California Diagnostic Tinnitus Evaluations
Diagnostic Tinnitus Evaluations
Diagnostic Tinnitus Evaluations – Tinnitus is a common symptom encountered in family medicine. It is defined as sound perception in the absence of sound input external to the patient. Subjective tinnitus is the most common type, and is audible only to the patient, without internal or external sound input. Objective tinnitus is rare, accounting for less than 1% of cases. It involves the perception of an internal sound, such as a bruit, as tinnitus. The causes of objective tinnitus are chiefly vascular or muscle dysfunction.
Diagnostic Tinnitus Evaluations – Tinnitus lasting at least five minutes was reported by 30% of persons 49 years and older in an Australian population-based cohort. In a U.S. population-based study, slightly more than 8% of persons 48 years and older were affected by tinnitus that was moderately severe or that impacted sleep. Although it can be transient, older persons are more likely to have persistent tinnitus. A simple and efficient approach to the evaluation and diagnosis of tinnitus can safely detect the minority of persons with more serious etiologies, such as Meniere disease or vestibular schwannoma.
Diagnostic Tinnitus Evaluations – Etiology
Because tinnitus is a symptom and not a disease, there is no objective test to confirm its existence or grade its severity. For this reason, much of the workup for tinnitus is without evidence. The etiology of tinnitus is often multifactorial, but in many cases, it is a response of the central nervous system to insufficient or abnormal input from the ear, comparable to phantom limb syndrome. In this syndrome, persons perceive their limb even after it has been amputated. In a similar manner, tinnitus persists even after surgical transection of the auditory nerve.
Tinnitus occurs in most persons with normal hearing who are exposed to silence. It can be affected by input outside of the auditory system. For example, in patients with somatosensory tinnitus, movements of the head, neck, or limbs or palpation of myofascial trigger points can modulate or reproduce tinnitus. The belief that tinnitus is entirely psychosomatic is outmoded. Appreciation of a person’s subjective response to tinnitus can help establish a therapeutic alliance that will support further education and therapy.