Neurotologic Evaluation of Post-Traumatic Tinnitus

Post-traumatic tinnitus isn’t always easy to diagnose and treat.  There are numerous causes of post-traumatic tinnitus, making it difficult to find an appropriate treatment method that will work for every patient suffering from the condition.  This feeling of “ringing” in the ears is often experienced after a traumatic event that affects the brain and ears.

Common examples include post-traumatic tinnitus secondary to a traumatic brain injury (TBI) (following a motor vehicle accident for example), secondary to a loud explosion in the military setting, and secondary to rapid pressure change experienced while deep water diving or traveling by air, among others.  Additionally, some tinnitus may be pulsatile in nature (i.e., there’s a rhythm to the sound), or it could be non-pulsatile, where there is just sound without any distinctive rhythm.

Diagnosing Post-Traumatic Tinnitus

With all diagnostic evaluations, there must be a list of differential diagnoses that could be to blame for a patient’s post-traumatic tinnitus.  What this essentially means is that a physician must list all possible causes of the tinnitus, and then go one by one to eliminate those causes that can be ruled out as the cause of a patient’s post-traumatic tinnitus.  A thorough examination is essential to determine if there is a clear cause of the post-traumatic tinnitus and how it may be linked to a prior traumatic event.

Examining a Patient for Tinnitus – Otologic (Ear) Examination

All physicians evaluating a patient for tinnitus first take note of a patient’s overall appearance, from the patient’s physical features to the patient’s mood to whether or not the patient may suffer from depression or other mental health conditions that may play a role in tinnitus.

A thorough examination of the ear, head and neck is important to get a general picture of what is going on with a particular patient, and why the patient is suffering from post-traumatic tinnitus.  In addition to examining the inner ear, physicians also examine the temporomandibular joint (TMJ), as this joint can have an impact on ear function.  Further, a physician looks for any physical trauma such as facial fractures and signs of a traumatic brain injury (TBI), as TBIs can cause post-traumatic tinnitus.

A physician will also listen to a patient’s ear to determine if he or she can hear any sounds that the patient may also be hearing.  In most cases, tinnitus is subjective where only the patient can hear sounds.  With objective tinnitus, both the patient and the physician listening in the patient’s ear can hear the sounds.  This inner ear examination should also help to determine whether or not the tinnitus is pulsatile, or rhythmic, or whether the tinnitus is non-pulsatile, with just one tone or sound.

Tuning forks have been routinely used to test a patient’s ability to hear.  A fork is placed on a patient’s face, and around the ears, and the patient must indicate if he or she can hear tones in both ears, just one ear or neither ears.  The results of this test help physicians narrow down the possibilities of where the tinnitus is coming from and what may be the best treatment options for a particular patient.

Vestibular or “balance” testing can also be conducted to determine if a patient has balance issues, which is often interrelated with the inner ear.  The results of balance tests provide additional insight into the nature and severity of a patient’s tinnitus.

Diagnosing Post-Traumatic Tinnitus

Diagnosing post-traumatic tinnitus can be extremely difficult, but there are some methods of testing that can help to find the cause of one’s post-traumatic tinnitus.  Audiologic, or hearings tests, can shed light on a patient’s tinnitus.  Because there is no good objective way to say for certain whether or not a person suffers from post-traumatic tinnitus, subjective testing must be done to help patients find relief.  There is a type of audiometric test that uses “tinnitus matching” to determine what particular sound matches the tinnitus sound.  By finding out the frequency of the tinnitus, there may be a way to mask this sound and reduce or eliminate tinnitus symptoms An audiogram is another test which will help to diagnose hearing loss.  Tinnitus can be a secondary condition or symptom to hearing loss.  As such, determining whether or not a patient is suffering from hearing loss is a critical piece of the puzzle to finding a treatment method that will be best suited for a particular patient.  In addition to hearing loss, there can be neurologic conditions that cause tinnitus.  Auditory brainstem response (ABR) is a diagnostic tool that evaluates how the auditory brainstem responds to certain stimuli.  If the response is abnormal, this provides more clues as to whether or not a patient is suffering from post-traumatic tinnitus and why.

Radiologic imaging can be used to help diagnose the source and cause of a patient’s tinnitus.  Imaging can evaluate the structure of a patient’s ear to determine whether or not there could be a physical cause of a patient’s tinnitus.  Such imaging includes computed tomography (CT), CT angiography (CTA), magnetic resonance angiography (MRA), magnetic resonance venography (MRV), and magnetic resonance imaging (MRI).  Because tinnitus varies from one patient to the next, a physician will have to determine based on his or her evaluation of the patient which type of imaging is best suited to uncover a potential source and cause of the tinnitus.

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