PDF herunterladen
Semin Hear 2001; 22(1): 023-036
DOI: 10.1055/s-2001-13018
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Diagnostic Issues in Tinnitus: A Neuro-Otological Perspective

Robert Aaron Levine
  • Department of Otolaryngology, Eaton-Peabody Laboratory, Massachusetts Eye and Ear Infirmary; Auditory Neurology Unit, Neurology Service, Massachusetts General Hospital; and Department of Neurology, Harvard Medical School, Boston, Massachusetts
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
31. Dezember 2001 (online)

    Lizenzen und Reprints

ABSTRACT

Arriving at a diagnosis to account for tinnitus begins with the patient's description of the percept, because in some cases the quality of the tinnitus will make the diagnosis (e.g., clicking) and in other cases it will give direction to the diagnostic evaluation (e.g., pulsatile). With the exception of dural arteriovenous malformations, the source of pulsatile tinnitus can be determined without conventional cerebral angiography.

Establishing a diagnosis for nonspecific tinnitus is difficult because 1) tinnitus is common in the general population, 2) for any disease not all subjects will develop tinnitus, and 3) tinnitus can be multi-factorial. Unilateral tinnitus with nonspecific characteristics must be suspect for an acoustic neuroma. In the absence of stress or intense sound exposure, if tinnitus is intermittent, fluctuates widely in loudness or location, or has a diurnal pattern, then somatic influences upon tinnitus from the head or upper cervical region should be suspected.

Tinnitus is the perception of sound in the absence of an external sound. As such, it is a symptom and may have many diverse causes. The purpose of this article is to describe an approach to establishing the origin of this symptom. For this reason, we use the presenting complaint as the organizing principle, because this is what confronts the clinician upon encountering the tinnitus patient.

KEYWORD

Somatic (craniocervical) tinnitus - dorsal cochlear nucleus - hallucinations

REFERENCES

  • 1 Marchiando A, Per-Lee J H, Jackson R T. Tinnitus due to idiopathic stapedial muscle spasm.  Ear Nose Throat J . 1983;  62 8-13
    PubMedGoogle Scholar
  • 2 Sismanis A, Smoker W R. Pulsatile tinnitus: recent advances in diagnosis.  Laryngoscope . 1994;  104 681-688
    Google Scholar
  • 3 Ohashi N, Yasumura S, Nakagawa H, Mizukoshi K, Kuze S. Vascular cross-compression of the VIIth and VIIIth cranial nerves.  J Laryngol Otol . 1992;  106 436-439
    PubMedGoogle Scholar
  • 4 Waldvogel D, Mattle H P, Sturzenegger M, Schroth G. Pulsatile tinnitus-a review of 84 patients.  J Neurol . 1998;  245 137-142
    Google Scholar
  • 5 Makins A E, Nikolopoulos T P, Ludman C, O'Donoghue G M. Is there a correlation between vascular loops and unilateral auditory symptoms?.  Laryngoscope . 1998;  108 1739-1742
    CrossrefPubMedGoogle Scholar
  • 6 Weissman J L, Hirsch B E. Imaging of tinnitus: a review.  Radiology . 2000;  216 342-349
    Google Scholar
  • 7 Obach V, Obach J. Auditory hallucinosis in brainstem lesions and musical hallucinosis in deafness. Analogies and differences.  Europ J Neurol . 1996;  3 203-211
    PubMedGoogle Scholar
  • 8 Heller M F, Bergman M. Tinnitus aurium in normally hearing persons.  Ann Otol Rhinol Laryngol . 1963;  62 73-83
    PubMedGoogle Scholar
  • 9 Levine R A. Somatic (craniocervical) tinnitus and the dorsal cochlear nucleus hypothesis.  Am J Otolaryngol . 1999;  20 351-362
    CrossrefPubMedGoogle Scholar
  • 10 Fowler E P. Control of head noises: their illusions of loudness and timbre.  Arch Otolaryngol . 1943;  37 391-398
    CrossrefPubMedGoogle Scholar
  • 11 Coles R RA. Tinnitus. In: Stephens D, ed. Adult Audiology Guilford: Butterworth Heinemann; 1996
    Google Scholar
  • 12 Penner M J, Coles R R. Indications for aspirin as a palliative for tinnitus caused by SOAEs: a case study.  Br J Audiol . 1992;  26 91-96
    CrossrefPubMedGoogle Scholar
  • 13 Dornhoffer J L, Helms J, Hoehmann D H. Presentation and diagnosis of small acoustic tumors.  Otolaryngol Head Neck Surg . 1994;  111 232-235
    CrossrefPubMedGoogle Scholar
  • 14 Morrison G A, Sterkers J M. Unusual presentations of acoustic tumours.  Clin Otolaryngol . 1996;  21 80-83
    PubMedGoogle Scholar
  • 15 Dawes P J, Basiouny H E. Outcome of using magnetic resonance imaging as an initial screen to exclude vestibular schwannoma in patients with unilateral tinnitus.  J Laryngol Otol . 1999;  113 818-822
    PubMedGoogle Scholar
  • 16 Carrier D A, Arriaga M A. Cost-effective evaluation of asymmetric sensorineural hearing loss with focused magnetic resonance imaging.  Otolaryngol Head Neck Surg . 1997;  116 567-574
    PubMedGoogle Scholar
  • 17 Chung D Y, Gannon R P, Mason K. Factors affecting the prevalence of tinnitus.  Audiology . 1984;  23 441-452
    CrossrefPubMedGoogle Scholar
  • 18 Levine R A. Somatic modulation appears to be a fundamental attribute of tinnitus. In: Hazell J, ed. Proceedings of the Sixth International Tinnitus Seminar Cambrige: The Tinnitus and Hyperacusis Centre 1999: 193-197
    Google Scholar
  • 19 Chole R A, Parker W S. Tinnitus and vertigo in patients with temporomandibular disorder.  Arch Otolaryngol Head Neck Surg . 1992;  118 817-821
    CrossrefPubMedGoogle Scholar
  • 20 Tjell C, Tenenbaum A, Rosenhall U. Auditory function in whiplash-associated disorders.  Scand Audiol . 1999;  28 203-209
    CrossrefPubMedGoogle Scholar
  • 21 Hausler R, Levine R A. Auditory dysfunction in stroke.  Acta Otolaryngol (Stockh) . 2000;  120 689-703
    CrossrefPubMedGoogle Scholar
  • 22 Kaltenbach J A, McCaslin D L. Increases in spontaneous activity in the dorsal cochlear nucleus following exposure to high intensity sound: a possible neural correlate of tinnitus.  Auditory Neuroscience . 1996;  3 57-78
    PubMedGoogle Scholar
      >