tinnitus
Enable an agent to recognise and describe a person's tinnitus experience, track its impact and uncertainty, and support appropriate assessment and management decisions.
Research draft, second pass
A second pass drafted this model: the structure a model of this thing needs, and what is known about it in the world. The line under this one says how the second half was obtained - researched against sources, or recalled without web access, in which case nothing here was read anywhere and every claim is a lead to verify. Unreviewed either way.
recalled by Codex without web access - no source was read
Researched by: Codex
Purpose and description
Enable an agent to recognise and describe a person's tinnitus experience, track its impact and uncertainty, and support appropriate assessment and management decisions.
Tinnitus is the perception of sound without a corresponding external acoustic source, typically experienced as ringing, buzzing, hissing or other sounds in one or both ears or within the head.
It can be Elicit a structured account of the tinnitus percept while retaining the person's own wording.; Compare repeated observations using consistent scales and recording contexts.; Identify missing assessment information and route concerns through a current, locally applicable clinical pathway.; Separate candidate causes, associated conditions and unsupported causal claims.; Support shared selection and review of management goals without autonomously diagnosing or prescribing.; Prepare a concise assessment summary that distinguishes reported experience, measured findings and unresolved questions..
Distinguishing features
Determine whether the reported sound has a corresponding external source; an unnoticed environmental sound is not established as tinnitus merely because others do not hear it.
Record whether the experience is ringing, buzzing, hissing, clicking or another sound; the word 'ringing' alone must not define eligibility.
Distinguish an elementary sound percept from intelligible speech or music, leaving uncertain or mixed experiences open to further assessment.
Separate sound presence from sound intolerance: discomfort caused by actual sounds does not by itself establish tinnitus.
Test whether a rhythmic percept follows the heartbeat, and distinguish patient-reported synchrony from an examiner's detection of a bodily sound.
Scope
+ The reported sound percept, its location, temporal pattern and circumstances
+ Distinctions between subjective tinnitus, suspected bodily sound sources and other auditory experiences
+ Onset, persistence, fluctuations and associated symptoms
+ Effects on sleep, concentration, communication, participation and emotional wellbeing
+ Assessment evidence, unresolved explanations and management outcomes
- Complete models of hearing loss, ear disease, vascular conditions or neurological disorders
- External environmental noise and its source investigation
- Auditory hallucinations beyond the boundary assessment needed to characterise the reported experience
- General psychiatric diagnoses or sleep disorders
- Hearing-device engineering, drug prescribing and procedural treatment protocols
Characteristics
- Evidence and assessment status
- self-reported; clinically characterised; uncertain; alternative explanation documented Prevents an experience report from being mistaken for a confirmed cause or completed assessment.
- Perceived sound qualities
- person's description; tonal, noise-like, clicking, mixed or other; single or multiple percepts Preserves the actual experience without restricting tinnitus to ringing.
- Perceived location
- left ear; right ear; both ears; within head; other; uncertain Supports comparison over time and context-sensitive assessment.
- Temporal course
- onset date or estimate; episode duration; frequency; continuous or intermittent; stable, improving or worsening Distinguishes recent change, recurrent episodes and persistent experience without imposing an unexplained duration threshold.
- Heartbeat synchrony
- reported synchronous; reported nonsynchronous; uncertain; not assessed; independently assessed with method Preserves an assessment-relevant distinction without equating all rhythmic sounds with pulsatile tinnitus.
- Perceived loudness
- named self-rating scale and anchors; optional loudness match with method and dB reference Allows interpretable tracking while keeping subjective ratings separate from acoustic matching.
- Functional burden
- domain-specific reports; named questionnaire, version, score range and assessment date Captures disability and distress that cannot be inferred from loudness alone.
- Associated findings and candidate contributors
- linked symptoms, hearing assessments, exposures, conditions or medicines; timing, evidence source and causal confidence Keeps temporal associations and hypotheses distinct from established explanations.
- Modulation
- reported change with ambient sound, jaw or neck movement, posture, activity or other context; direction and repeatability Documents reproducible patterns without treating modulation as proof of cause.
- Management response
- approach, target outcome, dates, adherence, benefit, adverse effects and uncertainty Distinguishes changes in percept, distress and functioning.
Where this came from
wikidata · CC0 1.0
Also registered as vr.tr.tinnitus
Drafted structure
Bundle to layer to finding to question, as the second pass will find it: 6 bundles · 11 layers · 19 findings · 29 questions.
Percept and boundaries Establish what the person hears and whether tinnitus is an appropriate description.
An agent must distinguish the experienced sound from external noise and neighbouring auditory phenomena.
Sound description
Capture the percept without forcing it into a single conventional label.
