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⚕️ FREE MSRA PODCAST – Tinnitus
🎧 A clear, high-yield breakdown of this common but complex auditory symptom – perfect for exam prep and real-life clinical scenarios.
🧠 Key Learning Points
📌 Definition
• Tinnitus is the perception of sound in the absence of external stimuli.
• Sounds may be ringing, buzzing, hissing, or roaring, perceived in one or both ears, or inside the head.
• Can be subjective (heard only by the patient) or objective (can sometimes be heard by a clinician).
📌 Causes & Risk Factors
• Loud noise exposure, presbycusis, earwax, ear infections, head injury
• Medications: salicylates (e.g. aspirin), NSAIDs, aminoglycosides, loop diuretics, quinine
• Meniere’s disease, otosclerosis, sudden sensorineural hearing loss (SSNHL)
• Acoustic neuroma (rare), TMJ dysfunction, vascular causes (e.g. carotid stenosis)
• Risk factors: age, male gender, hearing loss, CVD, ototoxic drugs
🧠 Mnemonic: “NOISE DRUG” – Noise, Otosclerosis, Infection, Syphilis, Earwax | Drugs, Retrocochlear causes, Unilateral, Geriatric
📌 Pathophysiology
• Poorly understood, but theories include:
– Abnormal neural activity in auditory pathways
– Hair cell dysfunction in cochlea
– Misfiring nerves creating “phantom” sounds
• Objective tinnitus can arise from vascular or muscular sources
📌 Symptoms
• Persistent/intermittent ringing, buzzing, hissing
• Unilateral or bilateral, sometimes pulsing with heartbeat
• May be accompanied by hearing loss, ear fullness, or vertigo
• Psychological impact: anxiety, sleep disturbance, poor concentration
📌 Differential Diagnosis
• Otitis media, Meniere’s, acoustic neuroma, TMJ dysfunction
• Vascular abnormalities (if pulsatile)
• Rule out neuro causes or wax impaction
📌 Diagnosis
• Full history, ENT and cranial nerve exam
• Otoscopy, audiometry, tympanometry
• MRI IAM for unilateral or asymmetrical non-pulsatile tinnitus
• MRA/MRI/CT angiogram for pulsatile tinnitus
• Tinnitus Functional Index questionnaire to assess impact
📌 Management
• Treat underlying cause (e.g. remove wax, treat infection, hearing aids for loss)
• CBT: First-line for distress, NICE recommended
• Sound therapy: Background noise, music, or sound generators
• Digital CBT or group support may help
• Tinnitus retraining therapy (TRT): Not recommended
❗ No pharmacological treatment is currently recommended for tinnitus itself
📌 Complications
• Depression, anxiety, insomnia, poor concentration, social withdrawal
• Strong link with mental health, especially in chronic or severe tinnitus
📌 Prognosis
• Often chronic; severity may fluctuate
• Can improve or resolve spontaneously in some
• Prognosis depends on coping strategies and whether an underlying cause is found
• Referral guidance:
– Immediate: Suicide risk, red-flag neurological signs
– Urgent: Sudden hearing loss
– Routine: Persistent pulsatile/unilateral tinnitus, significant distress, associated hearing loss
📎 More MSRA Resources for Tinnitus
📝 Revision Notes:
https://www.passthemsra.com/topic/tinnitus-revision-notes/
🧠 Flashcards:
https://www.passthemsra.com/topic/tinnitus-flashcards/
💬 Accordion Q&A Notes:
https://www.passthemsra.com/topic/tinnitus-accordion-qa-notes/
🚀 Rapid Quiz:
https://www.passthemsra.com/topic/tinnitus-rapid-quiz/
🧪 Topic Quiz:
https://www.passthemsra.com/quizzes/tinnitus/
🎓 Full Course:
https://www.passthemsra.com/courses/ent-for-the-msra/
🔗 All resources are part of the ENT for the MSRA course at
https://www.passthemsra.com – explore full revision guides, quizzes, flashcards, and more.
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