Tinnitus and Hyperacusis

Context: Tinnitus, the perception of sound lacking an external source, is widely prevalent, affecting millions of individuals each year. When persistent and bothersome, it can impact individual quality of life and have societal implications for reduced productivity, absenteeism, and disability claims. Given the high prevalence and the broad differential, the evaluation and management of tinnitus require a thoughtful, evidence-based approach. Evidence Acquisition: Historical texts were reviewed and reconciled with recent peer-reviewed research identified through PubMed database and national, multidisciplinary published guidelines. Results: Successful management of tinnitus relies on prompt identification of causal and exacerbating factors. Tinnitus that is pulsatile, unilateral, and associated with focal neurologic changes or asymmetric hearing loss should prompt imaging studies. Comprehensive audiometry is an option for all patients with tinnitus and required for those with unilateral, persistent symptoms (lasting 6 months or longer) or associated with subjective hearing loss. A multitude of therapies, including pharmacologic, alternative, and invasive, have been investigated for subjective nonpulsatile bothersome tinnitus with limited success. Effective treatment of tinnitus relies on evaluation for causes of secondary tinnitus, mitigation of exacerbating factors, patient education, amplification of hearing loss if present, and cognitive behavioral therapy. Conclusions: Tinnitus is a frequent cause of otolaryngologic office visits; appropriate management utilizes a structured approach to assess for causes of secondary tinnitus and targeted therapeutic intervention. While a cure for primary subjective nonpulsatile tinnitus does not exist, effective therapeutic interventions do and, given the individual and societal impact, should be explored promptly without unnecessary testing or delays.