journal.pone.0034878. PMC3329543. PMID22529949.
^Schaette, R; McAlpine, D (21 September 2011). "Tinnitus with a Normal Audiogram: Physiological Evidence for Hidden Hearing Loss and Computational Model". The Journal of Neuroscience. 31 (38): 13452–13457. doi:10.1523/JNEUROSCI.2156-11.2011. PMC6623281. PMID21940438.
^Brown RD, Penny JE, Henley CM, et al. (1981). "Ototoxic drugs and noise". Ciba Foundation Symposium. Novartis Foundation Symposia. 85: 151–171. doi:10.1002/9780470720677.ch9. ISBN 978-0470720677. PMID7035098.
^Stas Bekman: stas (at) stason.org. "6) What are some ototoxic drugs?". Stason.org. Archived from the original on 19 October 2012. Retrieved 26 October 2012.
^ abRiba, Michelle B; Ravindranath, Divy (2010). Clinical manual of emergency psychiatry. Washington, DC: American Psychiatric Publishing Inc. p. 197. ISBN 978-1585622955.
^ abDelanty, Norman (2001). Seizures: medical causes and management. Totowa, NJ: Humana Press. p. 187. ISBN 978-0896038271.
^Fornaro M, Martino M (2010). "Tinnitus psychopharmacology: A comprehensive review of its pathomechanisms and management". Neuropsychiatric Disease and Treatment. 6: 209–218. doi:10.2147/ndt.s10361. PMC2898164. PMID20628627.
^ abcYew, KS (15 January 2014). "Diagnostic approach to patients with tinnitus". American Family Physician. 89 (2): 106–113. PMID24444578.
^Crummer RW, Hassan GA (2004). "Diagnostic approach to tinnitus". American Family Physician. 69 (1): 120–106. PMID14727828.
^Passchier-Vermeer W, Passchier WF (2000). "Noise exposure and public health". Environmental Health Perspectives. 108 Suppl 1 (Suppl 1): 123–131. doi:10.1289/ehp.00108s1123. JSTOR 3454637. PMC1637786. PMID10698728.
^Zempleni, Janos; Suttie, John W; Gregory, III, Jesse F; Stover, Patrick J, eds. (2014). Handbook of vitamins (Fifth ed.). Hoboken: CRC Press. p. 477. ISBN 978-1466515574. Archived from the original on 17 August 2016.
^Shulgin, Alexander; Shulgin, Ann (1997). "#36. 5-MEO-DET". TiHKAL: the continuation. Berkeley, CA: Transform Press. ISBN 978-0963009692. OCLC 38503252. Archived from the original on 31 October 2012. Retrieved 27 October 2012.
^"Erowid Experience Vaults: DiPT – More Tripping & Revelations – 26540". Archived from the original on 2 November 2014.
^ abMcFerran, Don; Magdalena, Sereda. "Pulsatile tinnitus" (PDF). Action on Hearing Loss. Royal National Institute for Deaf People (RNID). Retrieved 22 July 2018.
^Chandler JR (1983). "Diagnosis and cure of venous hum tinnitus". The Laryngoscope. 93 (7): 892–895. doi:10.1288/00005537-198307000-00009. PMID6865626. S2CID 33725476.
^Moonis G, Hwang CJ, Ahmed T, Weigele JB, Hurst RW (2005). "Otologic manifestations of petrous carotid aneurysms". American Journal of Neuroradiology. 26 (6): 1324–1327. PMC8149044. PMID15956490.
^ Selim, Magdy; Caplan, Louis R (2004). "Carotid Artery Dissection". Current Treatment Options in Cardiovascular Medicine. 6 (3): 249–253. doi:10.1007/s11936-996-0020-z. ISSN 1092-8464. PMID15096317. S2CID 7503852. (subscription required)
^Sismanis A, Butts FM, Hughes GB (4 January 2009). "Objective tinnitus in benign intracranial hypertension: An update". The Laryngoscope. 100 (1): 33–36. doi:10.1288/00005537-199001000-00008. PMID2293699. S2CID 20886638.
