Tinnitus is defined as the perception of sound without an external source.  It is a symptom and not a disease in itself.  Approximately 10% of patients have objective tinnitus where the noise is hear by the examining doctor, e.g. blood vessel narrowing.  Tinnitus can occur in children and adults and does occur in approximately 15 to 20% of adults.  Tinnitus can be heard in the head in one ear or both ears.  It may also be temporary, permanent or fluctuating.  It can occur alone or with other symptoms.  It can also be high or low pitched and improve, deteriorate or stay the same.  Tinnitus may have no effect on the patient but may significantly affect the quality of life with decreases concentration, mood changes, sleep deprivation and there is a high incidence of depression and anxiety.  The sound can be described as buzzing, ringing, pulsatile, roaring or even a hum.  The associated symptoms of the ear will be hearing loss in about 90% of patients, dizziness, weakness of the face, a fullness in the ear and often a pain or a discharging ear.  Other symptoms will be related to the systemic cause, e.g. diabetes or the central cause, for instance, a stroke or a tumour or even a local cause such as Temporomandibular Joint abnormalities.