|Classification and external resources|
Tinnitus // or //; from the Latin word tinnītus meaning "ringing" is the perception of sound within the human ear ("ringing of the ears") when no external sound is present. Despite the origin of the name, "ringing" is only one of many sounds the person may perceive.
Tinnitus is not a disease, but a condition that can result from a wide range of underlying causes. The most common cause is noise-induced hearing loss. Other causes include: neurological damage (multiple sclerosis), ear infections, oxidative stress, emotional stress, foreign objects in the ear, nasal allergies that prevent (or induce) fluid drain, wax build-up, and exposure to loud sounds. Withdrawal from benzodiazepines may cause tinnitus as well. Tinnitus may be an accompaniment of sensorineural hearing loss or congenital hearing loss, or it may be observed as a side effect of certain medications (ototoxic tinnitus).
Tinnitus is usually a subjective phenomenon, such that it cannot be objectively measured. The condition is often rated clinically on a simple scale from "slight" to "catastrophic" according to the difficulties it imposes, such as interference with sleep, quiet activities, and normal daily activities.
If there is an underlying cause, treating it may lead to improvements. Otherwise typically management involves talk therapy. As of 2013, there are no effective medications. It is common, affecting about 10-15% of people. Most however tolerate it well, with it being a significant problem in only 1-2% of people.
- 1 Signs and symptoms
- 2 Causes
- 3 Pathophysiology
- 4 Diagnosis
- 5 Prevention
- 6 Management
- 7 Prognosis
- 8 Epidemiology
- 9 Research
- 10 Children
- 11 See also
- 12 References
- 13 External links
- 14 Further reading
Signs and symptoms
Tinnitus can be perceived in one or both ears or in the head. It is usually described as a ringing noise, but in some patients, it takes the form of a high-pitched whining, electric buzzing, hissing, humming, tinging or whistling sound, or as ticking, clicking, roaring, "crickets" or "tree frogs" or "locusts (cicadas)", tunes, songs, beeping, sizzling, sounds that slightly resemble human voices or even a pure steady tone like that heard during a hearing test, and in some cases, pressure changes from the interior ear. It has also been described as a "whooshing" sound because of acute muscle spasms, as of wind or waves. Tinnitus can be intermittent, or it can be continuous, in which case it can be the cause of great distress. In some individuals, the intensity can be changed by shoulder, head, tongue, jaw, or eye movements.
Most people with tinnitus have some degree of hearing loss, in that they are often unable to hear clearly external sounds that occur within the same range of frequencies as their "phantom sounds". This has led to the suggestion that one cause of tinnitus might be a homeostatic response of central dorsal cochlear nucleus auditory neurons that makes them hyperactive in compensation to auditory input loss.
The sound perceived may range from a quiet background noise to one that can be heard even over loud external sounds. The specific type of tinnitus called pulsatile tinnitus is characterized by one hearing the sounds of one's own pulse or muscle contractions, which is typically a result of sounds that have been created from the movement of muscles near to one's ear, changes within the canal of one's ear or issues related to blood flow of the neck or face.
There has been little research on the course of tinnitus, and most research has been retrospective. An Australian study of participants aged 49–97 years found that 35% of participants reported that their tinnitus was present all the time and 4% rated their tinnitus as annoying. Findings from a retrospective National Study of Hearing found that for 25% of people surveyed, the perceived volume of their tinnitus increased over time, while for 75% it did not. The rate of annoyance decreased for 31% of people from onset of tinnitus to the middle time. A study of the natural history of tinnitus in older adults found that for women, tinnitus increased for 25%, decreased in 58%, leaving 17% unchanged. The study found that for men, tinnitus increased in 8%, decreased in 39%, leaving 53% unchanged. Information about the course of tinnitus would benefit from prospective studies investigating change over time as these studies may potentially be more accurate.
Tinnitus annoyance is more strongly associated with psychological symptoms than acoustic characteristics. Other psychological problems such as depression, anxiety, sleep disturbances and concentration difficulties are common in those with worse tinnitus.
