Tinnitus

HISTORY:

Tinnitus for ‍ ‍hoursdays

Type: ‍pulsatilenon-pulsatile, ‍ringingbuzzinghummingroaringhissingwhistling

Severity: ‍mildmoderatesevere, ‍012345678910 / 10

Pattern: ‍constantintermittent

Worsening factors: ‍nonequiet environments

Alleviating factors: ‍none, ‍effectiveineffective

‍hearing loss

‍vertigo

‍ear pain

‍ear fullness

‍headache

‍nausea

‍difficulty concentrating

‍difficulty sleeping

‍anxiety

‍depression



EXAM:

General appearance: ‍well-appearing

Ears: -R: ‍normal, -L: ‍normal

Neurologic: cranial nerves ‍normal, strength ‍5/5 throughout, sensation ‍normal, reflexes ‍2+ throughout, cerebellar function ‍normal, gait ‍stable

Mental status: ‍alert, ‍oriented, speech ‍clear, mood ‍normal, thought process ‍organized, ‍no suicidal ideation, judgment ‍good



ASSESSMENT:

‍Benign tinnitus ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Audiogram

- MRI of the brain and internal auditory canals if unilateral with hearing loss

- CT scan of the temporal bones

- Reassured that most cases are benign

- Sound therapy

- Cognitive behavioral therapy

- Avoidance of loud noises

- Limit caffeine and alcohol

- Hearing aids

- ‍Steroids

- Referral to otolaryngologist if sudden onset, pulsatile, unilateral, hearing loss, or if persistent

- Referral to audiologist

- Referral to psychologist

- Referral to tinnitus support group

- Follow-up in ‍ ‍weeksmonths

- Return if tinnitus worsens, if new symptoms develop such as hearing loss, dizziness, or if symptoms do not improve with treatment