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Tinnitus

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  • Visão geral
  • Teoria
  • Diagnóstico
  • Tratamento
  • ACOMPANHAMENTO
  • Recursos
Última revisão das evidências: 13 Feb 2026
Última atualização do tópico: 03 Mar 2026

Resumo

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

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

Risk factors

  • aging and older age
  • hearing loss
  • loud noise exposure
  • vestibular schwannoma
  • migraine
  • use of ototoxic drugs
  • exposure to heavy metals
  • history of cerebrovascular disease
  • history of multiple sclerosis
  • history of head trauma
  • history of depression
  • history of anxiety
  • micronutrient deficiency
Full details

Diagnostic tests

1st tests to order

  • audiometry
Full details

Tests to consider

  • CBC
  • thyroid function tests
  • lipid profile
  • fasting glucose
  • antinuclear antibodies, double-stranded (ds) DNA, Smith antigen
  • fluorescent treponemal antibody absorption assay
  • MRI of internal auditory canal
  • CT temporal bones
  • magnetic resonance angiography (MRA) or CT angiography
  • carotid angiography
  • auditory brainstem response (ABR)
  • minimum masking level
  • residual inhibition
  • loudness and pitch matching
  • loudness discomfort level testing
  • otoacoustic emissions
Full details

Emerging tests

  • 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

Chair Department of Otolaryngology-Head and Neck Surgery Central Division Advent Health

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

Visiting Professor Embry Riddle Aeronautical University

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 and the Department of Defense. He receives royalties from two of his nine patents. MDS is the author of several books and 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

AL, VR, and SH declare that they have no competing interests. HRD holds stocks in Cactus Medical LLC, Elinava Technologies and has a pending patent on electric stimulation device and combination therapy for treatment of ear condition.

Peer reviewers

Hamid R. Djalilian, MD

Director of Otology, Neurotology, and Skull Base Surgery

Professor of Otolaryngology, Neurological Surgery, and Biomedical Engineering

University of California

Irvine

CA

Disclosures

HRD holds stocks in Cactus Medical LLC, Elinava Technologies and has a pending patent on electric stimulation device and combination therapy for treatment of ear condition.

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

Dalrymple SN, Lewis SH, Philman S. Tinnitus: diagnosis and management. Am Fam Physician. 2021 Jun 1;103(11):663-71.Full text  Abstract

Tunkel DE, Bauer CA, Sun GH, et al. Clinical practice guideline: tinnitus. Otolaryngol Head Neck Surg. 2014 Oct;151(suppl 2):S1-40.Full text  Abstract

American College of Radiology. ACR Appropriateness Criteria: tinnitus. 2023 [internet publication].Full text

Reference articles

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

  • Differentials

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  • Guidelines

    • Consensus statements on tinnitus treatment: a Delphi study by the Korean Tinnitus Study Group
    • VA/DOD clinical practice guideline: tinnitus
    More Guidelines

  • Patient information

    Tinnitus

    More Patient information

  • Videos

    How to examine the ear

    More videos
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