Definition

Tinnitus is noise in the ear or head in the absence of a sound stimulus.

Incidence

Almost everybody experiences tinnitus or noises in the ear at some time or another. It is usually short-lived and may follow exposure to loud noise. It is most noticeable in quiet surroundings and only becomes problematic when it is prolonged and persistent.

Most tinnitus is subjective (heard only by the patient); however, it can be objective (can be heard by an observer). It is usually bilateral and sometimes pulsatile – in time with the heartbeat – in which case it is often caused by rapid blood flow through the vessels of the head and neck. Figure 11.1 demonstrates some of the causes of tinnitus.

Aetiology

In the vast majority of cases the cause of tinnitus is unknown. It is thought to arise because of electrical impulses occurring in the hair cells of the cochlea or inner ear in the absence of an appropriate sound stimulus. This sometimes comes about at an early stage in the development of degenerative disease of the cochlea.

In patients with presbycusis (age-related hearing loss) the deafness may sometimes be preceded by tinnitus. Patients with prolonged exposure to industrial noise will also often complain of tinnitus.

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