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Editorial

Tinnitus: Overview Hanyang Med Rev 2016;36:79-80 http://dx.doi.org/10.7599/hmr.2016.36.2.79 pISSN 1738-429X  eISSN 2234-4446

Chul Won Park Department of Otolaryngology and Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea

Tinnitus is defined as a perception of sound in the absence of a

derlying conditions. Classically tinnitus is considered as an oto-

corresponding external acoustic stimulus [1]. Tinnitus is distin-

logical disease, however some cases of tinnitus can be a warning

guished from auditory hallucinations, which frequently occur in

sign of a life-threatening condition such as vestibular schwanno-

patients with schizophrenia or other psychiatric disorders. While

ma or intracranial aneurysm [4,6]. In addition, its psychological

auditory hallucinations usually contain music playing or talking

influence can develop into a mood disorder leading to suicide [3].

voice, tinnitus manifest as an unformed nature sound. Tinnitus

Therefore, to access underlying cause and sequelae of tinnitus is a

patients usually describe the character of sound as ringing, crick-

very important step for comprehensive tinnitus diagnosis.

ets, roaring, ocean sound, buzzing, etc.

Treatment of tinnitus is very challenging. Considering the un-

Tinnitus is a very prevalent symptom, prevalence of tinnitus in

derlying cause and comorbid disease, tinnitus managements in-

Korean adults is estimated to be 19.7%. Among those with tinni-

clude pharmacological therapy, intratympanic steroid injection,

tus, 29.3% suffered annoying tinnitus that affected daily life [2].

tinnitus retraining therapy, and cognitive behavioral therapy. In

Clinical manifestation of tinnitus is heterogeneous which makes

addition, surgical management, such as cochlear implantation

it difficult to reveal its etiology. Tinnitus usually manifest with ac-

and microvascular decompression attempt to eliminate tinnitus.

companying symptoms including anxiety, depression, insomnia,

Recently, experimental treatment of transcranial magnetic stimu-

hearing loss and hyperacusis, which lower the quality of life [3].

lation and vagus nerve stimulation accumulate the clinical evi-

In general, tinnitus can be classified as subjective and objective

dence for their treatment relevance.

tinnitus [4]. An involuntary movement of middle ear muscle and

Herein, we review the pathophysiologic mechanism of tinnitus

turbulent sound of venous sinus or constricted artery can cause

[7] and the role of functional image in tinnitus research [8]. Tinni-

objective tinnitus that can be audible to an observer with a stetho-

tus and its psychological connections are also discussed [9]. Objec-

scope, while subjective tinnitus is meaningless noise which is not

tive tinnitus which has different pathophysiology and manage-

associated with physical sound. Subjective tinnitus is more preva-

ment protocol is reviewed separately [10]. The assessment strategy

lent than objective tinnitus.

for tinnitus [11] and several important management tools for sub-

Due to the diverse clinical manifestations, the pathophysiologic

jective tinnitus including classical pharmacological intervention

mechanism of tinnitus is unclear. However, lots of attempts have

[12], tinnitus retraining therapy [13], intratympanic steroid injec-

been made trying to find the underlying mechanism of tinnitus

tion [14], microvascular decompression surgery [15], and newly

generation. And recent advances in neuroimaging and develop-

developed techniques of transcranial magnetic stimulation or va-

ment of animal models expand the pathophysiologic understand-

gus nerve stimulation [16], are systemically discussed.

ing of this condition [1,5].

We expect that this review will provide important guidelines for

Tinnitus is not a disease entity, rather a symptom of various un-

physicians to access and manage tinnitus patients.

Correspondence to: Chul Won Park Department of Otolaryngology and Head and Neck Surgery, Hanyang University College of Medicine, 222-Wangshimni-ro, Seongdong-gu, Seoul 04763, Korea Tel: +82-2-2290-8580, Fax: +82-2-2293-3335, E-mail: [email protected] This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecom­mons.org/licenses/by-nc/3.0) which permits un­restricted non-commercial use, distribution, and reproduction in any medium, provided the origi­nal work is properly cited.

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© 2016 Hanyang University College of Medicine • Institute of Medical Science

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Chul Won Park • Tinnitus: Overview

REFERENCES 1. Langguth B, Kreuzer PM, Kleinjung T, De Ridder D. Tinnitus: causes and clinical management. Lancet Neurol 2013;12:920-30. 2. Park KH, Lee SH, Koo JW, Park HY, Lee KY, Choi YS, et al. Prevalence and associated factors of tinnitus: data from the Korean National Health and Nutrition Examination Survey 2009-2011. J Epidemiol 2014;24:41726. 3. Seo JH, Kang JM, Hwang SH, Han KD, Joo YH. Relationship between Tinnitus and Suicidal Behavior in Korean Men and Women: a Cross-sectional Study. Clin Otolaryngol 2015. 4. Bae SC, Kim DK, Yeo SW, Park SY, Park SN. Single-center 10-year experience in treating patients with vascular tinnitus: diagnostic approaches and treatment outcomes. Clin Exp Otorhinolaryngol 2015;8:7-12. 5. Brozoski TJ, Bauer CA. Animal models of tinnitus. Hear Res 2015. 6. Broomfield SJ, O’Donoghue GM. Self-reported symptoms and patient experience: a British Acoustic Neuroma Association survey. Br J Neurosurg 2015:1-8.

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7. Chung JH, Lee SH. The pathophysiologic mechanism of tinnitus. Hanyang Med Rev 2016;36:81-5. 8. Kim JH, Lee HJ. Functional imaging in tinnitus. Hanynag Med Rev 2016; 36:86-91. 9. Jang EY, Yi JH. The Role of Psychological Factors in Tinnitus. Hanyang Med Rev 2016;36:92-8. 10. Park SN. Objective tinnitus. Hanynag Med Rev 2016;36:99-108. 11. Yang CW, Byun JY. Tinnitus assessment. Hanyang Med Rev 2016;36: 109-12. 12. Park SY. Pharmacological treatments for tinnitus. Hanyang Med Rev 2016; 36:113-9. 13. Shin JW, Lee HK. Tinnitus retraining therapy. Hanyang Med Rev 2016; 36:120-4. 14. Shim HJ. Intratympanic steroid injection in tinnitus management. Hanyang Med Rev 2016;36:125-30. 15. Ko Y. Microvascular decompression for tinnitus. Hanyang Med Rev 2016;36:131-5. 16. Lee JM, Moon IS. Neuromodulation for the treatment of tinnitus. Hanyang Med Rev 2016;36:136-41.

Hanyang Med Rev 2016;36:79-80