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Tinnitus: Diagnosis and Management.
Am Fam Physician. 2021 06 01; 103(11):663-671.AF

Abstract

Tinnitus is the sensation of hearing a sound in the absence of an internal or external source and is a common problem encountered in primary care. Most cases of tinnitus are benign and idiopathic and are strongly associated with sensorineural hearing loss. A standard workup begins with a targeted history and physical examination to identify treatable causes and associated symptoms that may improve with treatment. Less common but potentially dangerous causes such as vascular tumors and vestibular schwannoma should be ruled out. A comprehensive audiologic evaluation should be performed for patients who experience unilateral tinnitus, tinnitus that has been present for six months or longer, or that is accompanied by hearing problems. Neuroimaging is not part of the standard workup unless the tinnitus is asymmetric or unilateral, pulsatile, associated with focal neurologic abnormalities, or associated with asymmetric hearing loss. Cognitive behavior therapy is the only treatment that has been shown to improve quality of life in patients with tinnitus. Sound therapy and tinnitus retraining therapy are treatment options, but evidence is inconclusive. Melatonin, antidepressants, and cognitive training may help with sleep disturbance, mood disorders, and cognitive impairments, respectively. Avoidance of noise exposure may help prevent the development or progression of tinnitus. Providing information about the natural progression of tinnitus and being familiar with the causes that warrant additional evaluation, imaging, and specialist involvement are essential to comprehensive care.

Authors+Show Affiliations

University of Virginia, Charlottesville, VA, USA.University of Virginia, Charlottesville, VA, USA.University of Virginia, Charlottesville, VA, USA.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

34060792

Citation

Dalrymple, Sarah N., et al. "Tinnitus: Diagnosis and Management." American Family Physician, vol. 103, no. 11, 2021, pp. 663-671.
Dalrymple SN, Lewis SH, Philman S. Tinnitus: Diagnosis and Management. Am Fam Physician. 2021;103(11):663-671.
Dalrymple, S. N., Lewis, S. H., & Philman, S. (2021). Tinnitus: Diagnosis and Management. American Family Physician, 103(11), 663-671.
Dalrymple SN, Lewis SH, Philman S. Tinnitus: Diagnosis and Management. Am Fam Physician. 2021 06 1;103(11):663-671. PubMed PMID: 34060792.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tinnitus: Diagnosis and Management. AU - Dalrymple,Sarah N, AU - Lewis,Sarah H, AU - Philman,Samantha, PY - 2021/6/1/entrez PY - 2021/6/2/pubmed PY - 2021/7/20/medline SP - 663 EP - 671 JF - American family physician JO - Am Fam Physician VL - 103 IS - 11 N2 - Tinnitus is the sensation of hearing a sound in the absence of an internal or external source and is a common problem encountered in primary care. Most cases of tinnitus are benign and idiopathic and are strongly associated with sensorineural hearing loss. A standard workup begins with a targeted history and physical examination to identify treatable causes and associated symptoms that may improve with treatment. Less common but potentially dangerous causes such as vascular tumors and vestibular schwannoma should be ruled out. A comprehensive audiologic evaluation should be performed for patients who experience unilateral tinnitus, tinnitus that has been present for six months or longer, or that is accompanied by hearing problems. Neuroimaging is not part of the standard workup unless the tinnitus is asymmetric or unilateral, pulsatile, associated with focal neurologic abnormalities, or associated with asymmetric hearing loss. Cognitive behavior therapy is the only treatment that has been shown to improve quality of life in patients with tinnitus. Sound therapy and tinnitus retraining therapy are treatment options, but evidence is inconclusive. Melatonin, antidepressants, and cognitive training may help with sleep disturbance, mood disorders, and cognitive impairments, respectively. Avoidance of noise exposure may help prevent the development or progression of tinnitus. Providing information about the natural progression of tinnitus and being familiar with the causes that warrant additional evaluation, imaging, and specialist involvement are essential to comprehensive care. SN - 1532-0650 UR - https://www.unboundmedicine.com/medline/citation/34060792/Tinnitus:_Diagnosis_and_Management_ L2 - https://www.aafp.org/link_out?pmid=34060792 DB - PRIME DP - Unbound Medicine ER -