Objective tinnitus

Douglas J Lanska MD FAAN MS MSPH (Dr. Lanska of the Great Lakes VA Healthcare System and the University of Wisconsin School of Medicine and Public Health has no relevant financial relationships to disclose.)
Originally released September 17, 2001; last updated January 30, 2017; expires January 30, 2020

Overview

The author explains the clinical presentation, pathophysiology, diagnostic workup, and management of objective tinnitus. Objective tinnitus is a perceived sensation of sound that occurs in the absence of external acoustic stimulation, but can also be heard by the examiner (eg, by placing a stethoscope over the patient's external auditory canal). Objective tinnitus is much less common than subjective tinnitus, but it often has an identifiable cause and may be curable, whereas subjective tinnitus is often idiopathic and is seldom curable.

Key points

 

• Objective tinnitus is a perceived sensation of sound that occurs in the absence of external acoustic stimulation but that can be also be heard by the examiner (eg, by placing a stethoscope over the patient's external auditory canal).

 

• Objective tinnitus can occur either from perception of an abnormal somatosound or abnormal perception of a normal somatosound.

 

• Objective tinnitus is much less common than subjective tinnitus, but it often has an identifiable cause and may be curable, whereas subjective tinnitus is often idiopathic and is seldom curable.

 

• Tinnitus is frequently associated with depression (in up to half of patients) as well as anxiety and insomnia.

 

• Objective tinnitus may be associated with a variety of vascular noises arising from the internal jugular vein or jugular bulb, arteriovenous malformations or fistulas, cavernous hemangiomas, aneurysms, vascular stenoses (particularly of the carotid arteries), vascular tumors, and intracranial hypertension.

 

• The cervical venous hum is a common but innocuous murmur that can be heard in the anterior neck and sometimes upper chest and that is often mistaken for more sinister sounds. A venous hum is caused by turbulence (ie, disruption of the otherwise smooth laminar flow into turbulent eddies) in the internal jugular vein, which causes the vessel walls to vibrate. This is precipitated or accentuated with turning the head away from the auscultated side.

 

• Objective tinnitus associated with a patulous Eustachian tube is synchronous with nasal breathing (usually more marked in the upright position), gradually disappears with lying down, and often transiently abates with sniffing, snorting, or a Valsalva maneuver.

 

• Objective tinnitus associated with abnormal clonic muscular contractions of palatal or middle ear muscles may occur as an intermittent series of sharp, regular clicks or with palatal myoclonus as a fairly regular, continuous clicking sound.

Historical note and terminology

Objective tinnitus is a perceived sensation of sound that occurs in the absence of external acoustic stimulation but that can be also be heard by the examiner (eg, by placing a stethoscope over the patient's external auditory canal). Objective tinnitus can occur either from perception of an abnormal somatosound or abnormal perception of a normal somatosound (Hertzano et al 2016). Objective tinnitus is much less common than subjective tinnitus, but it often has an identifiable cause and may be curable, whereas subjective tinnitus is often idiopathic and is seldom curable.

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