Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- 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
Otros factores de diagnóstico
- history of ototoxic drug use
- slow-onset progressive hearing loss
- high pitch
- low pitch
- unilateral
- bilateral
- worse with chewing
- polyuria/polydipsia
- diarrhea
- palpitations
- foreign body
Factores de riesgo
- aging and older age
- hearing loss
- loud noise exposure
- vestibular schwannoma
- migraine
- use of ototoxic drugs
- exposure to heavy metals
- history of cerebrovascular disease
- history of multiple sclerosis
- history of head trauma
- history of depression
- history of anxiety
- micronutrient deficiency
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- audiometry
Pruebas diagnósticas que deben considerarse
- CBC
- thyroid function tests
- lipid profile
- fasting glucose
- antinuclear antibodies, double-stranded (ds) DNA, Smith antigen
- fluorescent treponemal antibody absorption assay
- MRI of internal auditory canal
- CT temporal bones
- magnetic resonance angiography (MRA) or CT angiography
- carotid angiography
- auditory brainstem response (ABR)
- minimum masking level
- residual inhibition
- loudness and pitch matching
- loudness discomfort level testing
- otoacoustic emissions
Pruebas emergentes
- functional MRI
- PET scan
- magnetoencephalographic
Algoritmo de tratamiento
known etiology
troublesome tinnitus
hearing loss on audiogram
normal hearing
Colaboradores
Autores
Michael D. Seidman, MD, FACS
Chair Department of Otolaryngology-Head and Neck Surgery Central Division Advent Health
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
Visiting Professor Embry Riddle Aeronautical University
Past Board of Directors American Academy of Otolaryngology-Head and Neck Surgery
Celebration
FL
Divulgaciones
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 and the Department of Defense. He receives royalties from two of his nine patents. MDS is the author of several books and references cited in this topic.
Agradecimientos
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.
Divulgaciones
AL, VR, and SH declare that they have no competing interests. HRD holds stocks in Cactus Medical LLC, Elinava Technologies and has a pending patent on electric stimulation device and combination therapy for treatment of ear condition.
Revisores por pares
Hamid R. Djalilian, MD
Director of Otology, Neurotology, and Skull Base Surgery
Professor of Otolaryngology, Neurological Surgery, and Biomedical Engineering
University of California
Irvine
CA
Divulgaciones
HRD holds stocks in Cactus Medical LLC, Elinava Technologies and has a pending patent on electric stimulation device and combination therapy for treatment of ear condition.
Andrew McCombe, MD, FRCS(ORL)
Consultant ENT Surgeon
Frimley Park Hospital
Portsmouth Road
Frimley
Surrey
UK
Divulgaciones
AM declares that he has no competing interests.
Agradecimiento de los revisores por pares
Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.
Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
Dalrymple SN, Lewis SH, Philman S. Tinnitus: diagnosis and management. Am Fam Physician. 2021 Jun 1;103(11):663-71.Texto completo Resumen
Tunkel DE, Bauer CA, Sun GH, et al. Clinical practice guideline: tinnitus. Otolaryngol Head Neck Surg. 2014 Oct;151(suppl 2):S1-40.Texto completo Resumen
American College of Radiology. ACR Appropriateness Criteria: tinnitus. 2023 [internet publication].Texto completo
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
- Meniere disease
- Acoustic neuroma (schwannoma)
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Más DiferencialesGuías de práctica clínica
- Consensus statements on tinnitus treatment: a Delphi study by the Korean Tinnitus Study Group
- VA/DOD clinical practice guideline: tinnitus
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