Tinnitus

Abstract

Tinnitus is a common otologic symptom secondary to numerous etiologies, such as noise exposure, otitis, Meniere's disease, otosclerosis, trauma, medications, and presbycusis. A thorough evaluation is necessary to rule out less common causes, which may include acoustic neuromas, glomus tumors, atherosclerosis of the carotid arteries, arteriovenous fistulae (AVFs), arteriovenous fistulae malformations (AVMs), and intracranial hypertension. Treating physicians need to have a very compassionate attitude towards these patients, and statements such as "there is nothing that can be done" are very inappropriate and should be strongly condemned. Reassurance, hearing aids, masking devices, retraining methods, antidepressants, intratympanic medications, and management of underlying pathologies such as carotid artery atherosclerosis, skull base tumors, intracranial hypertension, and AVMs/AVFs provide relief for the majority of these patients.

Clinical Practice Guideline: Tinnitus

“…Ultimately, the low yield [96][97][98] of these imaging studies and their potential downsides including costs, expensive incidental findings, and risks reduce their utility in the routine evaluation of a patient with isolated or primary tinnitus. Imaging of a patient with tinnitus should instead be directed by presence or absence of associated symptoms (eg, unilateral or asymmetric hearing loss, cranial neuropathy).…”

Idiopathic intracranial hypertension in Dubai: nature and prognosis

“…Idiopathic intracranial hypertension (IIH) is a syndrome of raised intracranial pressure, normal cerebrospinal fluid (CSF) constituents, computerized tomography (CT) and/or magnetic resonance imaging (MRI) brain findings (1). It primarily affects obese women of childbearing age who present with a combination of headache, nausea, vomiting, transient visual obscuration, diplopia, pulsatile tinnitus and the absence of lateralizing features on physical examination (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). The neurological examination is normal, apart from bilateral papilledema and occasional sixth nerve palsy.…”

A Compartment-Based Approach for the Imaging Evaluation of Tinnitus

“…Consequently, most patients with isolated nonpulsatile tinnitus do not have imaging abnormalities. 5 The imaging work-up should be guided by associated symptoms, such as hearing loss, dizziness, or headache. A contrastenhanced MR imaging remains the study of choice for these patients.…”

“…A contrastenhanced MR imaging remains the study of choice for these patients. 5 In patients with pulsatile tinnitus, nearly 57%-100% of all examinations will reveal imaging abnormalities, [6][7][8][9] though the diagnostic relevance of some imaging findings such as jugular bulb variants is controversial. Some authors consider the presence of these abnormalities as a "positive scan," 8 whereas others regard these findings as incidental because they are relatively common in the general population and are usually asymptomatic.…”