Tinnitus complaint
The patient who is the main complaint of tinnitus is of interest to the doctor. Since tinnitus is a symptom, not a disease, doctors work as diagnosticians to determine if tinnitus is related to hearing loss and to screen the retro-cochlear fate.
Hospital Survey
In a hospital, a patient with tinnitus is treated like any other patient. A thorough history is conducted and a full audiological and otological assessment is carried out. Patients are then referred for audiometry of the response to the brain stem (BSERA).
Patients are transmitted if they have unilateral hearing loss, bilateral or bilateral tinnitus, tinnitus, not associated with hearing loss, meninges disease, vestibular complaints, asymmetric hearing loss, and progressive hearing loss. You can also order screening of X-rays and / or blood tests.
Tomograms of the temporal bone are taken to display the presence of space-occupying lesions in or around the internal auditory canal. Blood tests are conducted, for example, to check blood sugar levels, thyroid function, or to detect sexually transmitted diseases. The story is taken to determine the possible etiology of tinnitus.
Audiological evaluation
Audiological assessment includes standard purity and speech audiometry, decomposition of tones, 500 Hz. the difference in masking levels and impedance audiometry, including acoustic reflex disorder. Adult and pediatric patients were tested for one and a half years. For these patients, both BSERA data and other central test data are available.
Six cases were selected to illustrate (1) a significant variety of hearing loss patterns and neurological symptoms experienced by a tinnitus case; and (2) as cases with almost identical standard audiometric data and a complaint of tinnitus, may have very different results for BSERA and other central tests. In each case, tinnitus was considered the result of a sensory or nervous defect. The goal was by no means tinnitus.
First case
The first case is a 14-year-old girl with a stable, unilateral, high-frequency hearing loss in the left ear. A significant history of the disease includes measures and lead poisoning. No decomposition of the tone could be seen at 500 or 2000 Hz. Alternative binaural volume balance test (ABLB) at a frequency of 2000 Hz. the complete set is shown. For the left ear, the acoustic reflex was absent at 4000 Hz. and anomalous reflex decay was observed at 2000 Hz.
BSERA at equal levels showed that the delays for the Jewett 5 wave are identical. Tomograms were unremarkable. This conclusion contrasts directly with the following case.
Second case
A 13-year-old girl with a one-sided loss in her right ear. Significant history includes parental mismatch Rh (hemolytic disease of the newborn) and delivery by cesarean section. If this was a typical nuclear ischemic hearing loss, we expect it to be bilateral. The acoustic reflex is absent at 4000 Hz. in the right ear. BSERA at equal levels (absolute level and level of sensation) shows that latency for the right ear is clearly lower than for the left ear.
Tomograms were normal. Since her hearing loss is stable for seven years, the medical solution was simply to monitor her status with audiometry and BSERA at regular intervals.
Third case
A 9-year-old boy with a newly identified loss of high frequencies in his right ear. There was no significant history. Speech discrimination for the right ear is bad. Acoustic reflexes were present bilaterally through ipsilateral and contralateral stimulation. BSERA shows the delay for the Jewett V wave on the right, to be 0-42 millisecond below the left. Tomograms showed that the internal acoustic meat should be symmetrical.
This patient will pass at regular intervals.
Fourth case
9-year-old man, the main complaint of which was tinnitus and random disability. Auditometrically there is no difference between his data and the data observed in the third case, which indicates a high frequency of sensor-sensory losses. The speech discrimination in the left ear was bad. Suspicious was acoustic neuroma. No abnormal tone decay could be seen at 500, 2000, or 4000 Hz. Radiological studies revealed no irregularities. The waves of Jewett 3 and 5 were evident only when recording BSERA. Wave 5 latencies were within 0.2 milliseconds for both sides.
Fifth case
A 62-year-old woman presents a major complaint of tinnitus as part of menis disease. Additional complaints caused by interrogation were side headaches and dizziness when they got up in the morning. Blood pressure was normal. There has been a long history of exposure to occupational noise.
The audiogram showed normal hearing sensitivity bilaterally. Acoustic reflexes were present bilaterally through ipsilateral and contralateral stimulation. There was no anomalous reflex decay. BSERA at equal levels of hearing are shown for two ears. Wave 3 occurs 0.42 milliseconds earlier than the right. Wave 5 comes 0.3 milliseconds later for the left than for the right. This is a case where the BSERA records are clear, but the results are mixed.
How do we interpret this data? It was decided to closely monitor the patient.
Sixth case
34-year-old woman with a five-year history of tinnitus. Audiometrically there is no difference between its data and indications in the fifth case above. The audiogram showed normal hearing sensitivity. Acoustic reflexes were present on a bilateral basis. BSERA, at equal levels for the two sides, shows identical delays for Ivette 3 and 5 waves.
Comparing these results with previous cases, we find no differences based on standard audiometric information, but in the first case a small inter-turn lateral disparity for BSERA was found. A postoperative analysis of our data pool was simply an attempt to determine whether a routine procedure tests were in any case exceptionally sensitive to a complaint of tinnitus.
BSERA utility
In addition, we questioned the usefulness of BSERA as a differential diagnostic tool in these cases. Since tinnitus is only a symptom, this issue cannot be approached in exactly the same way as the usefulness of BSERA, for example, when detecting acoustic tumors. BSER A was useful in a wide range of cases for both adults and children. However, we have cases of tinnitus when normal BSERA has not been confirmed by radiological studies.
We have to ask if the abnormal BSERA is a very early indicator of retro-cochlear lesions, or have we stumbled upon yet another unknown problem to which BSERA is quite sensitive?
Especially in those few cases where there is no hearing loss, and in which tinnitus was the only symptom, would this unknown problem be related to what causes tinnitus?
One of the obvious problems is the use of BSERA as a tool for studying tinnitus, based on the nature of the tool itself, at least as we usually use it. The full set of Juvette waves is manifested only in moderate or high levels of stimulation. We might expect tinnitus to actually be masked by the test stimulus in many cases. At levels low enough for the stimulus to mask tinnitus at loudness, only wave 5 is usually present, and not as stable and well defined as at higher levels.
When it comes to hearing loss, it always works at a fairly high level compared to the usual hearing thresholds. In the unusual case of a patient with normal hearing and abnormal BSERA, we must again ask if there is a disease that can cause a change in the time of the nerve signals transmitted in the central nervous system, and yet will not lead to obvious hearing loss.
It can be postulated that we should carefully study such cases, we could find the prevalence of tinnitus and, thus, have an instance in which BSERA was selective for tinnitus. Comparisons between such cases and the BSERA standards and the absence of a complaint of tinnitus may be most illustrative.
