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№ 25Neurology12 min read

The most important causes and the treatment of tinnitus

1. Big picture

Tinnitus is the perception of sound without an external sound source. Patients may describe it as ringing, buzzing, hissing, roaring, clicking, or pulsating. For the neurology exam, tinnitus is important because it can be a benign cochlear symptom, but it can also be the first clue to Ménière’s disease, vestibular schwannoma, vascular disease, posterior circulation pathology, ototoxicity, or sudden sensorineural hearing loss.

The examiner usually wants three things:

  1. Is it pulsatile or non-pulsatile?

  2. Is it unilateral/asymmetric or bilateral/symmetric?

  3. Is it associated with hearing loss, vertigo, focal neurological signs, or severe distress?

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