Tinnitus

 In this article, a number of common questions about the diagnosis and treatment of tinnitus are discussed, based on the first author’s PhD thesis. It is hoped that this will help general practitioners when deciding whether to refer a patient with tinnitus to an otorhinolaryngologist or an audiological centre. Tinnitus is defined as an auditory phantom perception of meaningless sounds. It is a common condition (prevalence 7-19%), and while most patients experience only mild symptoms, a small proportion suffers from severe tinnitus symptoms and an impaired quality of life. Tinnitus is generally caused by hearing loss, in particular age-related (presbycusis) or noise-induced hearing loss and familial hearing loss. The studies presented in the PhD thesis show that: 1) the severity of tinnitus is associated with various tinnitus characteristics and health-related factors, 2) a routine MRI is of little or no value in patients with tinnitus with persistent (longer than 3 months) symptoms, and 3) there is currently no therapy available to cure tinnitus. All patients with tinnitus should undergo screening audiometry, to assess whether they should be referred to an otorhinolaryngologist or an audiological centre. Referral should be considered in patients with unilateral tinnitus and/or serious symptoms. Patients should be told why this is necessary and informed about the effectiveness of various treatment options. A stepwise approach to the care of tinnitus patients is advised.