Tinnitus
Differential Overview
❑ Impacted cerumen
❑ Otitis media
❑ Eustachian dysfunction
❑ Presbyacusis
❑ Hypertension
❑ Drugs
❑ Ménière
❑ Arterial bruit
❑ Acoustic neuroma
❑ Vascular aneurysm
❑ Arteriovenous malformation
❑ Functional
❑ Glomus tumor
Diagnostic Approach
A high-pitched continuous tone is the most common type, due to a sensorineural hearing loss or cochlear injury. Low-pitched tinnitus is seen with Meniere disease. Vascular tinnitus is most often pulsatile and occurs with hypertension, berry aneurysm, arteriovenous malformation, internal carotid stenosis, a tortuous carotid within the temporal bone, increased intracranial pressure or glomus tumor. A clicking noise, or irregular or rapid pulsations that do not follow the pulse originate in myoclonus of the palatal, stapedial, or tensor tympani muscles. Tinnitus that can be heard with a stethoscope is usually a result of a tumor, aneurysm, or arteriovenous malformation.
Clinical Findings
Impacted cerumen It is evident on otoscopic examination and confirmed by relief with irrigation.
Otitis media The tympanic membrane is bright red.
Eustachian dysfunction Associated with allergies or an upper respiratory infection, this dysfunction causes the patient’s hearing to be muffled as if he or she is hearing underwater or like the roar of the ocean. The tympanic membrane is dull gray, often with bubbles or a fluid level behind it.
Presbyacusis High-pitched tinnitus appears near the frequency of the greatest hearing loss. Sometimes sensory deprivation may induce faint auditory illusions of voices or music.
Hypertension Pulsatile tinnitus can occur with elevated blood pressure.
Drugs Salicylate toxicity (usually >4 gm/day), aminoglycosides, ethacrynic acid, furosemide, quinidine, cocaine, heavy metals, or methotrexate all can cause tinnitus.
Ménière A low-pitched roaring tinnitus is associated with fluctuating vertigo, hearing loss, and a sense of fullness in the ear.
Arterial bruit Tinnitus is pulsatile on the affected side, without hearing loss or vertigo. A carotid bruit may be heard with auscultation.
Acoustic neuroma This often presents with unilateral continuous or pulsatile tinnitus, with subsequent development of vertigo and unilateral hearing loss. Speech discrimination is especially impaired. Facial numbness may be concurrently present.
Vascular aneurysm Tinnitus can precede neurological phenomena. There may be an audible bruit, especially when the intrapetrous portion of the internal carotid is involved.
Arteriovenous malformation A to-and-fro bruit may be heard when listening to the skull with the stethoscope.
Functional Accentuation of normal head sounds is a likely cause, especially of tinnitus that is heard mostly at night. Depression and fatigue lower the threshold of tolerance.
Glomus tumor Pulsatile tinnitus, conductive hearing loss, paralysis of cranial nerves IX, X, and XI, and spontaneous bleeding from the ear canal are signs. This tumor can sometimes be seen as a red-blue mass through the tympanic membrane.
Book Source Details
- Book Title: Field Guide to Bedside Diagnosis
- Author(s): David S. Smith
- Year of Publication: 2007
- Copyright Details: Field Guide to Bedside Diagnosis, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Hearing impairment
Read excerpts from these other book chapters related to Hearing impairment:
Medical Books Excerpts
- TINNITUS
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- DEAFNESS
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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- Tinnitus
- "In A Page: Pediatric Signs and Symptoms" (2007)
- [ read ]
- Tinnitus
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Deafness
- "A Pocket Manual of Differential Diagnosis" (1999)
- [ read ]
- Hearing loss
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Tinnitus
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Hearing Loss
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Tinnitus
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Tinnitus
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Tinnitus
- "Nursing: Interpreting Signs and Symptoms" (2007)
- [ read ]
Copyright Details: Field Guide to Bedside Diagnosis, Copyright © 2008 Williams & Wilkins.
More About Causes of Hearing impairment
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More About This Book:
Title: Field Guide to Bedside Diagnosis
Authors: David S. Smith
Publisher: Lippincott Williams & Wilkins
Copyright: 2007
ISBN: 0-78178-165-5
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» Next page: Hearing loss (Handbook of Diseases)
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