Finding Cause for Tinnitus

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Tinnitus is not a disease rather an annoying symptom of myriad of conditions, caused by minor changes in the sensitive hearing system (Cochlea and auditory nerve).

 

Patient with tinnitus should undergo thorough otologic and audiological evaluation and if required neurological examination. In most cases tinnitus is not harmful but patient should be investigated properly to find any treatable condition.

Most common cause for tinnitus is hearing loss because of aging, noise, drugs or chemicals.

Possible theory: –

  1. Because cochlea is no longer sending normal signals to brain, confused brain create own noise.
  2. Made worse by anything that makes hearing worse like infection/wax.

Causes: –

I. Related to ear (otologic)-

** Cause may be in the external, middle or inner ear

Subjective causes-

  • Impacted wax
  • Fluid in the middle ear
  • Acute and chronic otitis media
  • Otosclerosis
  • Menieres disease
  • Presbiacusis (age related hearing loss)
  • Head trauma
  • Noise-trauma
  • Ototoxic drugs (such as ACE inhibitors, Antibiotics-ciprofloxacin, erythromycin, streptomycin, and vancomycin, Anti depressant-alprazolam, Anti-malarials-chloroquine and quinine, B-blockers, Diuretics-acetazolamide and amiloride, NSAIDs and Aspirin)
  • Tumor (acoustic neuroma)

Objective causes are less frequent-

  • Aneurism of carotid artery (it is synchronous with pulse)
  • Vascular tumor of middle ear
  • Palatal myoclonus
  • Temporomandibular joint syndrome (misaligned jaw)
  • Tinnitus synchronous with respiration may occur with abnormally patent Eustachian tube (mostly seen after weight loss).

II. Not related to ear-

Disease of CNS, anemia, arteriosclerosis, hypertension, hypotension, hypoglycemia, epilepsy, migraine,

III.  Psychological-

Assessment of tinnitus-

Most important is History and Identification of hearing loss and Clinical Examination of ear by otoscope/operating microscope with detail head and neck examination by specialist.

Investigations:-

  • Pure tone Audiometry, speech audiometry, if required special tests like SISI, ABLB etc.
  • Brain-stem Evoked Response Audiometry If tinnitus is accompanied with other complaints like  headache, vertigo, vomiting,
  • CT scan (especially if tinnitus is asymmetrical, 10% of cases it may be a tumor (Acoustic Neuroma).
  • Blood Investigations to test Anaemia- CBC, Hypothyroidism- TSH, Diabetes-sugar, Syphilis- FTABS and lipid profile.

Comprehensive evaluation of tinnitus and sound tolerance:

  • VAS loudness scale and the quality of life Tinnitus Questionnaire
    Pitch matching
    Loudness matching
    Post masking effect
    Feldman Masking curves
    MCL
    UCL

Most important aspect is educating person with respect to nature of tinnitus,  keep in mind treat the patient not the tinnitus…

Some Latest Research news:-

Hyperactivity of Touch-sensing Nerves in Head, Neck Causes Tinnitus

Scientists Exploring Brain Area Responsible for Tinnitus

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