In some cases, others can perceive an actual sound (e.g., a bruit) coming from the person’s ears. This is called objective tinnitus. Objective tinnitus can arise from muscle spasms that cause clicks or crackling around the middle ear. Some people experience a sound that beats in time with the pulse (pulsatile tinnitus, or vascular tinnitus). Pulsatile tinnitus is usually objective in nature, resulting from altered blood flow or increased blood turbulence near the ear (such as from atherosclerosis or venous hum,) but it can also arise as a subjective phenomenon from an increased awareness of blood flow in the ear. Rarely, pulsatile tinnitus may be a symptom of potentially life-threatening conditions such as carotid artery aneurysm or carotid artery dissection. Pulsatile tinnitus may also indicate vasculitis, or more specifically, giant cell arteritis. Pulsatile tinnitus may also be an indication of idiopathic intracranial hypertension.
Subjective tinnitus can have many possible causes, but most commonly results from otologic disorders – the same conditions that cause hearing loss. The most common cause is noise-induced hearing loss, resulting from exposure to excessive or loud noises. Tinnitus, along with sudden onset hearing loss, may have no obvious external cause. Ototoxic drugs can cause subjective tinnitus either secondary to hearing loss or without hearing loss and may increase the damage done by exposure to loud noise, even at doses that are not in themselves ototoxic.
Subjective tinnitus is also a side effect of some medications, such as aspirin, and may also result from an abnormally low level of serotonin activity. It is also a classical side effect of quinidine, a Class IA anti-arrhythmic. Over 260 medications have been reported to cause tinnitus as a side effect. In many cases, however, no underlying physical cause can be identified.
Tinnitus can also occur due to the discontinuation of therapeutic doses of benzodiazepines. It can sometimes be a protracted symptom of benzodiazepine withdrawal and may persist for many months.
Causes of subjective tinnitus include:
- ear problems and hearing loss:
- conductive hearing loss
- sensorineural hearing loss
- neurologic disorders:
- other causes:
- tension myositis syndrome
- hypertonia (muscle tension)
- thoracic outlet syndrome
- Lyme disease
- sleep paralysis
- glomus tympanicum tumor
- anthrax vaccines which contain the anthrax protective antigen
- Some psychedelic drugs can produce temporary tinnitus-like symptoms as a side effect
- benzodiazepine withdrawal
- nasal congestion
- intracranial hyper or hypotension caused by, for example, encephalitis or a cerebrospinal fluid leak
One of the possible mechanisms relies on otoacoustic emissions. The inner ear contains thousands of minute inner hair cells with stereocilia which vibrate in response to sound waves, and outer hair cells which convert neural signals into tension on the vibrating basement membrane. The sensing cells are connected with the vibratory cells through a neural feedback loop, whose gain is regulated by the brain. This loop is normally adjusted just below onset of self-oscillation, which gives the ear spectacular sensitivity and selectivity. If something changes, it is easy for the delicate adjustment to cross the barrier of oscillation, and tinnitus results. Exposure to excessive sound kills hair cells, and studies have shown as hair cells are lost, different neurons are activated, activating auditory parts of the brain and giving the perception of sound.
Another possible mechanism underlying tinnitus is damage to the receptor cells. Although receptor cells can be regenerated from the adjacent supporting Deiters cells after injury in birds, reptiles, and amphibians, in mammals it is believed they can be produced only during embryogenesis. Although mammalian Deiters cells reproduce and position themselves appropriately for regeneration, they have not been observed to transdifferentiate into receptor cells except in tissue culture experiments. Therefore, if these hairs become damaged, through prolonged exposure to excessive sound levels, for instance, then deafness to certain frequencies results. In tinnitus, they may relay information that an externally audible sound is present at a certain frequency when it is not.
The mechanisms of subjective tinnitus are often obscure. While it is not surprising that direct trauma to the inner ear can cause tinnitus, other apparent causes (e.g., temporomandibular joint dysfunction and dental disorders) are difficult to explain. Research has proposed there are two distinct categories of subjective tinnitus: otic tinnitus, caused by disorders of the inner ear or the acoustic nerve, and somatic tinnitus, caused by disorders outside the ear and nerve, but still within the head or neck. It is further hypothesized somatic tinnitus may be due to "central crosstalk" within the brain, as certain head and neck nerves enter the brain near regions known to be involved in hearing.
It may be caused by increased neural activity in the auditory brainstem where the brain processes sounds, causing some auditory nerve cells to become overexcited. The basis of this theory is most people with tinnitus also have hearing loss, and the frequencies they cannot hear are similar to the subjective frequencies of their tinnitus. Models of hearing loss and the brain support the idea a homeostatic response of central dorsal cochlear nucleus neurons could result in them being hyperactive in a compensation process to the loss of hearing input.
