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, Ménière'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 1â 2% of people.[5] The word tinnitus is from the Latin tinnÄ«re 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 personâ 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 49â 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

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

It can sometimes be a protracted symptom of benzodiazepine withdrawa l and may persist for many months . no underlying cause can be identified. however.[2] Tinnitus can also occur due to the discontinuation of therapeutic doses of benzo diazepines.ny cases.