^Diamond BJ, Mosley JE (2011). "Arteriovenous Malformation (AVM)". In Kreutzer JS, DeLuca J, Caplan B (eds.). Encyclopedia of Clinical Neuropsychology. Springer. pp. 249–252. doi:10.1007/978-0-387-79948-3. ISBN 978-0387799476.
^Nicolas-Puel C, Faulconbridge RL, Guitton M, Puel JL, Mondain M, Uziel A (2002). "Characteristics of tinnitus and etiology of associated hearing loss: a study of 123 patients". The International Tinnitus Journal. 8 (1): 37–44. PMID14763234.
^Møller AR (2016). "Sensorineural Tinnitus: Its Pathology and Probable Therapies". International Journal of Otolaryngology. 2016: 1–13. doi:10.1155/2016/2830157. PMC4761664. PMID26977153.
^Sedley W, Friston KJ, Gander PE, Kumar S, Griffiths TD (2016). "An Integrative Tinnitus Model Based on Sensory Precision". Trends in Neurosciences. 39 (12): 799–812. doi:10.1016/j.tins.2016.10.004. PMC5152595. PMID27871729.
^Shore SE, Roberts LE, Langguth B (2016). "Maladaptive plasticity in tinnitus – triggers, mechanisms and treatment". Nature Reviews Neurology. 12 (3): 150–160. doi:10.1038/nrneurol.2016.12. PMC4895692. PMID26868680.
^Park, Jung Mee; Kim, Woo Jin; Han, Jae Sang; Park, So Young; Park, Shi Nae (14 May 2020). "Management of palatal myoclonic tinnitus based on clinical characteristics: a large case series study". Acta Oto-Laryngologica. 140 (7): 553–557. doi:10.1080/00016489.2020.1749724. ISSN 1651-2251. PMID32406274. S2CID 218635840.
^Crummer, RW; et al. (2004). "Diagnostic Approach to Tinnitus". American Family Physician. 69 (1): 120–126. PMID14727828.
^Davis, A (1989). "The prevalence of hearing impairment and reported hearing disability among adults in Great Britain". International Journal of Epidemiology. 18 (4): 911–917. doi:10.1093/ije/18.4.911. PMID2621028.
^Henry, J.A., 2016. "Measurement" of tinnitus. Otology & Neurotology, 37(8), pp. e276–e285.
^Henry, JA (2000). "Psychoacoustic Measures of Tinnitus" (PDF). Journal of the American Academy of Audiology. 11 (3): 138–155. PMID10755810. Archived (PDF) from the original on 8 August 2017. Retrieved 22 September 2017.
^Vielsmeier V, Lehner A, Strutz J, Steffens T, Kreuzer PM, Schecklmann M, Landgrebe M, Langguth B, Kleinjung T (2015). "The Relevance of the High Frequency Audiometry in Tinnitus Patients with Normal Hearing in Conventional Pure-Tone Audiometry". BioMed Research International. 2015: 1–5. doi:10.1155/2015/302515. PMC4637018. PMID26583098.
^Roberts LE (2007). "Residual inhibition". Tinnitus: Pathophysiology and Treatment. Progress in Brain Research. Vol. 166. pp. 487–945. doi:10.1016/S0079-6123(07)66047-6. ISBN 978-0444531674. PMID17956813.
^Roberts LE, Moffat G, Baumann M, Ward LM, Bosnyak DJ (2008). "Residual inhibition functions overlap tinnitus spectra and the region of auditory threshold shift". Journal of the Association for Research in Otolaryngology. 9 (4): 417–435. doi:10.1007/s10162-008-0136-9. PMC2580805. PMID18712566.
^Knipper M, Van Dijk P, Nunes I, Rüttiger L, Zimmermann U (2013). "Advances in the neurobiology of hearing disorders: recent developments regarding the basis of tinnitus and hyperacusis". Progress in Neurobiology. 111: 17–33. doi:10.1016/j.pneurobio.2013.08.002. PMID24012803.
^Tyler RS, Pienkowski M, Roncancio ER, Jun HJ, Brozoski T, Dauman N, Dauman N, Andersson G, Keiner AJ, Cacace AT, Martin N, Moore BC (2014). "A review of hyperacusis and future directions: part I. Definitions and manifestations" (PDF). American Journal of Audiology. 23 (4): 402–419. doi:10.1044/2014_AJA-14-0010. PMID25104073. Archived (PDF) from the original on 9 May 2018. Retrieved 23 September 2017.
