Comparison of Subjective vs. Objective Tinnitus (ENT Guide)

Comparison of the Subjective vs. Objective Tinnitus for ENT

Definitions of Tinnitus Types

• Subjective Tinnitus (S-Tinnitus):
  A perception of sound (e.g., ringing, buzzing, hissing) heard only by the patient, with no actual external or internal sound source detectable by others. It is the most common form of tinnitus.

• Objective Tinnitus (O-Tinnitus):
  A rare form of tinnitus where a real sound is generated within the body (e.g., by vascular or muscular activity) and can sometimes be heard by an examiner using a stethoscope.

---

Comparison Table: Subjective vs. Objective Tinnitus

Feature	Subjective Tinnitus	Objective Tinnitus
Perception	Heard only by the patient	Can be heard by examiner (with tools)
Cause	Often neurological or auditory	Usually mechanical or vascular
Common Examples	Noise-induced hearing loss, ototoxic drugs	Vascular bruits, palatal myoclonus
Prevalence	Very common (>95% of cases)	Very rare (<5% of cases)
Audibility to Others	Not audible to others	Audible to others (e.g., with stethoscope)
Sound Characteristics	Ringing, buzzing, hissing	Pulsatile or clicking
Associated Disorders	Cochlear damage, Meniere’s disease	AV malformations, muscle spasms
Diagnostic Approach	Audiometry, MRI, ENT exam	Stethoscope exam, Doppler, imaging
Treatment Focus	Symptom management, sound therapy	Treat underlying physical cause

Let me know if you’d like this in a downloadable format or visual chart.

Objective tinnitus is a rare form of tinnitus where the sound can actually be heard by an examiner, often through a stethoscope placed near the ear. It is usually caused by internal bodily sounds, and often has a physical/mechanical source. Here’s a list of common causes of objective tinnitus:

Vascular Causes (Pulsatile Tinnitus)

1. Arteriovenous malformations (AVMs)

2. Carotid artery stenosis or dissection

3. Glomus tumors (paragangliomas)

4. Dural arteriovenous fistulas

5. Aberrant carotid artery

6. Persistent stapedial artery

7. Increased intracranial pressure (e.g., idiopathic intracranial hypertension)

8. Venous hums (especially in high-flow states like anemia or pregnancy)

Muscular Causes (Myoclonic Tinnitus)

9. Tensor tympani muscle spasms

10. Stapedius muscle spasms

11. Palatal myoclonus (rhythmic contractions of the soft palate)

12. Middle ear myoclonus (can involve both tensor tympani and stapedius)

Patulous Eustachian Tube

13. Abnormally open Eustachian tube – allows internal sounds (like breathing or voice) to be heard more clearly.

Other Causes

14. Vascular tumors near the ear (e.g., hemangiomas)

15. High cardiac output states (e.g., hyperthyroidism, anemia)

Would you like a diagram showing where these conditions occur in the head and ear?