Tinnitus Part Two: What to Expect From Your Audiologist or ENT

You have tinnitus. Now what?  
1)      If tinnitus is your only symptom, have your hearing checked by an audiologist. The audiologist may ask you about recent exposure to loud sounds, use of caffeine or alcohol and stress or fatigue—all of which can make perceived tinnitus worse. They may ask you how often the tinnitus occurs (is it constant or transitory?), what it sounds like (is it buzzing or more like a pulse?), or what time of day it occurs (upon standing first thing in the morning, or at night when you are trying to fall asleep?). This is all useful for the audiologist to know to help determine if further medical referral is necessary.  

Tinnitus is very often associated with hearing loss, though not always. If no hearing loss is present the audiologist may recommend that you follow-up with your primary care physician. They will more closely examine non-hearing related possible causes of the tinnitus. Such causes include medications you are taking or other pre-existing medical conditions.  

2)      If your tinnitus is accompanied by hearing loss, have your hearing checked by an audiologist. As there is a high prevalence of association between hearing loss and tinnitus, this is most likely the contributing factor to the tinnitus (though other possible causes that require medical intervention will be ruled out through case history in conjunction with the full hearing evaluation). Depending on the type, degree, and configuration of your hearing loss the audiologist will decide if referral to Otolaryngologist or ENT (ear, nose, and throat physician) is warranted.  

Though tinnitus cannot usually be directly measured, the audiologist may do a series of measurements to try and match the intensity and pitch of your tinnitus. This can be helpful information if there will be use of sound generating devices or hearing aids for treatment of tinnitus.  

Hearing loss reduces auditory stimulation resulting in increased awareness of tinnitus. The audiologist may recommend hearing aids for management of both the hearing loss and the tinnitus. Clinical evidence has shown that consistent use of hearing aids in tinnitus patients provides two major benefits. First, it helps the patient to be less aware of the sound of the tinnitus. Second, it helps to improve communication by reducing the sensation that sounds and voices are being masked by the tinnitus.  

3)      If tinnitus is combined with pain or pressure in the ears, drainage from the ears, or a sudden change in hearing, follow-up directly with your primary care physician. If they are not available see Urgent/Emergency care. These are signs for possible need of medical intervention. The physician may attempt preliminary treatment for any infection or condition seen on examination (ear infections, drainage from the ear, or other infection). They may also refer you to an ENT for continued treatment and follow-up. ENTs work closely with audiologists; the ENT may request that you have your hearing evaluated at the time of the appointment, especially if preliminary medical intervention has not cleared up the tinnitus or hearing loss.  

Be on the lookout for the next segment: Tinnitus Part Three: Tinnitus Management  

Sarah Nordberg, AuD is an audiologist at Affinity Hearing in Plymouth.  She may be reached at 763-744-1190 for any questions.  Affinity Hearing provides free hearing screenings and hearing protection consults to the general public. Please visit www.affinityhearing.com for more information.