Summary
Definition
History and exam
Key diagnostic factors
- history of noise exposure
- episodic sounds
- hearing loss
- vertigo
- pulsatile sounds
- clicking sounds
- visual changes
- presence of bruits or hums
- cranial nerve palsies
- cerumen (ear wax)
- abnormal otoscopy
- abnormal Weber test
- abnormal Rinne test
Other diagnostic factors
- medication history
- slow-onset progressive hearing loss
- high pitch
- low pitch
- unilateral
- bilateral
- worse with chewing
- polyuria/polydipsia
- diarrhea
- palpitations
- foreign body
Risk factors
- older age
- hearing loss
- loud noise exposure
- vestibular schwannoma
- ototoxic medications
- heavy metal exposure
- history of cerebrovascular disease
- history of multiple sclerosis
- history of head trauma
- history of depression
- history of anxiety
Diagnostic investigations
1st investigations to order
- audiometry
Investigations to consider
- CBC
- thyroid function tests
- lipid profile
- fasting glucose
- fluorescent treponemal antibody absorption assay
- MRI head
- CT temporal bones
- MR angiography or CT angiography
- carotid angiography
- auditory brainstem response (ABR)
- minimal masking level
- residual inhibition
- loudness and pitch matching
- loudness discomfort level testing
Emerging tests
- otoacoustic emissions
- functional MRI
- PET scan
- magnetoencephalographic
Treatment algorithm
known etiology
troublesome tinnitus
hearing loss on audiogram
normal hearing
Contributors
Authors
Michael D. Seidman, MD, FACS
Medical Director Otologic/Neurotologic/Skull Base Surgery
Medical Director Wellness
Advent Health Medical Group
Professor of Otolaryngology-Head and Neck Surgery
University of Central Florida
Collaborative Prof of Oto-HNS University of South FLa
Past Board of Directors American Academy of Otolaryngology-Head and Neck Surgery
Celebration
FL
Disclosures
MDS is a consultant for Acclarent, the founder of PEAK 365 Nutrition and Body Language Vitamins, and is involved in post-market studies for Envoy (noncompensated) and research for MicroTransponder, Inc (noncompensated), Auris Medical, and the National Institutes of Health. He receives royalties from seven patents. MDS is the author of several references cited in this topic.
Acknowledgements
Dr Michael D. Seidman would like to gratefully acknowledge Dr Hamid Djalilian, Dr Alice Lee, Dr Vanessa Rothholtz, and Dr Sanaz Hamidi, the previous contributors to this topic.
Disclosures
HD, AL, VR, and SH declare that they have no competing interests.
Peer reviewers
Aaron Benson, MD
Clinical Adjunct Professor
Division of Neurotology
Department of Otolaryngology Head and Neck Surgery
University of Michigan
Ann Arbor
MI
Consulting Staff
Toledo ENT
Toledo
OH
Disclosures
AB declares that he has no competing interests.
Andrew McCombe, MD, FRCS(ORL)
Consultant ENT Surgeon
Frimley Park Hospital
Portsmouth Road
Frimley
Surrey
UK
Declarações
AM declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referências
Principais artigos
Henry JA, Dennis KC, Schechter MA. General review of tinnitus: prevalence, mechanisms, effects, and management. J Speech Lang Hear Res. 2005 Oct;48(5):1204-35. Resumo
Tyler RS. Tinnitus hand book of medicine. San Diego, CA: Singular Publishing Group; 2000.
Cima RF, Maes IH, Joore MA, et al. Specialised treatment based on cognitive behaviour therapy versus usual care for tinnitus: a randomised controlled trial. Lancet. 2012 May 26;379(9830):1951-9. Resumo
Muehlmeier G, Biesinger E, Maier H. Safety of intratympanic injection of AM-101 in patients with acute inner ear tinnitus. Audiol Neurootol. 2011;16(6):388-97. Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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