The basis of quantitatively measuring tinnitus relies on the brain’s tendency to select out only the loudest sounds heard. Based on this tendency, the amplitude of a patient's tinnitus can be measured by playing sample sounds of known amplitude and asking the patient which they hear. The volume of the tinnitus will always be equal to or less than that of the sample noises heard by the patient. This method works very well to gauge objective tinnitus (see above). For example: if a patient has a pulsatile paraganglioma in their ear, they will not be able to hear the blood flow through the tumor when the sample noise is 5 decibels louder than the noise produced by the blood. As sound amplitude is gradually decreased, the tinnitus will become audible, and the level at which it does so provides an estimate of the amplitude of the objective tinnitus.
Objective tinnitus, however, is quite uncommon. Often patients with pulsatile tumors will report other coexistent sounds, distinct from the pulsatile noise, that will persist even after their tumor has been removed. This is generally subjective tinnitus, which, unlike the objective form, cannot be tested by comparative methods. However, pulsatile tinnitus can be a symptom of intracranial vascular abnormalities, and should be evaluated for bruits by a medical professional with auscultation over the neck, eyes, and ears. If the exam reveals a bruit, imaging studies such as transcranial doppler (TCD) or magnetic resonance angiography (MRA) should be performed.
The accepted definition of chronic tinnitus, as compared to normal ear noise experience, is five minutes of ear noise occurring at least twice a week. However, people with chronic tinnitus often experience the noise more frequently than this, and can experience it continuously or regularly, such as during the night, when there is less environmental noise to mask the sound.
Assessment of psychological processes related to tinnitus involves measurement of tinnitus severity and distress (i.e. nature and extent of tinnitus-related problems), measured subjectively by validated self-report tinnitus questionnaires. These questionnaires measure the degree of psychological distress and handicap associated with tinnitus, including effects on hearing, lifestyle, health and emotional functioning. A broader assessment of general functioning, such as levels of anxiety, depression, stress, life stressors and sleep difficulties is also important in the assessment of Tinnitus due to higher risk of negative well-being across these areas, which may be affected by and/or exacerbate the Tinnitus symptoms for the individual. Overall, current assessment measures are aimed to identify individual levels of distress and interference, coping responses and perceptions of tinnitus in order to inform treatment and monitor progress. However, wide variability, inconsistencies and lack of consensus regarding assessment methodology is evidenced in the literature, limiting comparison of treatment effectiveness. Developed to guide diagnosis or classify severity, most tinnitus questionnaires have also been shown to be treatment-sensitive outcome measures.
Auditory evoked response
Tinnitus is the description of a noise inside a person’s head in the absence of auditory stimulation. The noise can be described in many different ways, but the most common description of the tinnitus is a pure tone sound. Tinnitus affects one third of adults at some time in their lives, whereas ten to fifteen percent are disturbed enough to seek medical evaluation.
Tinnitus can be classified as either subjective or objective. Objective tinnitus can be detected by other people and is usually caused by myoclonus or a vascular condition. Subjective tinnitus can only be heard by the affected person and is caused by otology, neurology, infection, or drugs. A frequent cause of subjective tinnitus is noise exposure which damages hair cells in the inner ear causing tinnitus. Tinnitus can be associated with many emotions. It is best illustrated by Jastreboff’s Neurophysiological model.
Tinnitus can be evaluated with most auditory evoked potentials; however results may be inconsistent. Results must be compared to age and hearing matched control subjects to be reliable. This inconsistently reported may be due to many reasons: differences in the origin of the tinnitus, ABR recording methods, and selection criteria of control groups. Since research shows conflicting evidence, more research on the relationship between tinnitus and auditory evoked potentials should be carried out before these measurements are used clinically.
Other potential sources of the sounds normally associated with tinnitus should be ruled out. For instance, two recognized sources of high-pitched sounds might be electromagnetic fields common in modern wiring and various sound signal transmissions. A common and often misdiagnosed condition that mimics tinnitus is radio frequency (RF) hearing, in which subjects have been tested and found to hear high-pitched transmission frequencies that sound similar to tinnitus.
Avoidance of potentially ototoxic medicines. Ototoxicity of multiple medicines can have a cumulative effect, and can increase the damage done by noise. If ototoxic medications must be administered, close attention by the physician to prescription details, such as dose and dosage interval, can reduce the damage done.
