What causes tinnitus (ear ringing)?

Two categories of tinnitus, each with different etiologies.

1. subjective - only heard by patient

• causes of conductive hearing loss - cerumen impaction, external otititis, TM perforation, middle ear fluid, otosclerosis


• causes of sensorineural hearing loss - noise induced hearing loss, Meniere's disease, acoustic neuroma


• other - ototoxic medications (aspirin, NSAIDs, aminoglycosides, vancomycin, tetracyclcine, lasix), head trauma, metabolic disorders (hypo- hyper - thyroidism, hyperlipidemia, anemia, vit B12 or zinc deficiency)

2. objective - actual sound which may be appreciated by the examiner

• vascular abnormality - arterial bruit, venous hums, AV shunts


• neurologic disorders - brain-stem tumor, infarction, multiple sclerosis lesions which can cause repetitive rapid contractions of soft palate muscles or idiopathic stapedial muscle spasm

Source

Crummer, Richard MD and Hassan, Ghinwa MD. "Diagnostic Approach to Tinnitus." American Family Physician. v 69. 1 Jan 2004.