When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Tinnitus

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 5 Aug 2025
Last updated: 05 Dec 2024

Summary

Definition

History and exam

Key diagnostic factors

  • history of noise exposure
  • episodic sounds
  • hearing loss
  • vertigo
  • pulsatile sounds
  • clicking sounds
  • visual changes
  • presence of bruits or hums
  • cranial nerve palsies
  • cerumen (ear wax)
  • abnormal otoscopy
  • abnormal Weber test
  • abnormal Rinne test
Full details

Other diagnostic factors

  • medication history
  • slow-onset progressive hearing loss
  • high pitch
  • low pitch
  • unilateral
  • bilateral
  • worse with chewing
  • polyuria/polydipsia
  • diarrhea
  • palpitations
  • foreign body
Full details

Risk factors

  • older age
  • hearing loss
  • loud noise exposure
  • vestibular schwannoma
  • ototoxic medications
  • heavy metal exposure
  • history of cerebrovascular disease
  • history of multiple sclerosis
  • history of head trauma
  • history of depression
  • history of anxiety
Full details

Diagnostic tests

1st tests to order

  • audiometry
Full details

Tests to consider

  • CBC
  • thyroid function tests
  • lipid profile
  • fasting glucose
  • fluorescent treponemal antibody absorption assay
  • MRI head
  • CT temporal bones
  • MR angiography or CT angiography
  • carotid angiography
  • auditory brainstem response (ABR)
  • minimal masking level
  • residual inhibition
  • loudness and pitch matching
  • loudness discomfort level testing
Full details

Emerging tests

  • otoacoustic emissions
  • functional MRI
  • PET scan
  • magnetoencephalographic

Treatment algorithm

ACUTE

known etiology

troublesome tinnitus

ONGOING

hearing loss on audiogram

normal hearing

Contributors

Authors

Michael D. Seidman, MD, FACS

Medical Director Otologic/Neurotologic/Skull Base Surgery

Medical Director Wellness

Advent Health Medical Group

Professor of Otolaryngology-Head and Neck Surgery

University of Central Florida

Collaborative Prof of Oto-HNS University of South FLa

Past Board of Directors American Academy of Otolaryngology-Head and Neck Surgery

Celebration

FL

Disclosures

MDS is a consultant for Acclarent, the founder of PEAK 365 Nutrition and Body Language Vitamins, and is involved in post-market studies for Envoy (noncompensated) and research for MicroTransponder, Inc (noncompensated), Auris Medical, and the National Institutes of Health. He receives royalties from seven patents. MDS is the author of several references cited in this topic.

Acknowledgements

Dr Michael D. Seidman would like to gratefully acknowledge Dr Hamid Djalilian, Dr Alice Lee, Dr Vanessa Rothholtz, and Dr Sanaz Hamidi, the previous contributors to this topic.

Disclosures

HD, AL, VR, and SH declare that they have no competing interests.

Peer reviewers

Aaron Benson, MD

Clinical Adjunct Professor

Division of Neurotology

Department of Otolaryngology Head and Neck Surgery

University of Michigan

Ann Arbor

MI

Consulting Staff

Toledo ENT

Toledo

OH

Disclosures

AB declares that he has no competing interests.

Andrew McCombe, MD, FRCS(ORL)

Consultant ENT Surgeon

Frimley Park Hospital

Portsmouth Road

Frimley

Surrey

UK

Disclosures

AM declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Henry JA, Dennis KC, Schechter MA. General review of tinnitus: prevalence, mechanisms, effects, and management. J Speech Lang Hear Res. 2005 Oct;48(5):1204-35. Abstract

Tyler RS. Tinnitus hand book of medicine. San Diego, CA: Singular Publishing Group; 2000.

Cima RF, Maes IH, Joore MA, et al. Specialised treatment based on cognitive behaviour therapy versus usual care for tinnitus: a randomised controlled trial. Lancet. 2012 May 26;379(9830):1951-9. Abstract

Muehlmeier G, Biesinger E, Maier H. Safety of intratympanic injection of AM-101 in patients with acute inner ear tinnitus. Audiol Neurootol. 2011;16(6):388-97. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

  • Differentials

    • Meniere disease
    • Acoustic neuroma (schwannoma)
    • Glomus tumor
    More Differentials

  • Guidelines

    • ACR Appropriateness Criteria: tinnitus
    • Clinical practice guideline: tinnitus
    More Guidelines

  • Patient information

    Tinnitus

    More Patient information

  • Videos

    How to examine the ear

    More videos
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer