Tinnitus is the hearing of sound when no external sound is present.

[1] While oft

en described as a ringing, it may also sound like a clicking, hiss or roaring.[2
] Rarely, unclear voices or music are heard.[3] The sound may be soft or loud, l
ow pitched or high pitched and appear to be coming from one ear or both.[2] Most
of the time, it comes on gradually.[3] In some people, the sound causes depress
ion, anxiety or interferes with concentration.[2]
Tinnitus is not a disease but a symptom that can result from a number of underly
ing causes. One of the most common causes is noise-induced hearing loss. Other c
auses include:ear infections, disease of the heart or blood vessels, Mnire's disease
, brain tumors, emotional stress, exposure to certain medications, a previous he
ad injury, and earwax.[2][4] It is more common in those with depression.[3]
The diagnosis of tinnitus is usually based on the person's description. A number
of questionnaires exist that assess how much tinnitus is interfering with a per
son's life.[3] The diagnosis is commonly assisted with an audiogram and neurolog
ical exam.[1][3] If certain problems are found, medical imaging, such as with MR
I, may be performed. Other tests are suitable when tinnitus occurs with the same
rhythm as the heartbeat. Occasionally, the sound may be heard by someone else u
sing a stethoscope, in which case it is known as objective tinnitus.[3]
Prevention involves avoiding loud noise.[2] If there is an underlying cause, tre
ating it may lead to improvements.[3] Otherwise, typically, management involves
talk therapy.[5] Sound generators or hearing aids may help some.[2] As of 2013,
there are no effective medications.[3] It is common, affecting about 10-15% of p
eople. Most, however, tolerate it well with its being a significant problem in o
nly 1 2% of people.[5] The word tinnitus is from the Latin tinnre which means "to ring
".[3]
Signs and symptoms
Tinnitus can be perceived in one or both ears or in the head. Tinnitus is the de
scription of a noise inside a person s head in the absence of auditory stimulation.
The noise can be described in many different ways but the most common descriptio
n of the tinnitus is a pure tone sound. It is usually described as a ringing noi
se but, in some patients, it takes the form of a high-pitched whining, electric
buzzing, hissing, humming, tinging or whistling sound or as ticking, clicking, r
oaring, "crickets" or "tree frogs" or "locusts (cicadas)", tunes, songs, beeping
, sizzling, sounds that slightly resemble human voices or even a pure steady ton
e like that heard during a hearing test and, in some cases, pressure changes fro
m the interior ear.[6] It has also been described as a "whooshing" sound because
of acute muscle spasms, as of wind or waves.[7] Tinnitus can be intermittent or
it can be continuous: in the latter case, it can be the cause of great distress
. In some individuals, the intensity can be changed by shoulder, head, tongue, j
aw or eye movements.[8]
Most people with tinnitus have some degree of hearing loss:[9] they are often un
able to clearly hear external sounds that occur within the same range of frequen
cies as their "phantom sounds".[10] This has led to the suggestion that one caus
e of tinnitus might be a homeostatic response of central dorsal cochlear nucleus
auditory neurons that makes them hyperactive in compensation to auditory input
loss.[11]
The sound perceived may range from a quiet background noise to one that can be h
eard even over loud external sounds. The specific type of tinnitus called pulsat
ile tinnitus is characterized by hearing the sounds of one's own pulse or muscle
contractions, which is typically a result of sounds that have been created from
the movement of muscles near to one's ear, changes within the canal of one's ea
r or issues related to blood flow of the neck or face.[12]
Course
There has been little research on the course of tinnitus and most research has b
een retrospective. An Australian study of participants aged 49 97 years found that 3
5% of participants reported that their tinnitus was present all the time and 4%
rated their tinnitus as annoying. Findings from a retrospective National Study o
f Hearing found that, for 25% of people surveyed, the perceived volume of their
tinnitus increased over time while, for 75%, it did not. The rate of annoyance d
ecreased for 31% of people from onset of tinnitus to the middle time. A study of

