Intended for healthcare professionals

Practice ABC of Ear, Nose and Throat, 6th Edition


BMJ 2014; 348 doi: (Published 13 January 2014) Cite this as: BMJ 2014;348:bmj.g216
  1. Thomasina Meehan1,
  2. Claudia Nogueira1
  1. 1Nottingham University Hospitals Queen's Medical Centre Campus Nottingham, UK

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  • Approximately 10% of the UK population is affected by tinnitus

  • Of vestibular schwannomas (acoustic neuromas), 13% present with unilateral tinnitus and have normal hearing

  • Pulsatile tinnitus should be fully investigated as it may be a symptom of a cardiovascular disorder

  • There are several methods designed to alleviate the distress associated with tinnitus

Tinnitus is defined as the aberrant perception of sound without any external stimulation. Tinnitus may be described as either subjective or objective. Subjective tinnitus, the most common type, occurs in the absence of any physical sound reaching the ear and is audible only to the patient. Objective tinnitus, which affects a minority of patients (1%), is generated in the body and reaches the ear through conduction in body tissue and is audible to the patient as well as the clinician (also referred to as somatosounds).

Epidemiology of Tinnitus

Most people experience transient tinnitus at some time or other, particularly following exposure to loud noise. Prolonged tinnitus is experienced by approximately 10% of the adult UK population and in approximately 1% of adults, the severity of the tinnitus may severely affect their quality of life (Figure 1). Prevalence increases with age, although tinnitus is also commonly reported in children.

Figure 1 

Tinnitus can have a serious impact on the quality of life.

iStock © Daniel Kaesler

Clinical Presentation

Tinnitus may be audible in one ear, both ears or in the head, and some people describe it as emanating from outside the head. Most patients report an increased awareness of tinnitus in quiet surroundings. It consists of an intermittent or continuous …

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