If there is an underlying cause, treating it may lead to improvements. Otherwise the primary treatment for tinnitus is talk therapy and sound therapy with there being little support for medications.
The best supported treatment for tinnitus is a type of counseling called cognitive behavioral therapy (CBT) which can be delivered via the internet or in person. It decreases the amount of stress those with tinnitus feel. These benefits appear to be independent of any effect on depression or anxiety in an individual. Acceptance and Commitment Therapy (ACT) is also demonstrating promise in Tinnitus treatment.Relaxation techniques may also be useful. A program has been developed by the United States Department of Veterans Affairs.
There are no medications as of 2014 that are effective for tinnitus and thus none is recommended. There is not enough evidence to determine if antidepressants or acamprosate is useful. While there is tentative evidence for benzodiazepines, it is insufficient to support usage. Anticonvulsants have not been found to be useful.
The use of sound therapy by either hearing aids or tinnitus maskers help the brain ignore the specific tinnitus frequency. Although these methods are poorly supported by evidence, there are no negative effects which makes them a reasonable option. There is some tentative evidence supporting tinnitus retraining therapy. There is little evidence supporting the use of transcranial magnetic stimulation. It is thus not recommended.
Ginkgo biloba does not appear to be effective. Tentative evidence supports zinc supplementation and in those with sleep problems, melatonin. The American Academy of Otolaryngology, however, recommends against melatonin and zinc.
Tinnitus is present in 10-15% of people.
As of 2013 many potential treatments are being investigated. Recent psychological research on tinnitus focuses on the Tinnitus Distress Reaction (TDR) to account for differences in tinnitus severity. Research has stigmatized patients with severe tinnitus by implying they suffer from personality disorders, such as neuroticism, anxiety sensitivity, and catastrophic thinking, which all predispose increased TDR. These findings suggest that at the initial perception of tinnitus, conditioning links tinnitus with negative emotions, such as fear and anxiety from unpleasant stimuli at the time. This enhances activity in the limbic system and autonomic nervous system, thus increasing tinnitus awareness and annoyance.
Tinnitus is commonly thought of as a symptom of adulthood; this may be why tinnitus in children is generally overlooked. Children with hearing loss have a high incidence of tinnitus, even though they do not express that they have tinnitus and the effect it has on their lives. Children do not generally report tinnitus spontaneously and their complaints may not be taken seriously. Among those children who do complain of tinnitus, there is an increased likelihood of associated otological or neurological pathology such as migraine, juvenile Meniere’s disease or chronic suppurative otitis media. Its reported prevalence varies from 12% to 36% in children with normal hearing thresholds and up to 66% in children with a hearing loss and approximately 3-10% of children have been reported to be troubled by tinnitus.
- Pall ML, Bedient SA (2007). "The NO/ONOO- cycle as the etiological mechanism of tinnitus". The International Tinnitus Journal 13 (2): 99–104. PMID 18229788.
- Han BI, Lee HW, Kim TY, Lim JS, Shin KS (March 2009). "Tinnitus: characteristics, causes, mechanisms, and treatments". J Clin Neurol 5 (1): 11–19. doi:10.3988/jcn.2009.5.1.11. PMC 2686891. PMID 19513328. "About 75% of new cases are related to emotional stress as the trigger factor rather than to precipitants involving cochlear lesions."
- "Guidelines for the grading of tinnitus severity". Retrieved 2009-12-31.
- Baguley, D; McFerran, D; Hall, D (Nov 9, 2013). "Tinnitus.". Lancet 382 (9904): 1600–7. doi:10.1016/S0140-6736(13)60142-7. PMID 23827090.
- Langguth, B; Kreuzer, PM; Kleinjung, T; De Ridder, D (Sep 2013). "Tinnitus: causes and clinical management.". Lancet neurology 12 (9): 920–30. doi:10.1016/S1474-4422(13)70160-1. PMID 23948178.
- "Information and resources: Tinnitus: About tinnitus: What is tinnitus". RNID.org.uk. Retrieved 2012-10-26.
- MedlinePlus Encyclopedia Ear noises or buzzing
- Simmons, R, Dambra, C, Lobarinas, E, Stocking, C, Salvi, R (2008). "Head, Neck, and Eye Movements That Modulate Tinnitus". Seminars in hearing 29 (4): 361–370. doi:10.1055/s-0028-1095895. PMC 2633109. PMID 19183705.
