Evaluation of Tinnitus and Hearing Loss in the Adult

Abstract

Tinnitus and hearing loss in the adult can have profound effects on the quality of life. Tinnitus is the perception of sound when no external sound is present and may be described as ringing, buzzing, swishing, or clicking sensations. Hearing loss ranges from partial to a total inability to hear sounds. Hearing loss and tinnitus can occur concurrently or in isolation. The role of imaging is to help identify the etiology of these symptoms and evaluate for the extent of disease. 15.2 Causes of Tinnitus and Hearing Loss 15.2.1 Tinnitus Tinnitus may be categorized as (1) pulsatile or non-pulsatile, (2) primary (idiopathic) or secondary (due to another condition), and (3) subjective or objective. Evaluation of tinnitus starts with otoscopic examination to determine if there is a vascular retro-tympanic mass, audiometric examination, and review of medical history and medications. This evaluation helps to determine if imaging is necessary and if so, what study(ies) are indicated. 15.2.1.1 Pulsatile Tinnitus Causes include vascular masses (glomus tympanicum), aberrant arterial or venous anatomy, vascular malformations, and intracranial hypertension. Objective tinnitus (auscultation of a bruit on physical examination) is uncommon and has been attributed to turbulent flow in the setting of dural fistulas, atherosclerotic carotid artery disease, jugular bulb abnormalities, and large condylar or mastoid emissary veins. 15.2.1.2 Non-pulsatile Tinnitus Causes are wide ranging and include cerumen impaction, middle ear infection, mass, medications, noise-induced hearing loss, presbycusis or chronic bilateral hearing loss, hemorrhage, neurodegeneration, and spontaneous intracranial hypotension.

Pediatric tinnitus: The role of neuroimaging

“…CT demonstrates bone attenuation replacing the cochlea, vestibule, and semicircular canals (Figure 14). 38…”

“…Labyrinthitis ossificans affects the membranous labyrinth and mostly occurs secondary to bacterial meningitis, otitis media, or instrumentation 38,39 . It was also reported in children with sickle cell disease that leads to inner ear ischemia secondary to vaso‐occlusion 39 .…”

“…CT demonstrates bone attenuation replacing the cochlea, vestibule, and semicircular canals (Figure 14). 38 MRI shows loss of the normal high T2 signal intensity of the endolymph within the cochlea/semicircular canals on fluid‐sensitive MRI sequences 39 …”