The source and cause of tinnitus is not always limited to the ear itself. It makes logical sense to start with the ears, where a person experiences the ringing sensation. In many people, tinnitus is subjective in which a person can hear sounds or ringing that may pulse or be constant, but nobody else can hear the sounds. Some people experience objective tinnitus in which both the person and the physician can hear the sounds. Causes of tinnitus that do not come from the ear itself are sometimes not considered by physicians. Examinations which are limited to the ear itself may not be helpful in individuals whose tinnitus is caused by something else, such as a traumatic brain injury.
Finding the Cause of Non-Otological Tinnitus – Importance of the Examination
When evaluating a patient for a non-otological (non-ear-related) cause of tinnitus, a cause that does not come from the ear itself, physicians determine first whether or not the tinnitus is pulsatile or non-pulsatile. If the tinnitus is pulsatile where the sounds have a certain pulse or rhythm to it, then there could be a link between the tinnitus and the patient’s cardiac rhythm. If the pulse of the tinnitus matches the cardiac rhythm, the two may be related. If the two do not match, then the cause of the non-otological tinnitus is likely not cardiac-related.
Another potential non-otological cause of tinnitus is idiopathic intracranial hypertension (IIH), which is a condition that mimics the symptoms associated with a brain tumor, but with IIH, no brain tumor or disease is present. IIH causes increased pressure around the brain that leads to headaches and ringing in the ears (tinnitus), among other symptoms. Because tinnitus is a symptom of IIH, testing for IIH is important to rule out whether or not this could be the source of one’s non-otological tinnitus.
Additional causes of non-otological tinnitus include, but are certainly not limited to, the following:
- Hypertension (aside from IIH discussed above);
- Cardiac arrhythmia;
- Vascular causes (carotid cavernous fistulas, arteriovenous malformations, carotid dissection, and aneurysms, among others);
- Muscular and/or myofascial conditions;
- Structural conditions such as temporomandibular joint (TMJ) disorders;
- Movement disorders (Parkinson’s, tardive dyskinesia, etc.);
- Tumors outside the ear;
- Traumatic brain injuries (TBIs); and
- Psychological causes such as post-traumatic stress disorder (PTSD) and anxiety.
Given that the trigger for tinnitus can come from various parts of the body, and even the environment, it takes a diligent physician to ensure all possible causes of the tinnitus are evaluated to make sure a patient has the best chance possible of receiving treatment that will help to reduce or eliminate tinnitus symptoms.
Testing for Non-Otological Tinnitus
Based on a physician’s evaluation of a patient’s non-otological tinnitus, certain diagnostic testing may be done to establish further the cause of the tinnitus and a treatment plan for helping the patient reduce the tinnitus symptoms. Depending on the suspected source of the non-otological tinnitus, a computed tomogram (CT), magnetic resonance angiography (MRA), as well as other radiological imaging that may be helpful in identifying an underlying cause to the tinnitus may be administered. Based on the results of diagnostic imaging, a physician is in a better position to move forward with determining the cause of the tinnitus, and what treatment options are available.
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