Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- medication history
- 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's test
- abnormal Rinne's test
Other diagnostic factors
- slow-onset progressive hearing loss
- high pitch
- low pitch
- unilateral
- bilateral
- worse with chewing
- polyuria/polydipsia
- diarrhoea
- palpitations
- foreign body
Risk factors
- older age
- hearing loss
- loud noise exposure
- vestibular schwannoma
- ototoxic medicines
- 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
- FBC
- 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 aetiology
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 (non-compensated) and research for MicroTransponder, Inc (non-compensated), 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
Disclosures
AM declares that he has no competing interests.
Differentials
- Meniere's disease
- Acoustic neuroma (schwannoma)
- Glomus tumour
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- Clinical practice guideline: tinnitus
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