Percept profile
Record sound quality, perceived location and whether distinct sounds coexist.
- How does the person describe the sound, and are there several distinguishable percepts? definition
- Where is each sound perceived, and does its location change? measurement
Auditory boundary assessment
Record evidence for and against alternative descriptions of the experience.
Source and experience distinction
Separate external sound, suspected bodily sound, sound intolerance and speech- or music-like experiences.
- What evidence distinguishes this experience from an external sound or discomfort elicited by actual sounds? boundary
- Does it include intelligible speech or music, or an examiner-detectable sound, and how was that established? provenance
Course and modulation Describe onset, recurrence and changes across time and circumstances.
A single tinnitus label obscures meaningful differences between episodes, persistent symptoms and new changes.
Onset and trajectory
Anchor the experience to a timeline with explicit uncertainty.
Episode history
Record first awareness, onset pattern, continuity and subsequent trajectory.
- When was the sound first noticed, how suddenly did it begin, and how certain is that history? provenance
- How long do episodes last, how often do they occur, and what has changed since onset? measurement
Rhythm and context
Characterise rhythmic patterns and reproducible contextual changes.
Synchrony and modifiers
Keep heartbeat synchrony and contextual modulation as observations rather than causal conclusions.
- Is the sound rhythmic, and has synchrony with the heartbeat been reported or assessed? measurement
- Which sound environments, movements, postures or activities change it, and how repeatable are those changes? measurement
Burden and personal goals Represent percept intensity, distress and interference as distinct dimensions.
Management priorities depend on lived impact and cannot be inferred from the apparent loudness of tinnitus.
Percept measurement
Make loudness and awareness observations interpretable and comparable.
Loudness and awareness
Record rating methods, observation context and optional psychoacoustic measurements separately.
- How loud or noticeable is the tinnitus using a specified scale, time window and listening context? measurement
- If pitch or loudness matching was performed, what method, units and limitations were documented? provenance
Life interference
Capture effects on activities and the outcomes the person values.
Impact and priorities
Describe sleep, attention, communication, emotional burden and participation without assuming equal impact.
- Which activities or aspects of wellbeing are affected, and what reports or named measures support that assessment? measurement
- Which concrete improvement would matter most to the person even if the sound remained present? action
Assessment and explanatory evidence Organise associated findings, candidate contributors and assessment needs.
Tinnitus characterisation must support appropriate evaluation while avoiding unsupported attribution to a single cause.
Associated findings
Link relevant history and examinations with their sources and dates.
Hearing and contributor evidence
Record hearing status, concurrent symptoms and candidate contributors with explicit causal confidence.
- What hearing changes, ear symptoms, balance symptoms or other associated findings were reported or assessed, and when? provenance
- What supports each proposed connection to an exposure, condition or medicine beyond its occurrence near tinnitus onset? provenance
Assessment routing
Represent the evidence and current guidance needed to choose a next assessment step.
Urgency and unresolved assessment
Track assessment-relevant features and immediate wellbeing concerns without embedding an unverified triage rule.
- Have sudden hearing changes, unilateral symptoms, heartbeat synchrony, neurological symptoms and severe distress or self-harm concerns been assessed? boundary
- Which current local guideline determines the appropriate timing and destination of assessment for the recorded features? action
Management and follow-up Connect individual goals, management choices and observed outcomes.
An agent must distinguish relief of distress or interference from reduction of the sound and account for uncertain benefit.
Management selection
Record the rationale and evidence behind an agreed approach.
Goal-linked plan
Link each approach to its target, evidence basis, professional involvement and the person's preferences.
- Is the approach intended to address an identified contributor, hearing difficulty, distress, sleep disruption or the percept itself? definition
- What evidence, clinician advice and personal preferences support this choice, and what uncertainties were discussed? provenance
Response and reassessment
Evaluate benefit and burden against baseline observations and agreed goals.
Outcome review
Separate changes in tinnitus perception, functioning and distress while accounting for concurrent changes.
- What changed in loudness, awareness, distress and daily functioning, using comparable baseline and follow-up observations? measurement
- What adverse effects, lack of benefit or new symptoms justify reviewing the plan or seeking reassessment? action
Evidence and external alignment What the world already says about this thing, gathered so the model can be checked against it.
A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.
Reported evidence
Findings from the breadth pass, kept separate from the structural claims.
Check these first
Recalled without web access and unsourced; every item is a lead to verify.
- This describes the clinical symptom or condition, not an abstract concept; the supplied domain classification should be reviewed.
- The listed kinds overlap: pulsatile tinnitus is not necessarily objective, and bothersomeness is independent of the sound's mechanism.
