Ear, Nose, and Throat – Tinnitus: By Carol Bauer M.D.

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Ear, Nose, and Throat – Tinnitus
Whiteboard Animation Transcript
with Carol Bauer, MD
https://medskl.com/Module/Index/tinnitus


Tinnitus is the awareness of sound without an obvious external source. New onset tinnitus can be very disturbing and cause significant distress and anxiety. Chronic tinnitus, defined as being present for longer than 6 months, is less intrusive and bothersome, primarily because most people with chronic tinnitus adapt through natural habituation.

The two most common causes of tinnitus are age-related hearing loss and hearing loss secondary to noise damage to the inner ear. Rarely does tinnitus signify a serious medical condition but this should be considered under specific conditions and clinical presentations.

Signs and symptoms of a possible serious medical condition causing tinnitus are:

unilateral tinnitus
pulsatile tinnitus
tinnitus temporally related to sudden hearing loss
tinnitus associated with vertigo or other neurological deficits

A thorough otoscopic examination is important to identify serious conditions causing unilateral tinnitus, such as chronic mastoiditis and cholesteatoma.

If there are no signs of acute or chronic ear infection, consider a retrocochlear cause, such as vestibular schwannoma, and vascular lesions such as glomus tumor, arterio-venous malformation, arteriovenous fistula causing tinnitus synchronous with the pulse, or asynchronous pulsatile tinnitus related to spasm of the tensor tympani or stapedius muscles.

Tinnitus almost universally occurs with sudden sensorineural hearing loss. This is a medical emergency since prompt treatment may reverse the hearing loss and eliminate the tinnitus.

Tinnitus that occurs as part of a symptom complex of neurologic deficits can require urgent or emergent evaluation. Episodic tinnitus occurring in conjunction with vertigo and fluctuating hearing loss may be the presenting symptoms of endolymphatic hydrops or Meniere’s disease, migraine vertigo, or perilymphatic fistula. These are uncommon conditions but should be referred for evaluation and management by an Otolaryngologist. More serious conditions requiring emergent evaluation would include tinnitus and prolonged vertigo with ataxia, dysphagia, and dysarthria suggesting central cerebrovascular events.

A hearing evaluation is the most important element in the tinnitus work-up, after the history and physical exam. Rarely is imaging a necessary or beneficial part of the evaluation, except in the case of suspected retrocochlear, neurologic, or infectious causes of tinnitus, which would be evident from the history and physical examination. - bsocially