the natural history of tinnitus in older adults found that, for women, tinnitus
increased for 25%, decreased in 58%, leaving 17% unchanged. The study found tha
t, for men, tinnitus increased in 8%, decreased in 39%, leaving 53% unchanged. I
nformation about the course of tinnitus would benefit from prospective studies i
nvestigating change over time as these studies may potentially be more accurate.
[13]
Psychological
Persistent tinnitus may cause irritability, fatigue and, on occasions, clinical
depression[14][15] and musical hallucinations.[16]
Tinnitus annoyance is more strongly associated with psychological condition than
loudness or frequency range.[17][18][19] Other psychological problems such as d
epression, anxiety, sleep disturbances and concentration difficulties are common
in those with worse tinnitus.[20][21][22] 45% of people with tinnitus have an a
nxiety disorder at some time in their life.[23]
As part of the idea that the central-auditory-system may be implicated into the
tinnitus development, serotonin has also been implicated. Indeed, serotonin has
been postulated to be involved in plastic changes in the brain. Serotonin re-upt
ake inhibitors (such as some anti-depressant drugs) have often been used for thi
s reason.[24] However those medications do not benefit in a consistent fashion o
n non-depressant people.[25]
Psychological research has looked at the tinnitus distress reaction (TDR) to acc
ount for differences in tinnitus severity.[20] Research has stigmatized people w
ith severe tinnitus by implying they have personality disorders, such as neuroti
cism, anxiety sensitivity, and catastrophic thinking, which all predispose incre
ased TDR.[26][27][28] These findings suggest that at the initial perception of t
innitus, conditioning links tinnitus with negative emotions, such as fear and an
xiety from unpleasant stimuli at the time. This enhances activity in the limbic
system and autonomic nervous system, thus increasing tinnitus awareness and anno
yance.[29]
Causes
There are two types of tinnitus: subjective tinnitus and objective tinnitus.[3]
Tinnitus is usually subjective, meaning that others cannot hear it.[3] Subjectiv
e tinnitus has been also called "tinnitus aurium" "nonauditory" and "nonvibrator
y" tinnitus. Occasionally, tinnitus may be heard by someone else using a stethos
cope: in which case, it is objective tinnitus.[3] Objective tinnitus has been ca
lled "pseudo-tinnitus" or "vibratory" tinnitus.
Subjective tinnitus
Subjective tinnitus is the most frequent type of tinnitus. It can have many poss
ible causes but, most commonly, results from hearing loss. A frequent cause of s
ubjective tinnitus is noise exposure which damages hair cells in the inner ear c
ausing tinnitus. Subjective tinnitus can only be heard by the affected person an
d is caused by otology, neurology, infection or drugs.[30]
There is a growing body of evidence suggesting that 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.[31] H
earing loss could indeed cause a homeostatic response of neurons in the central
auditory system, and therefore cause tinnitus.[32]
Despite the opinion amongst researchers that tinnitus is primarily a central ner
vous system pathology, there certainly exists a class of people whose tinnitus i
s peripherally based.[33]
Hearing loss
The most common cause of tinnitus is noise-induced hearing loss. Hearing loss ma
y be implicated even for people with normal audiograms.[32]
Hearing loss may have many different causes; but among tinnitus subjects, the ma
jor cause is cochlear damage.[31]
Ototoxic drugs (such as aspirin) can also cause subjective tinnitus, as they may
cause hearing loss, or increase the damage done by exposure to loud noise. Thos
e damages can occur even at doses that are not considered ototoxic.[34] Tinnitus
is also a classical side effect of quinidine, a Class IA anti-arrhythmic. Over
260 medications have been reported to cause tinnitus as a side effect.[35] In ma

ny cases, however, no underlying cause can be identified.[2]

Tinnitus can also occur due to the discontinuation of therapeutic doses of benzo
diazepines. It can sometimes be a protracted symptom of benzodiazepine withdrawa
l and may persist for many months