Tinnitus is the perception of sound in the absence of an objective internal or external source. Tinnitus is a symptom, not a disease, and although it is typically not associated with a dangerous condition, it can significantly affect an individual’s quality of life. Guidelines recommend a standard approach to history and physical examination to determine the etiology, followed by audiometric testing and imaging, laboratory studies, and other testing as appropriate. Cognitive behavior therapy is the only treatment that has been shown to improve quality of life in patients with tinnitus. Avoidance of noise exposure may prevent the development or progression of tinnitus.

Polycythemia vera is a common myeloproliferative neoplasm characterized by erythrocytosis, often with associated leukocytosis and thrombocytosis. It has a significant negative impact on overall mortality and morbidity in the form of arterial and venous clots, fatigue, pruritus, and conversion to leukemia and myelofibrosis. Major diagnostic criteria include elevated hemoglobin or hematocrit level, abnormal bone marrow biopsy, and presence of the Janus kinase 2 genetic mutation. First-line treatments, such as low-dose aspirin and goal-directed phlebotomy to a hematocrit level of less than 45% to reduce thrombotic events, improve quality of life and prolong survival.

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