Definition:

Tinnitus is defined as the perception of noise or sounds in the head or ears in the absence of an actual stimulus. Tinnitus is associated with many different medical pathologies, including hearing loss, acoustic trauma, closed head injury, disease processes, etc.

Diagnostic/Types:

1. Objective Tinnitus: can be heard by other people.
   Possible Causes of Objective Tinnitus: muscular abnormalities, spastic activities of the palatal muscles, spastic activities of the stapedius muscle in the middle ear, abnormally open eustachian tubes, abnormalities in the large blood vessels near the ears, tumors of the middle ear space or nearby areas, temporal bone fractures, misconnection between adjoining arteries and veins, narrowing of the carotid artery walls, high blood pressure, hyper or hypo thyroidism.



2. Subjective Tinnitus: can only be heard by the person affected.
   Possible Causes of Subjective Tinnitus: noise induced hearing loss, age related hearing loss, ear infection, wax build-up, otosclerosis (disease where the middle ear space fills with spongy bony growth), problems with the eardrum, adverse drug reactions, auto-immune disorders, brain chemistry disruptions or disorders, substance abuse, poisoning, metabolic disorders, closed head injuries, toxic reactions to ingested or inhaled substances, multiple sclerosis, meningitis, encephalitis, acoustic schwannoma (tumor on the nerve from the ear to the brain), brain disease or disorder.



3. Associated emotional/social conditions: Anxiety, anger, depression, irritation, insomnia, sadness, frenzy, panic, despair, fear, isolation, rejection, distrust of medical community, avoidance, rationalization of negative behaviors, poor social interactions, loss of sense of humor and feeling that the conditions will worsen.



4. Medical/Audiologic Evaluation/Exams Should Include:
• Complete case history including tinnitus and hyperacusis, overall health
• Investigation into whether vertigo or imbalance is present.
• History of head trauma, other illnesses or conditions.
• History of medication use, abuse, previous and present.
• Physical exam of head, neck, throat, ears, chest, etc. etc.
• Blood pressure, pulse, listening to heart and lungs.
• Possible blood testing recommended for Lyme disease, thyroid, etc.
• MRI or CAT scans as indicated by presence of objective tinnitus.
• Complete audiologic evaluation including tinnitus/hyperacusis.
• Possibly an Auditory Brainstem Response if problem is one sided and test results demonstrate the need.

( Realistically, this sort of examination requires a longer session than the typical 10 minute office visit. When you schedule an examination with an ear specialist for a tinnitus evaluation, you may wish to express a desire for a more involved consultation. According to my two favorite local otologists, this is a perfectly acceptable way to ensure a little more time with them but needs special approval prior to the visit. Also be sure that your primary care physician has completed a referral if your insurance company requires one ).