Tinnitus: When the Ears Ring

Joshua J. Pray; W. Steven Pray

US Pharmacist. 2005;30(6) 

In This Article


Tinnitus must be distinguished from auditory hallucinations. The latter are phantom experiences of hearing meaningful sounds, such as people speaking or music.[6] Auditory hallucinations may be a component of schizophrenic disorders or other causes, e.g., temporal lobe tumors or medications.[5]

Aural sounds other than auditory hallucinations may be symptoms of tinnitus. In regard to classification taxonomies, tinnitus can be subcategorized using several criteria. Tinnitus can be differentiated as either subjective or objective. Objective tinnitus is also referred to as vibratory or extrinsic tinnitus, or pseudotinnitus.[3] This type may be heard by another person (e.g., physician, audiologist). On the other hand, the subjective category is heard only by the patient.[2] Experts also divide tinnitus into pulsatile or nonpulsatile categories. The pulsatile variant coincides with the heartbeat, while the nonpulsatile type is continuous.[2] The two taxonomies overlap. Pulsatile tinnitus may be either objective or subjective (simply not loud enough for the physician/audiologist to hear), while nonpulsatile tinnitus is virtually always subjective in nature.

Pulsatile tinnitus is caused by a host of venous or arterial problems, usually in the thoracic area or region of the head, neck, or cranial cavity.[7] In patients over the age of 50, a common cause of arterial pulsatile tinnitus is atherosclerotic coronary artery disease. Another cause, an intracranial vascular abnormality, is less common. A typical venous cause of pulsatile tinnitus in younger, obese female patients is known as pseudotumor cerebri syndrome. The increased intracranial pressure seen in this disorder may be caused by such medications as oral contraceptives, trimethoprim/sulfamethoxazole, steroids, phenytoin, lithium, tetracycline, amiodarone, or indomethacin.

Vibratory forms of tinnitus may be caused by hearing one's own pulse or the sounds of muscles in the face contracting, mucus in the eustachian tube changing surface tension, and so forth. Nonvibratory subjective tinnitus, that is, a continuous sound heard only by the patient, is the most common form of the disorder.[2] It has no mechanical cause.[1] Most patients with this problem also have cochlear hearing loss. When the tinnitus produces a specific tone, that tone is usually the one in which hearing has been impaired.


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