Disorders of the endocrine system can appear with tinnitus, although the mechanism is sometimes unclear. Addison's disease can present with hyperacusis, a condition closely related to tinnitus (8). Hyperacusis is a subjective sensitivity to sound where people find sounds of intensities typical in the world to be uncomfortable. Approximately 50% of people with tinnitus have hyperacusis. Hypothyroidism can present with tinnitus [(3), p. 32]. There may be a link between subclinical depression, hypothyroidism, and tinnitus. As described above, the hyperdynamic cardiac state that appears in pregnancy can result in a pulsatile objective tinnitus; however, the hormonal changes that occur with pregnancy and premenstrually also appear to have an influence on the auditory system and can trigger the common subjective tinnitus sensations.
Paraneoplastic syndrome was first described by Moersch (9). In this syndrome, malignant tumors manifest antibody sites against which immune responses are developed. The immune responses can cross-react with neural tissues, typically cerebellar or brainstem. Thus, unusually, tinnitus may be the first manifestation of a remote pulmonary or renal tumor (10). Soon after the appearance of tinnitus, more severe brainstem or cerebellar symptoms appear, including ataxia, hearing loss, diplopia, and uncontrollable nystagmus.
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