Diagnosis and treatment of tinnitus
Tinnitus is a symptom that can be caused by different pathologies related or not to the ear. It can also be the consequence of a treatment. It appears at any age and without distinction of sex. In its diagnosis, the first step is to consult the clinical history, which will inform us about the time of onset, its intensity, its relationship with triggering maneuvers and the presence of associated symptoms such as the sensation of full ear, hypoacusis and hyperacusis.
Diagnosis of tinnitus
Once the medical history has been taken, the patient should be asked about any medical history unrelated to the ear, such as alterations in blood pressure, blood sugar, thyroid, recent changes in any medication and accidents or spinal or cervical traumas. Also if there is a family history of ear diseases.
Subsequently, an otoscopy will be performed, that is to say, an inspection of the external and middle ear, observing the parts that form them: the pinna, the duct and the eardrum. When the cause of tinnitus is located in the ear canal, as in the case of wax plugs, or in the middle ear, with acute otitis media or postotitis sequelae, we can identify it and it will guide the rest of the explorations. In case the conflict is not in the ear or is in the inner ear, the otoscopy will be the usual one.
On the other hand, audiometry is an important test because many ear pathologies can cause tinnitus and alter hearing. The test consists of placing headphones on the patient and, by means of beeps, the patient must communicate the hearing of the noise to the examiner by pressing a button or raising his or her hand. The disadvantage of this procedure is that it is a subjective test (the patient must hear, identify the stimulus and communicate it to the specialist) and there are patients who confuse their beeps with the stimulus.
Another important step is the assessment of the impact of tinnitus on the patient’s quality of life and the stress it generates. There are no direct studies for this, so ENT specialists apply standardized and validated questionnaires that guide us on how tinnitus affects the patient and how he/she approaches it.
It should be noted that it is important to specifically explore the temporomandibular joint, since its pathology is frequently associated with the presence of tinnitus.
Blood tests and radiological tests, mainly of the skull and spine, are a complement to the above, to rule out any systemic pathology that may be the cause.
How are tinnitus treated?
The first step is to detect the cause of the disorder, since its treatment will improve the patient’s condition, for example if it is a plug, remove it; if it is due to hyper or hypotension, sugar or thyroid problems. In all cases, we must review the medication that the patient usually takes to detect if any of them could cause or worsen tinnitus.
The patient must be clear that establishing the cause of the tinnitus and being able to eliminate it, and thus suppress the tinnitus, is the exception. Usually we cannot clearly find a cause, but we can guide the treatment, although not the elimination of tinnitus, but the reduction of its impact on the patient’s quality of life.
In recent years, a multitude of pharmacological treatments have been tested, from vasodilators to metabolic protectors, vitamins and many others. Each of them has its function in specific cases, but there is not a “catch-all” drug that can be applied in all cases.
Nowadays, treatment is multidisciplinary, i.e. professionals from different areas are involved, such as the otolaryngologist, the audiologist and even the psychiatrist. These are long-lasting and patient-specific treatments, but they result in an improvement in more than 80% of cases, which does not necessarily mean that the tinnitus disappears, but that it becomes tolerable for the patient.
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