Tinnitus. Diagnosis and treatment of this elusive symptom.

More than 37 million Americans experience tinnitus, and adults age 40 to 70 are most often affected. Tinnitus is a symptom, not a disease, and as such has many different causes. Tinnitus is classified as vibratory and nonvibratory and is further subdivided into objective and subjective categories. The evaluation of tinnitus always begins with a thorough history and physical examination, with further testing performed when indicated. Many medical and nonmedical treatments exist, with varying degrees of success and safety. Once the physician determines that the patient does not have a life-threatening or obviously treatable underlying condition, the patient should be counseled, reassured that the tinnitus is not a life-threatening disease, and offered appropriate treatment. The degree to which the tinnitus bothers the patient will help determine the extent of treatment necessary.