Tinnitus complaint
A patient presenting a chief complaint of tinnitus poses an interesting problem to the clinician. A tinnitus is a symptom and not a disease, doctors job as diagnologists is to determine if the tinnitus is associated with hearing loss and to screen for retro-cochlear involvement.
Hospital examination
At hospital, a patient with tinnitus is examined like any other patient. A thorough history is taken and a complete audiologic and Otologic evaluation is done.
In addition, screening X-rays and / or blood tests may be Patients may be if they have have have unilateral hearing loss, bilateral or bilateral tinnitus, tinnitus uncorrelated with hearing loss, meniere disease, vestibular complaints, asymmetric hearing loss, and progressive hearing loss. ordered.
Blood studies are done, for example, to test blood-sugar levels, thyroid function, or to venereal disease The history is taken with a view to determine a possible etiology for the tinnitus.
Audiological evaluation
The audiological evaluation includes standard pure-tone and speech audiometry, tone decay, 500 Hz. Masking level difference and impedance audiometry including acoustic reflex decay. Adult and pediatric patients were tested during a year and a half. For these patients, both BSERA data as well as other central test data are available.
(2) how cases with near identity standard audiometric data and the complaint of tinnitus can exhibit very different findings for BSERA and other central tests. In each case, the tinnitus was thought to be the result of a sensory or neural defect. In no case was the tinnitus the objective.
First case
The first case, is a 14 - year - old girl with a stable unilateral high - frequency hearing loss in the left ear. Significant medical history Increment at 500 or 2000 Hz. The alternate binaural loudness balance test (ABLB) at 2000 Hz. shown complete recruitment. for the left ear, the acoustic reflex was absent at 4000 Hz. and abnormal reflex decay was observed at 2000 Hz.
The BSERA at equal levels revealed latencies for Jewett wave 5 to be identical. Tomograms were unremarkable. This finding is in direct contrast to the next case.
Second case
A 13 - year - old girl with a unilateral loss in the right ear. Significant history includes parental Rh incompatibility (Hemolytic disease of newborn) and delivery by emergency Cesarean section. Had this been a typical kern - icteric hearing loss, we would expect it The acoustic reflex is absent at 4000 Hz. in the right ear. The BSERA at equal levels (absolute level and sensation level) shows latencies for the right ear to be clearly later than for the left ear.
Tomograms were normal. Since her hearing loss has been stable for seven years, the medical decision was simply to monitor her status with audiometry and BSERA at regular intervals.
Third case
The BSERA shows The BSERA shows The BSERA shows The BSERA shows The BSERA shows latencies for Jewett wave V on the right side to be later than the left by 0-42 milliseconds. Tomograms shown both internal acoustic meati to be symmetric.
This patient will be be follows closely at regular intervals.
Forth case
A 9 - year - old man who chief complaint was tinnitus and occasional dyseilibilititim. Speech discrimination in the left ear was poor. No abnormal tone decay was evident at 500, 2000, or 4000 Hz. Radiological studies indicated no abnormality. Jewett waves 3 and 5 only were evident on the BSERA recording. Latencies for wave 5 were within 0.2 milliseconds for the two sides.
Fifth case
A 62 - year - old woman presenting a chief complaint of tinnitus as part of meniere 'emptied upon questioning were incidental frontal headaches and light - headedness when rising in the morning. long history of occupational noise exposure.
There is no abnormal reflex decay. Wave 3 occurs 0.42 milliseconds earlier in the left than for hearing sensitivity are bilaterally through. This right. Wave 5 occurs 0.3 milliseconds later for for the right. This is a case in which the BSERA records are clear, yet results are equivocal.
How do we interpret these data? The decision was made to monitor the patient closely.
Sixth case
The audiogram indicated normal hearing sensitivity. A coustic reflexes were present bilaterally. The BSERA, at equal levels for the two sides, shows identical latencies for Jewett waves 3 and 5.
Comparing these findings with the previous case, we have no audiometric information alone, yet the first case showed a slight inter-aural latency discrepancy for the BSERA. The post hoc analysis of our data pool determine if it is exclusively sensitive to the tinnitus complaint.
The usefulness of BSERA
Yes, we questioned the usefulness of BSERA, for instance, in the detection of acoustic tumors in the symptom, this question can not be approached in quite the same way BSER A was not useful in a wide range of cases for both adults and children. We have have tinnitus cases where normal BSERA was not confirmed by radiological studies.
We must ask whether or abnormal BSERA is a very early indication of a retro-cochlear lesion, or have we stumbled upon another unknown problem to which BSERA is rather sensitive?
Especially in hearing loss, and in which tinnitus was the only symptom, would this unknown problem be related to that giving rise to the tinnitus?
A full complement of Jewett waves is evident only a moderate-to-high levels of stimulation. We might BS over as a tool to study tinnitus arises from the nature of the tool itself expect the tinnitus to actually be masked by the test stimulus in many cases. tinnitus in loudness, only wave 5 is normally present and not as stable and well defined as at higher levels.
When hearing loss is involved, in the unusual case of the patient with normal hearing and abnormal BSERA, we again must ask if a disease exists that can cause an alteration in the timing of neural signals transmitted in the central nervous system and yet not to obvious hearing loss.
BSERA and no complaint of tinnitus could prove that such cases, we might find a preponderance of tinnitus and therefore have have an instance in which BSERA was selective for tinnitus. most revealing.