^Sherlock LP, Formby C (2005). "Estimates of loudness, loudness discomfort, and the auditory dynamic range: normative estimates, comparison of procedures, and test-retest reliability" (PDF). Journal of the American Academy of Audiology. 16 (2): 85–100. doi:10.3766/jaaa.16.2.4. PMID15807048. S2CID 14910239. Archived from the original (PDF) on 9 August 2020.
^Pienkowski M, Tyler RS, Roncancio ER, Jun HJ, Brozoski T, Dauman N, Coelho CB, Andersson G, Keiner AJ, Cacace AT, Martin N, Moore BC (2014). "A review of hyperacusis and future directions: part II. Measurement, mechanisms, and treatment". American Journal of Audiology. 23 (4): 420–436. doi:10.1044/2014_AJA-13-0037. PMID25478787. S2CID 449625.
^McCombe A, Baguley D, Coles R, McKenna L, McKinney C, Windle-Taylor P (2001). "Guidelines for the grading of tinnitus severity: the results of a working group commissioned by the British Association of Otolaryngologists, Head and Neck Surgeons, 1999". Clinical Otolaryngology and Allied Sciences. 26 (5): 388–393. doi:10.1046/j.1365-2273.2001.00490.x. PMID11678946. Archived (PDF) from the original on 24 September 2017.
^Langguth B, Goodey R, Azevedo A, et al. (2007). "Consensus for tinnitus patient assessment and treatment outcome measurement: Tinnitus Research Initiative meeting, Regensburg, July 2006". Tinnitus: Pathophysiology and Treatment. Progress in Brain Research. Vol. 166. pp. 525–536. doi:10.1016/S0079-6123(07)66050-6. ISBN 978-0444531674. PMC4283806. PMID17956816.
^Meikle MB, Stewart BJ, Griest SE, et al. (2007). "Assessment of tinnitus: Measurement of treatment outcomes" (PDF). Tinnitus: Pathophysiology and Treatment. Progress in Brain Research. Vol. 166. pp. 511–521. doi:10.1016/S0079-6123(07)66049-X. ISBN 978-0444531674. PMID17956815. Archived (PDF) from the original on 25 September 2017.
^Meikle MB, Henry JA, Griest SE, et al. (2012). "The tinnitus functional index: development of a new clinical measure for chronic, intrusive tinnitus" (PDF). Ear and Hearing. 33 (2): 153–176. doi:10.1097/AUD.0b013e31822f67c0. PMID22156949. S2CID 587811. Archived (PDF) from the original on 25 January 2017.
^Henry, J. L.; Wilson, PH (2000). The Psychological Management of Chronic Tinnitus: A Cognitive Behavioural Approach. Allyn and Bacon.
^Landgrebe M, Azevedo A, Baguley D, Bauer C, Cacace A, Coelho C, et al. (2012). "Methodological aspects of clinical trials in tinnitus: A proposal for international standard". Journal of Psychosomatic Research. 73 (2): 112–121. doi:10.1016/j.jpsychores.2012.05.002. PMC3897200. PMID22789414.
^ abMartinez-Devesa, P; Perera, R; Theodoulou, M; Waddell, A (8 September 2010). "Cognitive behavioural therapy for tinnitus". The Cochrane Database of Systematic Reviews (9): CD005233. doi:10.1002/14651858.CD005233.pub3. PMID20824844.
^Pegge S, Steens S, Kunst H, Meijer F (2017). "Pulsatile Tinnitus: Differential Diagnosis and Radiological Work-Up". Current Radiology Reports. 5 (1): 5. doi:10.1007/s40134-017-0199-7. PMC5263210. PMID28203490.
^Hofmann E, Behr R, Neumann-Haefelin T, Schwager K (2013). "Pulsatile tinnitus: imaging and differential diagnosis". Deutsches Ärzteblatt International. 110 (26): 451–458. doi:10.3238/arztebl.2013.0451. PMC3719451. PMID23885280.