- Nicolas-Puel, C, Faulconbridge, RL, Guitton, M, Puel, JL, Mondain, M, Uziel, A (2002). "Characteristics of tinnitus and etiology of associated hearing loss: a study of 123 patients". The international tinnitus journal 8 (1): 37–44. PMID 14763234.
- Knig, O, Schaette, R, Kempter, R, Gross, M (2006). "Course of hearing loss and occurrence of tinnitus". Hearing research 221 (1–2): 59–64. doi:10.1016/j.heares.2006.07.007. PMID 16962270.
- Schaette, R, Kempter, R. (2006). "Development of tinnitus-related neuronal hyperactivity through homeostatic plasticity after hearing loss: a computational model". Eur J Neurosci 23 (11): 3124–38. doi:10.1111/j.1460-9568.2006.04774.x. PMID 16820003.
- "Tinnitus (Ringing in the Ears) Causes, Symptoms, Treatments". Webmd.com. 2010-02-12. Retrieved 2013-02-03.
- Baguley D, Andersson g, McFerran D, McKenna L (2013). Tinnitus: AMultidisciplinary Approach (2nd ed.). Blackwell Publishing Ltd. pp. 16–17.
- Berrios, G E; Rose, G S (1992). "Psychiatry of subjective tinnitus: conceptual, historical and clinical aspects". Neurology, Psychiatry and Brain Research 1: 76–82.
- Berrios, G E; Ryley, J R; Garvey, N; Moffat, DA (1988). "Psychiatric Morbidity in subjects with inner ear disease". Clinical Otolaryngology 13 (4): 259–266. doi:10.1111/j.1365-2273.1988.tb01129.x. PMID 3180496.
- Berrios, G E (1990). "Musical hallucinations: a historical and clinical study". British Journal of Psychiatry 156 (2): 188–194. doi:10.1192/bjp.156.2.188. PMID 2180526.
- Andersson G (2002). "Psychological aspects of tinnitus and the application of cognitive-behavioural therapy". Clinical Psychology Review 22 (7): 977–9. doi:10.1016/s0272-7358(01)00124-6. PMID 12238249.
- Baguley DM (2002). "Mechanisms of tinnitus". British Medical Bulletin 63: 195–212. doi:10.1093/bmb/63.1.195. PMID 12324394.
- Henry JA, Meikele MB (1999). "Pulsed versus continuous tones for evaluating the loudness of tinnitus". Journal of the American Academy of Audiology 10 (5): 261–272. PMID 10331618.
- Henry JA, Dennis KC, Schechter MA (2005). "General review of tinnitus: Prevalence, mechanisms, effects, and management". Journal of Speech, Language, and Hearing Research 48 (5): 1204–1235. doi:10.1044/1092-4388(2005/084). PMID 16411806.
- Andersson G (2002). "Psychological aspects of tinnitus and the application of cognitive-behavioural therapy". Clinical Psychology Review 22 (7): 977–979. doi:10.1016/s0272-7358(01)00124-6. PMID 12238249.
- Davies A, Rafie EA (2000). "Epidemiology of Tinnitus". In R. S. Tyler. Tinnitus Handbook. San Diego: Singular. pp. 1–23. OCLC 42771695.
- "Tinnitus". American Academy of Otolaryngology — Head and Neck Surgery. 2012-04-03. Retrieved 2012-10-26.
- "Information and resources: Our factsheets and leaflets: Tinnitus: Factsheets and leaflets". RNID.org.uk. Retrieved 2012-10-26.
- Chandler JR (1983). "Diagnosis and cure of venous hum tinnitus". Laryngoscope 93 (7): 892–5. doi:10.1288/00005537-198307000-00009. PMID 6865626.
- Moonis G, Hwang CJ, Ahmed T, Weigele JB, Hurst RW (2005). "Otologic manifestations of petrous carotid aneurysms". AJNR Am J Neuroradiol. 26 (6): 1324–7. PMID 15956490.
- Selim, Magdy; Caplan, Louis R. (2004). "Carotid Artery Dissection". Current Treatment Options in Cardiovascular Medicine 6 (3): 249–25 3. doi:10.1007/s11936-996-0020-z. ISSN 1092-8464. PMID 15096317. (subscription required)
- Sismanis A, Butts FM, Hughes GB (2009-01-04). "Objective tinnitus in benign intracranial hypertension: An update". The Laryngoscope. doi:10.1288/00005537-199001000-00008.
