Tinnitus: The Daily PANCE Blueprint
A 55-year-old male develops ringing in both ears after taking high-dose NSAIDs for arthritis. Which of the following is the most appropriate management?
A. Discontinue the NSAID
B. Start meclizine
C. Give corticosteroid ear drops
D. Order an MRI of the brain and internal auditory canal
Answer and topic summary
The answer is A. Discontinue the NSAID
Tinnitus is the perceived sensation of a ringing sound; it may be heard in just one or both ears. It is relatively common and impacts about 10-15% of adults. The precise pathophysiology is unknown. Some etiologies include: ototoxic medications (NSAIDs, aspirin, aminoglycosides, loop diuretics, etc), cerumen impaction, vestibular schwannoma, Meniere disease, MS, infections, vascular issues (AV fistula or malformation, carotid stenosis, etc). There is no confirmatory test as tinnitus is a symptom. Testing depends on one’s clinical judgment. Management includes reassurance, discontinuing ototoxic medications, possibly hearing aids, cognitive behavioral therapy, treating any underlying issue, and relaxation therapy. No medication has been shown to help.
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