Diagnostic Tests for Tinnitus
Tinnitus Tests: Book Excerpts
Home Diagnostic Testing
These home medical tests may be relevant to Tinnitus:
Tinnitus Diagnosis: Book Excerpts
Diagnostic Tests for Tinnitus: Online Medical Books
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TINNITUS:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
The basic workup includes a CBC, sedimentation rate, urinalysis, chemistry panel, thyroid profile, VDRL test, audiometry, caloric tests (electronystagmography), and x-rays of the mastoids and petrous bones. Specialized audiometry may be performed, such as impedance audiometry, Békésy audiometry, and BSEP studies.
If an acoustic neuroma is strongly suspected, CT scans with iodine infusion or instillation of 4 cc of oxygen in the subarachnoid space would be indicated. Gadolinium-enhanced MRI may also diagnose an early acoustic neuroma. Angiography and venography may help diagnose objective tinnitus. A spinal tap may be helpful in diagnosing multiple sclerosis and central nervous system syphilis. A glucose tolerance test may be indicated to rule out diabetes mellitus.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Tinnitus:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Ask the patient to describe the sound he hears, including its onset, pattern, pitch,
location, and intensity. Ask whether it’s accompanied by other symptoms, such as vertigo, headache, or hearing loss. Next, take a health history, including a complete drug history.
Using an otoscope, inspect the patient’s ears and examine the tympanic membrane. To check for hearing loss, perform the Weber and Rinne tuning fork tests. (See Differentiating conductive from sensorineural hearing loss, page 316.)
Also, auscultate for bruits in the neck. Then compress the jugular or carotid artery to see if this affects the tinnitus. Finally, examine the nasopharynx for masses that might cause eustachian tube dysfunction and tinnitus.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Tinnitus:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Ask the patient to describe the sound he hears, including its onset, pattern, pitch, location, and intensity. Ask whether it’s accompanied by other symptoms, such as vertigo, headache, or hearing loss. Next, take a health history, including a complete drug history.
Using an otoscope, inspect the patient’s ears and examine the tympanic membrane. To check for hearing loss, perform the Weber and Rinne tuning fork tests. (See Differentiating conductive from sensorineural hearing loss, page 396.)
Also, auscultate for bruits in the neck. Then compress the jugular vein or carotid artery to see if this affects the tinnitus. Finally, examine the nasopharynx for masses that might cause eustachian tube dysfunction and tinnitus.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Tinnitus:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
Focus on the head, ears, eyes, nose, throat, and neck as well as the cardiovascular and neurologic systems. Assess vital signs and perform a complete ear examination, including evaluation for obstruction of the external auditory canal. Look for tympanic membrane landmarks, tympanic pulsations, or signs of tumor. Auscultate the external auditory canal for transmitted sounds and use tuning forks to assess air and bone conduction. Observe the neck for thyroid masses and auscultate for thyroid or carotid bruits. Evaluate extraocular movements, speech discrimination, and the integrity of the central nervous system (gait, equilibrium, sensation). If appropriate, include evaluation of mood, affect, and perception (e.g., hallucinations).
Testing
A. Clinical laboratory tests. Most tinnitus patients will need only audiometry (4,5). If indicated by history and physical examination, consider thyroid functions, electrolytes, lipids, sedimentation rate, toxicology, syphilis serology, or rheumatology screen. A complete audiometric evaluation (pure tone and speech thresholds, speech discrimination, acoustic reflexes, and impedence testing) should always be done, especially to search for sensorineural hearing loss (4,5). A tympanogram may reveal pulsations coincident with the heart rhythm or respirations.
B. Imaging. Plain radiographs are rarely useful. Evaluation for neoplasm, especially an acoustic neuroma, is best done with magnetic resonance imaging (MRI), which will also delineate eighth nerve lesions and cortex damage. Computed tomography (CT) with contrast is superior to MRI in suspected lesions of the temporal bone and mastoids (5). Auditory brainstem-evoked responses can help to localize cortical lesions or MS (1,5). Duplex ultrasound will reveal carotid stenosis. An angiogram may be necessary to examine vasculature near the inner ear. Patients with pulsatile tinnitus may need MRI, CT, and angiography before a definitive cause is found (5).
Diagnostic assessment
Because tinnitus is a symptom, not a disease, the focus of evaluation should be on identifying those few patients with serious or treatable causes and convincing the remaining patients of the nonthreatening nature of the symptom. The key to diagnosing tinnitus is determining if it is vibratory or nonvibratory. If vibratory, search for a structural source (e.g., vascular complex, muscular component, eustachian tube) of the sound through audiometry and imaging. Nonvibratory tinnitus, although more common, often has a less easily definable cause. Consider drug effects and hearing loss first, then search for altered metabolic states (e.g., diabetes, hyperthyroidism, or infection), not forgetting psychiatric causes. Evaluate for neurologic conditions (acoustic neuroma, damage to the organ of Corti or a brain lesion) as indicated.
References
1. Pfeifer KJ, Rosen GP, Rubin AM. Tinnitus: etiology and management. Clin Geriatr Med 1999;15:193–203.
2. Vesterager V. Fortnightly review: tinnitus—investigation and management. BMJ 1997;314:728–731.
3. Seligmann H, Podoshin L, Ben-David J, et al. Drug-induced tinnitus and other hearing disorders. Drug Saf 1996;14:198–212.
4. Seidman MD, Jacobson GP. Update on tinnitus. Otolaryngol Clin North Am 1996;
29:455–465.
5. Fortune DS, Haynes DS. Tinnitus—current evaluation and management. Med Clin North Am 1999;83:153–162.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Tinnitus:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
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.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Tinnitus:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Using an otoscope, inspect the patient’s ears and examine the tympanic membrane. To check for hearing loss, perform Weber’s and Rinne tuning fork tests. Also, auscultate for bruits in the neck. Then compress the jugular or carotid artery to see if this affects the tinnitus. Finally, examine the nasopharynx for masses that might cause eustachian tube dysfunction and tinnitus.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Tinnitus:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Ask the patient to describe the sound he hears, including its onset, pattern, pitch, location, and intensity. Ask whether it's accompanied by other symptoms, such as vertigo, headache, or hearing loss. Next, take a health history, including a complete drug history.
Inspect the patient's ears and examine the tympanic membrane. To check for hearing loss, perform the Weber and Rinne tuning fork tests.
Also, auscultate for bruits in the neck. Then compress the jugular or carotid artery to see if this affects the tinnitus. Finally, examine the nasopharynx for masses that might cause eustachian tube dysfunction and tinnitus.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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