- Brown RD, Penny JE, Henley CM, et al. (1981). "Ototoxic drugs and noise". Ciba Found Symp. 85: 151–71. PMID 7035098.
- Stas Bekman: stas (at) stason.org. "6) What are some ototoxic drugs?". Stason.org. Retrieved 2012-10-26.
- Riba, Michelle B.; Ravindranath, Divy (12 April 2010). Clinical manual of emergency psychiatry. Washington, DC: American Psychiatric Publishing Inc. p. 197. ISBN 978-1-58562-295-5.
- Delanty, Norman (27 November 2001). Seizures: medical causes and management. Totowa, N.J.: Humana Press. p. 187. ISBN 978-0-89603-827-1.
- Crummer RW, Hassan GA (2004). "Diagnostic approach to tinnitus". Am Fam Physician. 69 (1): 120–6. PMID 14727828.
- Passchier-Vermeer W, Passchier WF (2000). "Noise exposure and public health". Environ. Health Perspect. 108 Suppl 1 (Suppl 1): 123–31. doi:10.2307/3454637. JSTOR 3454637. PMC 1637786. PMID 10698728.
- Shulgin, Alexander; Shulgin, Ann (1997). "#36. 5-MEO-DET". TiHKAL: the continuation. Berkeley, CA, USA: Transform Press. ISBN 9780963009692. OCLC 38503252. Retrieved 27 October 2012.
- "Erowid Experience Vaults: DiPT - More Tripping & Revelations - 26540".
- Yamasoba T, Kondo K (2006). "Supporting cell proliferation after hair cell injury in mature guinea pig cochlea in vivo". Cell Tissue Res. 325 (1): 23–31. doi:10.1007/s00441-006-0157-9. PMID 16525832.
- White PM, Doetzlhofer A, Lee YS, Groves AK, Segil N (2006). "Mammalian cochlear supporting cells can divide and trans-differentiate into hair cells". Nature 441 (7096): 984–7. doi:10.1038/nature04849. PMID 16791196.
- Engmann, Birk: Ohrgeräusche (Tinnitus): Ein lebenslanges Schicksal? PTA-Forum. Supplement Pharmazeutische Zeitung. 1997 July
- Liyanage SH, Singh A, Savundra P, Kalan A. (February 2006). "Pulsatile tinnitus.". J Laryngol Otol. 120 (2): 93–7. doi:10.1017/S0022215105001714. PMID 16359136.
- Davis, A (1989). "The prevalence of hearing impairment and reported hearing disability among adults in Great Britain". International Journal of Epidemiology 18 (4): 911–917. doi:10.1093/ije/18.4.911.
- Wilson, P., Henry, J., Bowen, M., & Haralambous. (1991). "Tinnitus reaction questionnaire: psychometric properties of a measure of distress associated with tinnitus". Journal of Speech, Language, and Hearing Research 34 (1): 197–201. doi:10.1044/jshr.3401.197.
- Kuk, F., Tyler, R., Russell, D., & Jordan, H. (1990). "The psychometric properties of a Tinnitus Handicap Questionnaire.". Ear Hear 11: 434–445. doi:10.1097/00003446-199012000-00005.
- Hallam, R.S. (1996). Manual of the Tinnitus Questionnaire. |London: The Psychological Corporation.
- Meikle, M.B., Henry, J.A., Griest, S.E., Stewart, B.J., Abrams, H.B., McArdle, R., . . . Vernon, J.A. (2012). "The tinnitus functional index: development of a new clinical measure for chronic, intrusive tinnitus.". Ear Hear 33: 153–176. doi:10.1097/aud.0b013e31822f67c0.
- Henry, J. L., & Wilson, P. H. (2000). The Psychological Management of Chronic Tinnitus: A Cognitive Behavioural Approach. Boston: Allyn and Bacon.
- Landgrebe M, Azevedo A, Baguley D, Bauer C, Cacace A, Coelho C et al. (2012). "Methodological aspects of clinical trials in tinnitus: A proposal for international standard". Journal of Psychosomatic Research 73 (2): 112–121. doi:10.1016/j.jpsychores.2012.05.002. PMID 22789414.
- Martinez-Devesa, P; Perera, R; Theodoulou, M; Waddell, A (Sep 8, 2010). "Cognitive behavioural therapy for tinnitus.". The Cochrane database of systematic reviews (9): CD005233. doi:10.1002/14651858.CD005233.pub3. PMID 20824844.
