Tinnitus in the side with better hearing

OBJECTIVES

We aimed to confirm the characteristics of patients with tinnitus in the better-hearing side.

MATERIALS AND METHODS

Among the 778 patients who visited the tinnitus clinic complaining of unilateral tinnitus at a local university hospital between March 2014 and December 2017, we recruited 62 patients who showed tinnitus in the better-hearing side on pure-tone audiometry. The mean hearing threshold was calculated using the arithmetic mean of the pure tone thresholds at 1, 2, 3, and 4 kHz. In addition, patients' medical history, tinnitus questionnaires, and other audiologic test results were thoroughly analyzed together for diagnosis.

RESULTS

Fluctuating hearing loss without vertigo or Ménière's disease were the most common etiologies (n = 16, 25.8%), followed by high-frequency hearing loss (n = 13, 21.0%), sudden idiopathic hearing loss (n = 6, 9.7%), and presbycusis (n = 6, 9.7%). Somatosensory tinnitus was also observed in seven patients. Neck pain was associated with tinnitus in five patients (8.1%), and two other patients (3.2%) experienced temporomandibular disorder in the same side as the tinnitus.

CONCLUSION

Tinnitus was associated with deterioration of hearing even when it occurred in the better-hearing side. Among the possible etiologies, fluctuating hearing loss in the tinnitus side was the most common audiologic finding. Assessment of hearing level at each frequency was more effective in detecting high-frequency hearing loss rather than the use of the mean hearing level. In addition, somatosensory tinnitus should not be ignored.

Recent surgical options for vestibular vertigo

Vertigo is not a well-defined disease but a symptom that can occur in heterogeneous entities diagnosed and treated mainly by otolaryngologists, neurologists, internal medicine, and primary care physicians. Most vertigo syndromes have a good prognosis and management is predominantly conservative, whereas the need for surgical therapy is rare, but for a subset of patients often the only remaining option. In this paper, we describe and discuss different surgical therapy options for hydropic inner ear diseases, Menière's disease, dehiscence syndromes, perilymph fistulas, and benign paroxysmal positional vertigo. At the end, we shortly introduce the most recent developments in regard to vestibular implants. Surgical therapy is still indicated for vestibular disease in selected patients nowadays when conservative options did not reduce symptoms and patients are still suffering. Success depends on the correct diagnosis and choosing among different procedures the ones going along with an adequate patient selection. With regard to the invasiveness and the possible risks due to surgery, in depth individual counseling is absolutely necessary. Ablative and destructive surgical procedures usually achieve a successful vertigo control, but are associated with a high risk for hearing loss. Therefore, residual hearing has to be included in the decision making process for surgical therapy.

[Utricular function. Correlation of three investigations carried out in routine practice]

BACKGROUND

For vestibular disorders competence in otorhinolaryngology (ENT) is required to diagnose disorders in the complete vestibular system. It seems difficult, however, to evaluate otolithic functions although the influence and importance regarding vestibular dysfunction could be relevant. Currently it is possible to unilaterally diagnose different functions of the saccule by recording cervically registered vestibular evoked myogenic potentials (c-VEMP). Partial functions of the utricle can be checked through the so-called turn-over manoeuvre during thermal examination, a gravitation-dependant caloric examination. Ocular recorded VEMPs and registration of the subjective visual vertical (SVV) are further tools for the discrimination of utricular function. This paper evaluates whether the results using these diagnostic tools are in agreement for distinct ENT-relevant vestibular disorders.

PATIENTS AND METHODS

In this study 100 unselected patients attending the vestibular outpatient department of the tinnitus clinic Dr. Hesse in Bad Arolsen and who were suffering from various forms of dizziness were consecutively and prospectively examined. In addition to standard diagnostic examinations (i.e. caloric testing, rotary chair, optocinetics and posturography) the turnover manoeuvre during caloric testing, o-VEMP recording and registration of the SVV were also performed.

RESULTS

For 62 % of the patients all 3 methods that measure partial functions of the utricle concurred. For an additional 6 % the results of the turnover manoeuvre and o-VEMP matched. The most conformity, with respect to sufficient utricular function was found for patients with non-vestibular dizziness, psychogenic vertigo and for the majority of patients with Menière's disease.

CONCLUSIONS

In the context of specific vestibular examinations it is possible to test utricular function through o-VEMO recordings and the turnover manoeuvre during caloric (cold) testing which allow clear conclusions especially with sufficient (positive) function. With 68% conformity between o-VEMP and the turnover manoeuvre it is obvious that both tests give strong indications for possible utricular dysfunction but do not give complete proof alone. The SVV is easy to register but is discriminating for utricular function only in cases of acute disorders.