What are the appropriate tests and treatment plan for a patient experiencing tinnitus (ringing in the ears) and dizziness one week after attending a concert?

From the Guidelines

You should see a healthcare provider for evaluation of potential noise-induced hearing damage or acoustic trauma, and they will likely perform a comprehensive ear examination, hearing tests, and possibly balance testing to assess your vestibular system, as recommended by the American Academy of Otolaryngology and Head and Neck Surgery Foundation (AAO-HNS) guidelines 1. The patient's symptoms of ear ringing (tinnitus) and dizziness for a week after a concert suggest possible noise-induced hearing damage or acoustic trauma.

• A comprehensive ear examination and hearing tests (audiometry) are essential to evaluate the patient's condition, as stated in the clinical practice guideline: tinnitus executive summary 1.
• The healthcare provider may also conduct tympanometry to check middle ear function and otoacoustic emissions testing to evaluate inner ear health.
• Treatment typically begins with rest from loud noise exposure and possibly a short course of oral steroids like prednisone to reduce inflammation in the inner ear.
• For symptom management, the doctor might recommend over-the-counter pain relievers like ibuprofen for discomfort.
• The dizziness suggests possible vestibular involvement, which may require vestibular rehabilitation exercises if it persists, and the ACR Appropriateness Criteria topics for “Hearing Loss and/or Vertigo” should be used to guide imaging in those settings 1.
• These symptoms often improve gradually with time and proper care, but prompt medical attention is important as early intervention may prevent permanent damage, and the patient should avoid further noise exposure, not use cotton swabs in their ears, and stay well-hydrated while waiting for their appointment.
• The type of tinnitus and associated symptoms often determine the choice of imaging studies and their appropriateness, and the detection of retrotympanic lesions can be difficult without appropriate equipment 1.

From the Research

Tinnitus and Dizziness after Concert

• The patient is experiencing ears ringing (tinnitus) and dizziness after a concert, which may be related to noise exposure 2.
• A standard workup for tinnitus includes a targeted history and physical examination to identify treatable causes and associated symptoms 2.
• The patient's symptoms of tinnitus and dizziness may be related to noise-induced hearing loss, and a comprehensive audiologic evaluation may be necessary to assess the extent of the hearing loss 2.

Diagnostic Tests

• A physical examination, including orthostatic blood pressure measurement, a full cardiac and neurologic examination, assessment for nystagmus, and the Dix-Hallpike maneuver, may be helpful in evaluating the patient's dizziness 3, 4.
• The HINTS (head-impulse, nystagmus, test of skew) examination can help distinguish peripheral from central etiologies of dizziness 3, 4.
• Laboratory testing and imaging are usually not required but can be helpful in certain cases 3, 4.

Treatment Plan

• Sound therapy may be effective in reducing tinnitus symptoms, especially in patients with normal hearing and mild hearing loss 5.
• Cognitive behavioral therapy is the only treatment that has been shown to improve quality of life in patients with tinnitus 2, 6.
• Vestibular rehabilitation may be helpful in treating peripheral and central etiologies of dizziness 3, 4.
• Canalith repositioning procedures (e.g., Epley maneuver) can be effective in treating benign paroxysmal positional vertigo, a possible cause of the patient's dizziness 3, 4.