^Sismanis A (2011). "Pulsatile tinnitus: contemporary assessment and management". Current Opinion in Otolaryngology & Head and Neck Surgery. 19 (5): 348–357. doi:10.1097/MOO.0b013e3283493fd8. PMID22552697. S2CID 22964919. Archived (PDF) from the original on 25 September 2017.
^Elder, JA; Chou, CK (2003). "Auditory response to pulsed radiofrequency energy". Bioelectromagnetics. Suppl 6: S162–173. doi:10.1002/bem.10163. PMID14628312.
^Lin JC, Wang Z (2007). "Hearing of microwave pulses by humans and animals: effects, mechanism, and thresholds". Health Physics. 92 (6): 621–628. doi:10.1097/01.HP.0000250644.84530.e2. PMID17495664. S2CID 37236570.
^ abcTunkel DE, Bauer CA, Sun GH, et al. (2014). "Clinical practice guideline: tinnitus". Otolaryngology–Head and Neck Surgery. 151 (2 Suppl): S1–40. doi:10.1177/0194599814545325. PMID25273878. S2CID 206468767.
^"NIOSH Program Portfolio : Hearing Loss Prevention : Program Description". www.cdc.gov – CDC. 5 February 2019. Retrieved 26 March 2019.
^"Bike news". www.carolenash.com. Retrieved 28 June 2021.
^Cianfrone G, Pentangelo D, Cianfrone F, Mazzei F, Turchetta R, Orlando MP, Altissimi G (2011). "Pharmacological drugs inducing ototoxicity, vestibular symptoms and tinnitus: a reasoned and updated guide" (PDF). European Review for Medical and Pharmacological Sciences. 15 (6): 601–36. PMID21796866. Archived (PDF) from the original on 8 August 2017.
^Seligmann H, Podoshin L, Ben-David J, Fradis M, Goldsher M (1996). "Drug-induced tinnitus and other hearing disorders". Drug Safety. 14 (3): 198–212. doi:10.2165/00002018-199614030-00006. PMID8934581. S2CID 23522352.
^"Drug Therapies". American Tinnitus Association. 20 March 2015. Retrieved 3 March 2022. There are presently no FDA-approved drugs specifically for tinnitus, and no medications that have been shown to reverse the neural hyperactivity at the root of tinnitus. Drugs cannot cure tinnitus, but they may provide relief from some severe tinnitus symptoms.
^Kleinjung, Tobias; Langguth, Berthold (4 May 2020). "Avenue for Future Tinnitus Treatments". Otolaryngologic Clinics of North America. 53 (4): 667–683. doi:10.1016/j.otc.2020.03.013. ISSN 1557-8259. PMID32381341.
^ abHoare D, Kowalkowski V, Knag S, Hall D (2011). "Systematic review and meta-analyses of randomized controlled trials examining tinnitus management". The Laryngoscope. 121 (7): 1555–1564. doi:10.1002/lary.21825. PMC3477633. PMID21671234.
^Hesser H, Weise C, Zetterquist Westin V, Andersson G (2011). "A systematic review and meta-analysis of randomized controlled trials of cognitive–behavioral therapy for tinnitus distress". Clinical Psychology Review. 31 (4): 545–553. doi:10.1016/j.cpr.2010.12.006. PMID21237544.
^Ost, LG (October 2014). "The efficacy of Acceptance and Commitment Therapy: an updated systematic review and meta-analysis". Behaviour Research and Therapy. 61: 105–121. doi:10.1016/j.brat.2014.07.018. PMID25193001.
^Henry J, Zaugg T, Myers P, Kendall C (2012). "Chapter 9 – Level 5 Individualized Support". Progressive Tinnitus Management: Clinical Handbook for Audiologists. US Department of Veterans Affairs, National Center for Rehabilitative Auditory Research. Archived from the original on 20 December 2013. Retrieved 20 December 2013.
^Hoare DJ, Searchfield GD, El Refaie A, Henry JA (2014). "Sound therapy for tinnitus management: practicable options". Journal of the American Academy of Audiology. 25 (1): 62–75. doi:10.3766/jaaa.25.1.5. PMID24622861.
