Perception of sound in the absence of sound from the external environment. Common. M=F. Increased with noise exposure, obesity, DM, high BP, dyslipidaemia, anxiety. Primary: associated with hearing loss. Secondary: underlying cause/diagnosis other than hearing loss.

Assess: characteristics, uni/bilateral, continuous/episodic, pulsatile, hearing loss? Associated dizziness, vertigo. Subjective/objective. ENT examination. Weber/Rinne. CN. BP, CVS examination. BT: FBC (anaemia), thyroid, lipids, HBA1c. Audiogram.

Subjective: can only be hear by affected individual. Abnormality of inner ear of CNS. Subjective unilateral + sensorineural hearing loss (Meniere's, acoustic neuroma), bilateral (age-related heading loss, noise-induced, drug-induced e.g. aspirin, NSAID, abx, loop diuretics, cytotoxic). Subjective uni- or bilateral + conductive hearing loss suspect middle/outer ear disorder (e.g. wax, OM, cholersteatoma), otosclerosis. HI, neck injury, MS, DM, thyroid.

Objective (1%): can also be heard by examiner. Identifiable source close to ear e.g. vascular (AV malformation, vascular tumour, carotid stenosis/aneurysm, AS/MR, anaemia, patulous eustachian tube) or muscle-related noise. refer ENT. Pulsitile: immediate referral. Tinnitus (CKS), British Tinnitus Association