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Tinnitus Nursing Guide

Content Writer: Kathleen Koopmann, RN, BSN, PCCN

Overview: Tinnitus

This course is intended as a quick reference for tinnitus and will cover an overview as well as nursing considerations utilizing the nursing process.

Tinnitus Etiology and Epidemiology

Tinnitus is usually described as buzzing or ringing in the ears when there is no external auditory stimulus, and this buzzing or ringing is only audible to the affected person. Tinnitus can also be labeled as pulsatile tinnitus if a person hears blood pulsing or swishing in their vessels (Lenkeit & Khalili, 2022). Pulsatile tinnitus typically has a vascular cause.

Tinnitus is most commonly found in:

  • Men
  • Whites
  • People with increased body mass index
  • People with impaired hearing
  • Older adults
  • Certain careers with noise exposure such as:
    • Military service
    • Musician
    • Factory work

There are three classifications of tinnitus (DynaMed, 2022):

  • Primary: Idiopathic and may be caused by sensorineural hearing loss
  • Secondary: Typically has an underlying cause other than sensorineural hearing loss
  • Pulsatile: Related to physical changes that cause a person to hear their blood pulsing through vessels

There are many causes of tinnitus, including:

  • Trauma:
    • Cochlear damage
    • Loud noise
    • Otitis media
    • Ear drum perforation
  • Exposure to certain sounds:
    • Noise greater than 70 decibels for prolonged periods can lead to hearing loss.
    • Loud noise greater than 120 decibels can cause immediate harm to the ears.
  • Metabolic diseases, such as:
    • Heart disease
    • Hypertension
    • Diabetes
    • Ototoxic drug exposure
    • Serum zinc deficiency
  • Diseases of the ear, such as:
    • Meniere disease
    • Lesions of the 8th cranial nerve

Symptoms that may accompany the ringing or buzzing in the ears of those with tinnitus include (Grossan & Peterson, 2022):

  • Increased inner ear pressure
  • Hearing loss
  • Vertigo
  • Insomnia
  • Anxiety
  • Depression
  • Feeling of pressure in the ear

Tinnitus Diagnosis

Tinnitus is diagnosed primarily based on the person’s report of sound without an external source. It is sometimes accompanied by complaints of hearing loss. Diagnosis of tinnitus should start with a comprehensive audiology exam including:

  • A routine audiology exam for all who present with tinnitus.
  • A more comprehensive audiology exam for those with unilateral tinnitus, hearing loss, or tinnitus ≥ 6 months.
  • Bone and air conduction thresholds.
  • A complete hearing aid evaluation for anyone with hearing loss or bothersome tinnitus.

Prognosis is determined by an audiologist measuring how long they can mask the tone of the tinnitus during audiological testing. The longer the tone can be masked, the better the prognosis.

Standard comprehensive blood testing should be done, including:

  • Complete blood count with differential
  • Complete metabolic panel
  • Thyroid testing
  • Syphilis and Lyme disease testing

Imaging studies should also be completed, such as:

  • Computed tomography (CT)
  • Gadolinium-enhanced magnetic resonance imaging (MRI)
  • MR angiography (MRA) or CT angiography (CTA)
  • X-ray angiography

Tinnitus Management

If tinnitus has a diagnosed underlying cause, then the primary treatment is to manage the cause by managing symptoms and reducing the impact on the person’s life. The American Academy of Otolaryngology has recommended treatment guidelines for tinnitus (Grossan & Peterson, 2022):

  • Stress reduction: This should include biofeedback and measured breathing. Stress itself can increase the symptoms of tinnitus.
  • Cognitive therapy: The better a person understands tinnitus, the less negative they may feel about it. This can reduce stress and anxiety to help reduce symptoms.
  • Masking: The body hearing the same sound from another source can reduce the symptoms of tinnitus. Masking is introduced in several forms, such as:
    • Introducing the same sound that tinnitus makes from another source.
    • Introducing a differing sound that distracts from the tinnitus.
    • Adding music that has the tinnitus tone removed completely.
    • Adding white noises that are pleasing sounds.
  • Sleep improvement: Sleep hygiene is vital. Utilize routines and white noise when needed.