^Sereda, Magdalena; Xia, Jun; El Refaie, Amr; Hall, Deborah A.; Hoare, Derek J. (2018). "Sound therapy (using amplification devices and/or sound generators) for tinnitus". The Cochrane Database of Systematic Reviews. 2018 (12): CD013094. doi:10.1002/14651858.CD013094.pub2. ISSN 1469-493X. PMC6517157. PMID30589445.
^Shore, Susan E; Roberts, Larry E.; Langguth, Berthold (2016). "Maladaptive plasticity in tinnitus-triggers, mechanisms and treatment". Nature Reviews. Neurology. 12 (3): 150–160. doi:10.1038/nrneurol.2016.12. ISSN 1759-4758. PMC4895692. PMID26868680.
^ abHesse, Gerhard (15 December 2016). "Evidence and evidence gaps in tinnitus therapy". GMS Current Topics in Otorhinolaryngology, Head and Neck Surgery. 15: Doc04. doi:10.3205/cto000131. ISSN 1865-1011. PMC5169077. PMID28025604.
^Phillips JS, McFerran D (2010). "Tinnitus Retraining Therapy (TRT) for tinnitus". Cochrane Database of Systematic Reviews (3): CD007330. doi:10.1002/14651858.CD007330.pub2. PMC7209976. PMID20238353.
^Casale, Manuele; Costantino, Andrea; Rinaldi, Vittorio; Forte, Antonio; Grimaldi, Marta; Sabatino, Lorenzo; Oliveto, Giuseppe; Aloise, Fabio; Pontari, Domenico (11 November 2018). "Mobile applications in otolaryngology for patients: An update". Laryngoscope Investigative Otolaryngology. 3 (6): 434–438. doi:10.1002/lio2.201. ISSN 2378-8038. PMC6302723. PMID30599026.
^Mosa, Abu Saleh Mohammad; Yoo, Illhoi; Sheets, Lincoln (10 July 2012). "A Systematic Review of Healthcare Applications for Smartphones". BMC Medical Informatics and Decision Making. 12: 67. doi:10.1186/1472-6947-12-67. ISSN 1472-6947. PMC3534499. PMID22781312.
^Kalle, Sven; Schlee, Winfried; Pryss, Rüdiger C.; Probst, Thomas; Reichert, Manfred; Langguth, Berthold; Spiliopoulou, Myra (20 August 2018). "Review of Smart Services for Tinnitus Self-Help, Diagnostics and Treatments". Frontiers in Neuroscience. 12: 541. doi:10.3389/fnins.2018.00541. ISSN 1662-4548. PMC6109754. PMID30177869.
^ abcBauer, CA (March 2018). "Tinnitus". New England Journal of Medicine. 378 (13): 1224–1231. doi:10.1056/NEJMcp1506631. PMID29601255.
^Baldo, P; Doree, C; Molin, P; McFerran, D; Cecco, S (12 September 2012). "Antidepressants for patients with tinnitus". Cochrane Database of Systematic Reviews. 9 (9): CD003853. doi:10.1002/14651858.CD003853.pub3. PMC7156891. PMID22972065.
^Savage, J; Cook, S; Waddell, A (12 November 2009). "Tinnitus". BMJ Clinical Evidence. 2009. PMC2907768. PMID21726476.
^Miroddi, M; Bruno, R; Galletti, F; Calapai, F; Navarra, M; Gangemi, S; Calapai, G (March 2015). "Clinical pharmacology of melatonin in the treatment of tinnitus: a review". European Journal of Clinical Pharmacology. 71 (3): 263–270. doi:10.1007/s00228-015-1805-3. PMID25597877. S2CID 16466238.
^Hoekstra, Carlijn El; Rynja, Sybren P.; van Zanten, Gijsbert A.; Rovers, Maroeska M. (6 July 2011). "Anticonvulsants for tinnitus". The Cochrane Database of Systematic Reviews (7): CD007960. doi:10.1002/14651858.CD007960.pub2. ISSN 1469-493X. PMC6599822. PMID21735419.
^Pichora-Fuller, MK; Santaguida, P; Hammill, A; Oremus, M; Westerberg, B; Ali, U; Patterson, C; Raina, P (August 2013). "Evaluation and Treatment of Tinnitus: Comparative Effectiveness [Internet]". PMID24049842.