- Heller AJ (2003). "Classification and epidemiology of tinnitus". Otolaryngologic Clinics of North America 36 (2): 239–248. doi:10.1016/S0030-6665(02)00160-3. PMID 12856294.
- Chan Y (2009). "Tinnitus: etiology, classification, characteristics, and treatment". Discovery Medicine 8 (42): 133–136. PMID 19833060.
- Pawel J. Jastreboff, Ph.D., Sc.D., M.B.A. "Tinnitus & Hyperacusis Center". Emory University. Retrieved 2011-11-16.
- Elder, JA; Chou, CK (2003). "Auditory response to pulsed radiofrequency energy.". Bioelectromagnetics. Suppl 6: S162–73. doi:10.1002/bem.10163. PMID 14628312.
- Tunkel, D. E.; Bauer, C. A.; Sun, G. H.; Rosenfeld, R. M.; Chandrasekhar, S. S.; Cunningham, E. R.; Archer, S. M.; Blakley, B. W.; Carter, J. M.; Granieri, E. C.; Henry, J. A.; Hollingsworth, D.; Khan, F. A.; Mitchell, S.; Monfared, A.; Newman, C. W.; Omole, F. S.; Phillips, C. D.; Robinson, S. K.; Taw, M. B.; Tyler, R. S.; Waguespack, R.; Whamond, E. J. (1 October 2014). "Clinical Practice Guideline: Tinnitus". Otolaryngology -- Head and Neck Surgery 151 (2 Suppl): S1–S40. doi:10.1177/0194599814545325.
- Palomar García, V; Abdulghani Martínez, F; Bodet Agustí, E; Andreu Mencía, L; Palomar Asenjo, V (Jul 2001). "Drug-induced otoxicity: current status.". Acta oto-laryngologica 121 (5): 569–72. doi:10.1080/00016480121545. PMID 11583387.
- Hoare D, Kowalkowski V, Knag S, Hall D (2011). "Systematic review and meta-analyses of randomized controlled trials examining tinnitus management". The Laryngoscope 1211: 15555–15564. doi:10.1002/lary.21825. PMC 3477633. PMID 21671234.
- Hesser H, Weise C, Zetterquist Westin V, Andersson G (2011). "A systematic review and meta-analysis of randomized controlled trials of cognitive–behavioral therapy for tinnitus distress". Clinical Psychology Review 31 (4): 545–553. doi:10.1016/j.cpr.2010.12.006. PMID 21237544.
- Ruiz, F. J. (2010). "A review of Acceptance and Commitment Therapy (ACT) empirical evidence: Correlational, experimental psychopathology, component and outcome studies". International Journal of Psychology and Psychological Therapy 10 (1): 125–62.
- Henry J, Zaugg T, Myers P, Kendall C (2012). "Chapter 9 - Level 5 Individualized Support". Progressive Tinnitus Management: Clinical Handbook for Audiologists. U.S. Department of Veterans Affairs, National Center for Rehabilitative Auditory Research. Retrieved 2013-12-20.
- Baldo, P; Doree, C; Molin, P; McFerran, D; Cecco, S (Sep 12, 2012). "Antidepressants for patients with tinnitus.". The Cochrane database of systematic reviews 9: CD003853. doi:10.1002/14651858.CD003853.pub3. PMID 22972065.
- Savage, J; Cook, S; Waddell, A (Nov 12, 2009). "Tinnitus.". Clinical evidence 2009. PMID 21726476.
- Hobson, J; Chisholm, E; El Refaie, A (Nov 14, 2012). "Sound therapy (masking) in the management of tinnitus in adults.". The Cochrane database of systematic reviews 11: CD006371. doi:10.1002/14651858.CD006371.pub3. PMID 23152235.
- Meng, Z; Liu, S; Zheng, Y; Phillips, JS (Oct 5, 2011). "Repetitive transcranial magnetic stimulation for tinnitus.". The Cochrane database of systematic reviews (10): CD007946. doi:10.1002/14651858.CD007946.pub2. PMID 21975776.
- Hilton, MP; Zimmermann, EF; Hunt, WT (Mar 28, 2013). "Ginkgo biloba for tinnitus.". The Cochrane database of systematic reviews 3: CD003852. doi:10.1002/14651858.CD003852.pub3. PMID 23543524.