There are no medications that can treat tinnitus. Emphasis should be placed on finding what helps relieve stress and symptoms. Tinnitus retraining can help a person adapt to hearing the tinnitus. Neuromonics can help the person learn to ignore the tinnitus. Hearing aids help with hearing loss if this is a factor. Some hearing aids even come with sound masking to help overcome tinnitus.

There are some medications such as alprazolam (Xanax®) that can reduce stress, but these can become habitual. For people who do not respond well to treatments, antidepressants can be helpful.

Nursing Considerations

Tinnitus Assessment

Assess signs and symptoms, such as:

  • Airway, breathing, and circulation
  • Vital signs
  • Complaints of hearing loss
  • Continuous ringing or buzzing in the ears
  • Intermittent ringing or buzzing in the ears
  • Vertigo or dizziness
  • Insomnia
  • Anxiety
  • Depression signs or symptoms, such as:
    • Overwhelming sadness
    • Changes in sleep pattern
    • Changes in appetite
    • Decreased ability to complete activities of daily living
  • A feeling of pressure in the ear
  • Use of new medication
  • Consuming ototoxic medications such as aspirin

Nursing Diagnosis/Risk For

  • Impaired verbal communication related to hearing loss as evidenced by (Phelps, 2021a):
    • Congestion or fullness in the ears
    • Decreased hearing capacity
  • Disturbed sleep pattern related to tinnitus as evidenced by (Phelps, 2021a):
    • Continuous ringing or buzzing sound in ears

Interventions

  • Follow up with a healthcare provider or audiologist
  • Assist the person with setting up or attending an appointment for audiology testing
  • Assist the person with how to use and care for a hearing aid
  • Help the person to maintain routine sleep hygiene
  • Recommend a white noise machine
  • Monitor for changes in hearing status
  • Monitor for signs of depression
  • Decrease stimulation
  • Maintain a quiet atmosphere
  • Speak slowly and clearly
  • Eliminate background noises

Expected Outcomes

  • Remains free of depression
  • Improved quality of sleep
  • Verbalizes minimal or no anxiety
  • Maintains hearing or regains loss of hearing by receiving a hearing aid
  • Understands how to use and care for a hearing aid

Individual/Caregiver Education

Provide the following education:

  • Continue to attend follow-up appointments with the healthcare provider
  • Condition, treatment, and expected outcomes
  • Medication regimen
  • Notify a healthcare provider of:
    • Worsening symptoms
    • Sudden changes in vision
    • Feeling dizzy
    • Loss of hearing
    • Sudden numbness, tingling, or weakness in your face
    • Change in balance
    • Nausea or vomiting
  • Avoid products containing aspirin unless recommended by the healthcare provider
  • Avoid attending activities that have a high level of noise such as:
    • Concerts
    • Vehicle races
    • Sporting events
  • Continue to use music or white noise as directed by the healthcare provider

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Additional Information

Content Release Date 

4/1/2022

Content Expiration

12/31/2024

Content Contributor

The content was written by Kathleen Koopmann, RN, BSN, PCCN. Kathleen earned her Associate Degree in nursing in 1987 at Mid-Michigan Community College and her Bachelor of Science in nursing in 2018 from Western Governor’s University. She has training from the North Carolina Statewide Program for Infection Control and Epidemiology through NCDHHS and the University of North Carolina. Kathleen has worked in long-term care, outpatient care, acute care, and nursing education. She has hospital experience in Med-Surg, OR/PACU, Critical Care, Telemetry, and outpatient experience in Occupational Health. Kathleen has experience as a clinical instructor for the LPN program at Susquehanna County Career and Technical Center in Pennsylvania. Most recently, she worked in long-term care as a Staff Development Coordinator and Infection Control Practitioner.

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