Feature Article

Tinnitus: revisiting the phantom sound

John Curotta



Beethoven, although he is better known for going deaf, was afflicted by tinnitus. So was the composer Smetana, who incorporated the note he heard into one of his string quartets. Michelangelo had it too, and wrote of his affliction: ‘A spider’s web is hidden in one ear, and in the other a cricket sings throughout the night’.

Key Points

  • Tinnitus is now considered to be a disorder of the processing of electrical activity in the auditory pathways of the central nervous system, rather than a disorder of the ear.
  • When the presentation is persisting tinnitus in one ear, evaluation for a retrocochlear lesion must be carried out, even if the hearing is normal.
  • Patients often worry that tinnitus might indicate a brain tumour or never go away. The basis of management is the rational reassurance that tinnitus is not indicative of any serious medical condition and that it can and will subside.
  • Tinnitus management emphasises avoiding fluctuations in anything which may impact on tinnitus (including certain medications and excessively loud sounds or excessively quiet surroundings), and recognising and minimising stress.
  • Referral to an ENT surgeon should be considered for a patient who has tinnitus that is unilateral, of recent or abrupt onset, or accompanied by balance or hearing difficulties. Referral should also be considered if there is no clear diagnosis and further investigation is needed, or if the patient requests a specialist assessment.