- Coelho, CB; Tyler, R; Hansen, M (2007). "Zinc as a possible treatment for tinnitus.". Progress in brain research 166: 279–85. doi:10.1016/S0079-6123(07)66026-9. PMID 17956792.
- Piccirillo, JF (2007). "Melatonin.". Progress in brain research 166: 331–3. doi:10.1016/S0079-6123(07)66030-0. PMID 17956796.
- Penney SE, Bruce IA, Saeed SR (2006). "Botulinum toxin is effective and safe for palatal tremor: a report of five cases and a review of the literature". J Neurology 253 (7): 857–60. doi:10.1007/s00415-006-0039-9. PMID 16845571.
- Henry JA, Wilson P (2000). R.S. Tyler, ed. Tinnitus Handbook. San Diego: Singular. pp. 263–279. OCLC 42771695.
- Andersson G, Westin V (2008). "Understanding tinnitus distress: Introducing the concepts of moderators and mediators". International Journal of Audiology 47 ((Suppl. 2): S106–S111. doi:10.1080/14992020802301670. PMID 19012118.
- Weise C, Hesser H, Andersson G, Nyenhuis N, Zastrutzki S, Kröner-Herwig B, Jäger B (2013). "The role of catastrophizing in recent onset tinnitus: its nature and association with tinnitus distress and medical utilization". Journal of International Audiology 3 (3): 177–88. doi:10.3109/14992027.2012.752111. PMID 23301660.
- Jastreboff, PJ, last1=Hazell (2004). Tinnitus Retraining Therapy: Implementing the neurophysiological model. Cambridge: Cambridge University Press. OCLC 237191959.
- Celik, N.; Bajin, M. D.; Aksoy, S. (2009). "Tinnitus incidence and characteristics in children with hearing loss". Journal of International Advanced Otology (Ankara, Turkey: Mediterranean Society of Otology and Audiology) 5 (3): 363–369. ISSN 1308-7649. OCLC 695291085. Retrieved 2013-02-02.
- Mills, RP; Albert, D; Brain, C (1986). "Tinnitus in childhood". Clinical Otolaryngology and Allied Sciences 11 (6): 431–434.
- Ballantyne JC (2009). Graham J, Baguley D, ed. Ballantyne's Deafness (Seventh ed.). Chichester: Wiley-Blackwell. OCLC 275152841.
- Shetye, A; Kennedy, V (2010). "Tinnitus in children: an uncommon symptom?". Archives of Disease in Childhood 95 (8): 645–648. doi:10.1136/adc.2009.168252.
- "Tinnitus". Deafness Research UK. London, UK: Deafness Research UK. 22 October 2012. Retrieved 2 November 2012. Information about Tinnitus and the latest research work being done
|Wikimedia Commons has media related to Tinnitus.|
- Baguley, David; Andersson, Gerhard; McFerran, Don; McKenna, Laurence (March 2013) . Tinnitus: A Multidisciplinary Approach (2nd ed.). Indianapolis, IN, USA: Wiley-Blackwell. ISBN 978-1-4051-9989-6. LCCN 2012032714. OCLC 712915603.
- Hogan, Kevin; Battaglino, Jennifer (May 2010) . Tinnitus: Turning the Volume Down (Revised & Expanded ed.). Eden Prairie, MN, USA: Network 3000 Publishing. ISBN 9781934266038. OCLC 779877737.
- Langguth, B.; Hajak, G.; Kleinjung, T.; Cacace, A.; Møller, A.R., eds. (December 2007). Tinnitus : pathophysiology and treatment. Progress in brain research 166 (1st ed.). Amsterdam ; Boston: Elsevier. ISBN 9780444531674. LCCN 2012471552. OCLC 648331153. Archived from the original on 2007. Retrieved 5 November 2012.
- Møller, Aage R; Langguth, Berthold; Ridder, Dirk et al., eds. (2011). Textbook of Tinnitus. New York, NY, USA: Springer. doi:10.1007/978-1-60761-145-5. ISBN 9781607611448. LCCN 2010934377. OCLC 695388693, 771366370 and 724696022. Archived from the original on 2011. Retrieved 5 November 2012. (subscription required)
- Tyler, Richard S. (2000). Tinnitus Handbook. A Singular audiology textbook. San Diego, CA, USA: Singular Publishing Group. ISBN 9781565939226. OCLC 471533235.