Diagnostic Issues in Tinnitus: A Neuro-Otological Perspective

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Abstract
Arriving at a diagnosis to account for tinnitus 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) and in other cases it will give direction to the diagnostic evaluation (e.g., pulsatile). With the exception of dural arteriovenous malformations, the source of pulsatile tinnitus can be determined without conventional cerebral angiography. Establishing a diagnosis for nonspecific tinnitus is difficult because 1) tinnitus is common in the general population, 2) for any disease not all subjects will develop tinnitus, and 3) tinnitus can be multi-factorial. Unilateral tinnitus with nonspecific characteristics must be suspect for an acoustic neuroma. In the absence of stress or intense sound exposure, if tinnitus is intermittent, fluctuates widely in loudness or location, or has a diurnal pattern, then somatic influences upon tinnitus from the head or upper cervical region should be suspected. Tinnitus is the perception of sound in the absence of an external sound. As such, it is a symptom and may have many diverse causes. The purpose of this article is to describe an approach to establishing the origin of this symptom. For this reason, we use the presenting complaint as the organizing principle, because this is what confronts the clinician upon encountering the tinnitus patient.

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