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Chapters

0:00 Introduction
0:16 What is Tinnitus
0:48 What are the causes of Tinnitus
2:17 Is Tinnitus associated with hearing loss?
2:34 What are the symptoms of Tinnitus
3:09 How is Tinnitus diagnosed?
3:52 How is Tinnitus treated?




Tinnitus is the perception of sound when no corresponding external sound is present.[1] Nearly everyone experiences a faint "normal tinnitus" in a completely quiet room; but it is of concern only if it is bothersome, interferes with normal hearing, or is associated with other problems.[6] While often described as a ringing, it may also sound like a clicking, buzzing, hissing or roaring. It may be soft or loud, low- or high-pitched, and may seem to come from one or both ears or from the head itself. In some people, it may interfere with concentration, and in some cases is associated with anxiety and depression.[7][8]

Tinnitus is usually associated with a degree of hearing loss and decreased comprehension of speech in noisy environments.[2] 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.[5] It can trigger a fight-or-flight response, as the brain may perceive it as dangerous and important.[9][10][11] The word tinnitus comes from the Latin tinnire, "to ring".[3]

Rather than a disease, tinnitus is a symptom that may result from various underlying causes and may be generated at any level of the auditory system and structures beyond that system. The most common causes are hearing damage, noise-induced hearing loss or age-related hearing loss, known as presbycusis.[2] Other causes include ear infections, disease of the heart or blood vessels, Ménière's disease, brain tumors, acoustic neuromas (tumors on the auditory nerves of the ear), migraines, temporomandibular joint disorders, exposure to certain medications, a previous head injury, and earwax. It can suddenly emerge during a period of emotional stress.[4][3][2][12][13] It is more common in those with depression.[3]

The diagnosis of tinnitus is usually based on the person's description.[3] It is commonly supported by an audiogram, an otolaryngological and a neurological examination.[1][3] The degree of interference with a person's life may be quantified with questionnaires.[3] If certain problems are found, medical imaging, such as magnetic resonance imaging (MRI), may be performed. Other tests are suitable when tinnitus occurs with the same rhythm as the heartbeat.[3] Rarely, the sound may be heard by someone else using a stethoscope, in which case it is known as objective tinnitus.[3] Occasionally, spontaneous otoacoustic emissions, sounds produced normally by the inner ear, may result in tinnitus.[14]

Prevention involves avoiding exposure to loud noise for longer periods or chronically.[2] If there is an underlying cause, treating it may lead to improvements.[3] Otherwise, typically, management involves psychoeducation or counseling, such as talk therapy.[5] Sound generators or hearing aids may help.[2] No medication directly targets tinnitus.
Tinnitus may be perceived in one or both ears, or more centrally in the head. The noise commonly occurs inside a person's head or ear(s) in the absence of auditory stimulation, similar to ringing, although in some people, it is a high-pitched whining or electric buzzing, among numerous other sounds.[4] It may be intermittent or continuous. In some individuals, its intensity may be changed by shoulder, neck, head, tongue, jaw, or eye movements.[15]

A specific type of tinnitus, called objective tinnitus, is characterized by hearing the sounds of one's own muscle contractions or pulse, typically a result of sounds that have been created by the movement of jaw muscles or sounds related to blood flow in the neck or face.[16]
Course

Due to variations in study designs, data on the course of tinnitus showed few consistent results. Generally, the prevalence increased with age in adults, and the ratings of annoyance decreased with duration.[17][18][19]
Psychological effects

Although an annoying condition to which most people adapt, persistent tinnitus may cause anxiety and depression in some people.[20][21] Tinnitus annoyance is more strongly associated with the psychological condition of the person than the loudness or frequency range of the perceived sound.[22][23] Psychological problems such as depression, anxiety, sleep disturbances, and concentration difficulties are common in those with strongly annoying tinnitus.[24][25] 45% of people with tinnitus have an anxiety disorder at some time in their lives.[26]