- Recalled guideline identifiers, current recommendations and coding details should be verified; definitions of persistent or chronic tinnitus vary between frameworks.
- Which of these check these first hold for the sense of tinnitus this model covers, and on what evidence? provenance
Kinds and varieties
Recalled without web access and unsourced; every item is a lead to verify.
- Subjective tinnitus, perceived only by the affected person
- Objective tinnitus, arising from a bodily sound source that may also be detectable by an examiner
- Pulsatile tinnitus, typically perceived in time with the heartbeat
- Non-pulsatile tinnitus
- Bothersome tinnitus
- Non-bothersome tinnitus
- Which of these kinds and varieties hold for the sense of tinnitus this model covers, and on what evidence? provenance
Identifiers and schemes
Recalled without web access and unsourced; every item is a lead to verify.
- ICD-10 - H93.1 - Tinnitus; national clinical modifications may provide additional codes for laterality.
- Which of these identifiers and schemes hold for the sense of tinnitus this model covers, and on what evidence? provenance
Standards and regulation
Recalled without web access and unsourced; every item is a lead to verify.
- NICE guideline NG155, Tinnitus: assessment and management, issued by the National Institute for Health and Care Excellence
- Clinical Practice Guideline: Tinnitus, issued by the American Academy of Otolaryngology-Head and Neck Surgery Foundation
- Which of these standards and regulation hold for the sense of tinnitus this model covers, and on what evidence? provenance
Real-world use
Recalled without web access and unsourced; every item is a lead to verify.
- Clinical assessment distinguishes the perceived sound from its possible underlying causes and evaluates its impact.
- Audiological assessment identifies accompanying hearing loss and informs hearing rehabilitation.
- Patient-reported questionnaires measure functional impact and change during management.
- Cognitive behavioural therapy is used to reduce tinnitus-related distress and interference with daily life.
- Research investigates auditory processing, attention and emotional responses associated with persistent tinnitus.
- Which of these real-world use hold for the sense of tinnitus this model covers, and on what evidence? provenance
Typical measurements
Recalled without web access and unsourced; every item is a lead to verify.
- Tinnitus Handicap Inventory total score - 0-100, the instrument's possible range rather than a typical patient range - points
- Tinnitus Functional Index total score - 0-100, the instrument's possible range rather than a typical patient range - points
- Which of these typical measurements hold for the sense of tinnitus this model covers, and on what evidence? provenance
Failure modes and hazards
Recalled without web access and unsourced; every item is a lead to verify.
- Persistent bothersome tinnitus can disrupt sleep, concentration and daily functioning.
- Severe tinnitus-related distress can coexist with anxiety, depression or suicidal thoughts.
- Attributing all tinnitus to benign hearing loss can overlook an underlying vascular, middle-ear or other disorder.
- Tinnitus accompanying sudden hearing loss can be part of a time-sensitive clinical presentation.
- Perceived loudness alone can underestimate distress and functional impairment.
- Which of these failure modes and hazards hold for the sense of tinnitus this model covers, and on what evidence? provenance
Regional variation
Recalled without web access and unsourced; every item is a lead to verify.
- Diagnostic coding differs between the WHO ICD classification and national clinical modifications.
- Access to audiology, hearing aids and tinnitus-focused psychological care varies between health systems.
- Which of these regional variation hold for the sense of tinnitus this model covers, and on what evidence? provenance
Neighbouring kinds and how to tell them apart
Recalled without web access and unsourced; every item is a lead to verify.
- Hearing loss - Hearing loss reduces the ability to detect or understand external sounds; tinnitus adds a sound percept without a corresponding external source, and either can occur without the other.
- Hyperacusis - Hyperacusis involves reduced tolerance of external sounds; tinnitus is a sound percept that does not require an external sound.
- Misophonia - Misophonia involves strong reactions to particular sound triggers or associated stimuli; tinnitus concerns the perception of sound without a corresponding external source.
- Auditory hallucination - The terminology overlaps broadly, but tinnitus usually denotes relatively simple sounds; voices or structured music generally require a different clinical characterization.
- Which of these neighbouring kinds and how to tell them apart hold for the sense of tinnitus this model covers, and on what evidence? provenance
What the second pass must settle
- Which consensus definition should govern the boundary between tinnitus, detectable bodily sounds and complex auditory experiences?
- Which duration thresholds and distinctions between tinnitus presence and tinnitus disorder should be adopted, and from which authorities?
- Which measures and meaningful-change thresholds are appropriate across ages, languages and assessment settings?
- Which current jurisdiction-specific pathways should govern urgency, referral and further investigation for different symptom patterns?
- How strong is the evidence for proposed tinnitus subtypes and individual predictors of management response?