From the Guidelines
For a patient with 5 years of tinnitus, 3 years of intermittent fullness, mild low-frequency hearing loss, and difficulty hearing on the phone, a comprehensive audiologic examination, including pure tone audiometry (PTA), speech audiometry, tympanometry, and acoustic reflex testing, is the recommended initial diagnostic approach. This is based on the latest guidelines from the American Academy of Otolaryngology-Head and Neck Surgery Foundation, as outlined in the 2023 update of the ACR Appropriateness Criteria for Tinnitus 1.
The patient's symptoms of tinnitus, intermittent fullness, and mild low-frequency hearing loss are suggestive of a potential underlying condition such as Meniere's disease. However, the guidelines recommend a targeted history and clinical examination as the initial evaluation, followed by a prompt and comprehensive audiological examination in patients with hearing problems or unilateral persistent tinnitus 1.
The comprehensive audiologic examination, as described in the clinical practice guideline for age-related hearing loss 1, should include the measurement of pure tone thresholds, speech audiometry, tympanometry, and acoustic reflex testing. This will provide valuable information about the patient's hearing loss, middle ear function, and potential underlying conditions.
The guidelines also recommend against imaging studies of the head and neck for patients with tinnitus that does not localize to one ear, is nonpulsatile, and is not associated with focal neurological abnormalities or asymmetric hearing loss 1. Therefore, a comprehensive audiologic examination is the most appropriate initial diagnostic approach for this patient.
Key components of the diagnostic approach include:
- Pure tone audiometry (PTA) to measure hearing sensitivity and establish the pattern of hearing loss
- Speech audiometry to assess speech recognition and understanding
- Tympanometry to evaluate middle ear function and detect potential abnormalities
- Acoustic reflex testing to assess the reflexes of the middle ear muscles
By following this diagnostic approach, clinicians can gather valuable information about the patient's condition and develop an effective treatment plan to manage their symptoms and improve their quality of life.
From the Research
Diagnostic Approach
The diagnostic approach for a patient with 5 years of tinnitus and 3 years of intermittent aural fullness, presenting with mild low-frequency hearing loss and difficulty hearing on the telephone, involves a comprehensive evaluation of the patient's symptoms and medical history.
- A thorough history and physical examination can help differentiate between objective and subjective tinnitus, as well as identify any underlying conditions that may be contributing to the patient's symptoms 2.
- Audiometric testing, including pure tone audiometry and speech audiometry, can help assess the patient's hearing loss and identify any abnormalities in the middle ear or inner ear 3, 4.
- Impedance audiometry can also be useful in evaluating the function of the middle ear and identifying any abnormalities in the tympanic membrane or middle ear reflexes 3.
- High frequency audiometry may also be relevant in patients with normal hearing thresholds in conventional pure-tone audiometry, as it can provide additional information on the patient's hearing loss and tinnitus symptoms 5.
Additional Testing
In some cases, additional testing such as imaging studies (e.g. MRI) may be indicated to rule out any underlying conditions that may be contributing to the patient's symptoms 6.
- The results of these tests can help guide the development of a treatment plan that addresses the patient's specific needs and symptoms.
- Treatment options may include cognitive behavioral therapy, tinnitus retraining therapy, sound therapy, hearing aids, cochlear implants, pharmacotherapy, and brain stimulation 2, as well as management of any underlying conditions that may be contributing to the patient's symptoms.