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Tinnitus

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  • Visão geral
  • Teoria
  • Diagnóstico
  • Tratamento
  • ACOMPANHAMENTO
  • Recursos
Última revisão das evidências: 15 Feb 2026
Última atualização do tópico: 03 Mar 2026

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • 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
Detalhes completos

Outros fatores diagnósticos

  • 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
Detalhes completos

Fatores de risco

  • 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
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • audiometry
Detalhes completos

Investigações a serem consideradas

  • 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
Detalhes completos

Novos exames

  • functional MRI
  • PET scan
  • magnetoencephalographic

Algoritmo de tratamento

AGUDA

known etiology

troublesome tinnitus

CONTÍNUA

hearing loss on audiogram

normal hearing

Colaboradores

Autores

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

Declarações

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.

Agradecimentos

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.

Declarações

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.

Revisores

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

Declarações

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

Declarações

AM declares that he has no competing interests.

Créditos aos pareceristas

Os tópicos do BMJ Best Practice são constantemente atualizados, seguindo os desenvolvimentos das evidências e das diretrizes. Os pareceristas aqui listados revisaram o conteúdo pelo menos uma vez durante a história do tópico.

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Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

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

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

American College of Radiology. ACR Appropriateness Criteria: tinnitus. 2023 [internet publication].Texto completo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

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