From the Guidelines
The first step for addressing tinnitus and balance issues is to perform a targeted history and physical examination to identify conditions that may relieve tinnitus. This approach is based on the recommendation from the clinical practice guideline: tinnitus executive summary published in 2014 1. When evaluating a patient with presumed primary tinnitus, it is crucial to identify conditions that, if promptly identified and managed, may relieve tinnitus.
Some key points to consider during the initial evaluation include:
- Identifying potential underlying causes of tinnitus and balance issues, such as inner ear disorders, medication side effects, or neurological conditions
- Documenting the patient's medical history, including previous illnesses, injuries, and surgeries
- Conducting a physical examination to assess the patient's overall health and identify any potential contributing factors
- Using the information gathered during the initial evaluation to guide further testing and treatment, such as hearing tests, balance assessments, and imaging studies
It is essential to prioritize a thorough initial evaluation, as it can help identify potential underlying causes of tinnitus and balance issues and guide effective treatment. By following this approach, healthcare providers can provide personalized care and improve patient outcomes, as supported by the guideline recommendation based on observational studies, with a preponderance of benefit over harm 1.
From the Research
Initial Evaluation for Tinnitus and Balance Issues
- The first step in evaluating tinnitus and balance issues involves a thorough history and physical examination of the head, eyes, ears, nose, throat, neck, and neurologic system 2, 3.
- This initial evaluation aims to identify potential underlying causes of tinnitus, such as sensorineural hearing loss, otologic, vascular, neoplastic, neurologic, pharmacologic, dental, and psychological factors 2.
- A comprehensive audiologic evaluation, including audiometry with tympanometry, is recommended for patients with tinnitus, especially those with unilateral tinnitus, tinnitus present for six months or longer, or accompanied by hearing problems 2, 3.
Assessment Tools and Recommendations
- Commonly used tinnitus assessment tools include pure tone audiogram, standardized questionnaires, and tinnitus pitch and loudness matching 4.
- Approximately half of audiologists include otoacoustic emissions in their assessment, while fewer measure high-frequency thresholds, minimum masking levels, or loudness discomfort levels 4.
- The most common recommendations for tinnitus patients are amplification, counseling, and sound therapy, with around 80% of audiologists recommending counseling and 79% recommending sound therapy 4.
Importance of Comprehensive Evaluation
- A comprehensive evaluation is essential to rule out less common but potentially dangerous causes of tinnitus, such as vascular tumors and vestibular schwannoma 3.
- Neuroimaging may be necessary for patients with asymmetric or unilateral tinnitus, pulsatile tinnitus, or tinnitus associated with focal neurologic abnormalities or asymmetric hearing loss 3.
- Supportive counseling should begin during the initial evaluation to help patients cope with tinnitus, and may also improve the chances of successful subsequent treatment 2.