^Lavigne, P; Lavigne, F; Saliba, I (23 June 2015). "Intratympanic corticosteroids injections: a systematic review of literature". European Archives of Oto-Rhino-Laryngology. 273 (9): 2271–2278. doi:10.1007/s00405-015-3689-3. PMID26100030. S2CID 36037973.
^Hall, Deborah A; Wegner, Inge; Smit, Adriana Leni; McFerran, Don; Stegeman, Inge (2018). Cochrane ENT Group (ed.). "Betahistine for tinnitus". Cochrane Database of Systematic Reviews. 12 (8): CD013093. doi:10.1002/14651858.CD013093. PMC6513648. PMID30908589.
^Slengerik-Hansen J, Ovesen T (2016). "Botulinum Toxin Treatment of Objective Tinnitus Because of Essential Palatal Tremor: A Systematic Review". Otology & Neurotology. 37 (7): 820–828. doi:10.1097/MAO.0000000000001090. PMID27273401. S2CID 23675169.
^Sweetman, Sean C., ed. (2009). Martindale (36th ed.). Pharmaceutical Press. p. 2277. ISBN 978-0853698401.
^Langguth, B; Salvi, R; Elgoyhen, AB (December 2009). "Emerging pharmacotherapy of tinnitus". Expert Opinion on Emerging Drugs. 14 (4): 687–702. doi:10.1517/14728210903206975. PMC2832848. PMID19712015.
^Kwon, Diana (7 October 2020). "New Tinnitus Treatment Alleviated Annoying Ringing in the Ears". Scientific American. Springer Nature America, Inc.
^Meng, Z; Liu, S; Zheng, Y; Phillips, JS (5 October 2011). "Repetitive transcranial magnetic stimulation for tinnitus". Cochrane Database of Systematic Reviews (10): CD007946. doi:10.1002/14651858.CD007946.pub2. PMID21975776.
^Hilton, MP; Zimmermann, EF; Hunt, WT (28 March 2013). "Ginkgo biloba for tinnitus". Cochrane Database of Systematic Reviews. 3 (3): CD003852. doi:10.1002/14651858.CD003852.pub3. PMID23543524.
^Person, Osmar C; Puga, Maria ES; da Silva, Edina MK; Torloni, Maria R (23 November 2016). "Zinc supplements for tinnitus". Cochrane Database of Systematic Reviews. 11: CD009832. doi:10.1002/14651858.cd009832.pub2. PMC6464312. PMID27879981.
^Sanchez TG, Rocha CB (2011). "Diagnosis and management of somatosensory tinnitus: review article". Clinics. 66 (6): 1089–1094. doi:10.1590/S1807-59322011000600028. PMC3129953. PMID21808880.
^Heller AJ (2003). "Classification and epidemiology of tinnitus". Otolaryngologic Clinics of North America. 36 (2): 239–248. doi:10.1016/S0030-6665(02)00160-3. PMID12856294.
^Celik, N; Bajin, MD; Aksoy, S (2009). "Tinnitus incidence and characteristics in children with hearing loss" (PDF). Journal of International Advanced Otology. 5 (3): 363–369. ISSN 1308-7649. OCLC 695291085. Archived from the original (PDF) on 21 December 2013. Retrieved 2 February 2013.
^Lee, Doh Young; Kim, Young Ho (2018). "Risk factors of pediatric tinnitus: Systematic review and meta-analysis". The Laryngoscope. 128 (6): 1462–1468. doi:10.1002/lary.26924. ISSN 1531-4995. PMID29094364. S2CID 24633085.
^Mills, RP; Albert, D; Brain, C (1986). "Tinnitus in childhood". Clinical Otolaryngology and Allied Sciences. 11 (6): 431–434. doi:10.1111/j.1365-2273.1986.tb00147.x. PMID3815868.
^Ballantyne JC (2009). Graham JM; Baguley D (eds.). Ballantyne's Deafness (Seventh ed.). Chichester: Wiley-Blackwell. OCLC 275152841.
^Shetye A, Kennedy V (2010). "Tinnitus in children: an uncommon symptom?". Archives of Disease in Childhood. 95 (8): 645–648. doi:10.1136/adc.2009.168252. PMID20371585. S2CID 34443303. Archived (PDF) from the original on 29 September 2017.