Abstract
Optimal care for a patient with tinnitus begins with identifying the cause of the
tinnitus. Once the cause has been identified then an appropriate treatment plan can
be initiated. In this article, the author reviews how to identify the tinnitus etiology
and its treatment.
The workup begins with the patient's description of the percept because in some cases,
the quality of the tinnitus will make the diagnosis (e.g., clicking, which is readily
suppressed pharmacologically); in other cases, it will give direction in the diagnostic
evaluation (e.g., pulsatile). With the exception of a small dural arteriovenous malformation,
the source of objective pulsatile tinnitus can be determined without conventional
cerebral angiography. If the diagnostic workup is unrevealing and the pulsations are
not suppressed with somatic testing, then eighth nerve vascular compression becomes
the likely etiology, especially if there is some clicking also heard, no matter how
minor.
The two major causes of tinnitus are hearing loss and myofascial disorders of the
head and neck. Moreover, the two can combine and cause tinnitus even though either
condition alone would not have caused tinnitus. Although the tinnitus of hearing loss
is not easily treatable, the tinnitus from myofascial disorders is often responsive
to an optimized myofascial treatment program. Hyperacusis, a frequent accompaniment
of tinnitus, and its treatment are discussed.
Keywords
tinnitus - somatic - eighth nerve - craniocervical - dorsal cochlear nucleus - vascular
compression - stress - hyperacusis
