Diagnosis
H&P:
Tinnitus classification.
Evaluate for treatable causes of tinnitus.
Risk Factors:
Common Presentations:
Tinnitus red flag symptoms.
DDx of tinnitus.
Diagnostic tests
-Audiometry (audiogram) with tympanometry to determine the presence and degree of hearing loss.
-Electronystagmography to assess vestibular function
-Neuroimaging is indicated only if the “tinnitus is localized to one ear, is pulsatile, or is associated with focal neurologic abnormalities or asymmetric hearing loss.” NEJM 2018
Treatment
-Search for and treat any ear underlying disease.
-Evaluate and treat any coexisting mood disorder.
-Cognitive behavioral therapy (CBT), sound therapy
-Hearing aids per audiogram results.
-Consider acoustic stimulation with hearing aids.
-Vestibular Therapy
-Refer to ENT for consideration of hearing aids and further treatment as needed.
-No evidence that any medication helps.
**
Pearls
- Unilateral tinnitus or asymmetric sensorineural hearing loss should be evaluated with neuroimaging such as a contrast-enhanced MRI.
- Tinnitus red flags
- Assessment and plan sample.
“Almost all patients with tinnitus should undergo audiometry with tympanometry, and some patients require neuroimaging or assessment of vestibular function with electronystagmography.”
Electronystagmography (ENG) = Electronystagmogram (ENG)
Further Reading / References
N Engl J Med 2018; 378:1224-1231. Tinnitus.
JAMA. 2016 May 24-31;315(20):2221-2. https://www.ncbi.nlm.nih.gov/pubmed/27218631
Am Fam Physician. 2014 Jan 15;89(2):106-113. Diagnostic Approach to Patients with Tinnitus. https://www.aafp.org/afp/2014/0115/p106.html