Otologic Symptoms Research Articles

The changing landscape of vestibular schwannoma diagnosis and management: A cross-sectional study.

To assess the current state of the diagnosis and management of vestibular schwannoma (VS) as well as treatment trends, and to evaluate the role of treatment setting and various specialists in treatment plan. Patients diagnosed with VS completed a voluntary and anonymous survey. The questionnaires were distributed through Acoustic Neuroma Association website, Facebook page, and e-mail newsletters from January to March 2017. In total, 789 VS patients completed the survey. Of those, 414 (52%) underwent surgery; 224 (28%) underwent radiotherapy; and 121 (15%) were observed. General otolaryngologists diagnosed 62% of responders, followed by primary care (11%) and neurotologists (10%). Patients who underwent surgery were significantly younger and had larger tumors compared to those treated with radiation or observation. The ratio of patients having nonsurgical versus surgical resection changed from 1:2 to 1:1 for the periods of 1979 through 2006 versus 2007 through 2017, respectively. Neurosurgeons (40%) and neurotologists (38%) were the most influential in treatment discussion. Neurotologists (P < 0.001) and general otolaryngologists (P = 0.04) were more influential than neurosurgeons for the decision process in patients with smaller tumors. Patients treated at academic versus nonacademic private institutions reported similar tumor sizes (P = 0.27), treatment decisions (P = 0.09), and decision satisfaction (P = 0.78). There is a continuing trend toward nonsurgical management, with approximately half of the patients opting for nonsurgical management. In this cohort, the patients commonly presented with otologic symptoms and otolaryngologists made the most diagnoses. Neurotologists and neurosurgeons were the most influential in treatment discussion. NA Laryngoscope, 130:482-486, 2020.

Incidencia y características clínicas y epidemiológicas del carcinoma de nasofaringe en Cantabria en 2014

Introduction and Objective: The objective of this study was to describe the clinic-epidemiological characteristics of the nasopharyngeal carcinoma in Cantabria (Spain) and to compare it with previous studies performed. Material and methods: A retrospective study of nasopharyngeal carcinomas diagnosed in Marques de Valdecilla Hospital (Santander, Cantabria, Spain) between 2004 and 2015 was made, determining the following variables: age, occupation, toxics, outcome symptoms, treatment and clinical evolution. Results: 45 patients with ages range between 35 and 85 were diagnosed of nasopharyngeal carcinoma, with an incidence of 0,71/100000H/year. 38 were men (84,5%) and 7 were women (15,6%). The fifties decade was the most frequent period of diagnosis. Otological symptoms were the main clinical outcome (40%), followed by cervical adenopathy (26,6%). Undifferentiated carcinoma was the most common histological type (68,9%), being diagnosed in advanced stages. Conclusions: Nasopharyngeal carcinoma is an uncommon tumour in Cantabria being more frequent in males in their fifties. Its clinical presentation, often nonspecific, results in advanced stages diagnose. The most common histological type (undifferentiated carcinoma).

Prevalence of otological symptoms and parafunctional habits in patients with temporomandibular dysfunction

ABSTRACT Objective: to verify the relationship between otological symptoms and parafunctional habits in individuals with temporomandibular joint dysfunction. Methods: evaluations were based on the clinical records of 768 patients treated at a temporomandibular joint diagnostic center from 2010 to 2016. The inclusion criteria were completely filled out charts of adult patients (&gt; 18 years of age) and the final sample comprised 516 clinical records. The presence/absence of parafunctional habits and otological symptoms (tinnitus, hearing impairment, dizziness, the sensation of plugged ears and imbalance) was recorded. Results: statistically significant associations were found between otological symptoms and both sex and the presence of parafunctional habits, as otological symptoms were more prevalent among women and individuals with at least one parafunctional habit. Conclusion: in the present sample, otological symptoms were positively associated with parafunctional habits in individuals with temporomandibular joint dysfunction.

Ear Nose and Throat (ENT) Manifestations in Granulomatosis with Polyangiitis in Patients from Saudi Arabia

Granulomatosis with polyangiitis (GPA) frequently affects ear, nose and throat (ENT) at disease onset. Our aim was to report on our experience with the ENT manifestations in GPA patients, therapy and outcome. A retrospective study of GPA patients was performed who followed up in Rheumatology clinics at King Khalid University hospital, Riyadh during the period 1990-2016. Demographics, different ENT manifestations, laboratory and diagnostic features, therapy and outcome of GPA patients were retrieved from their medical charts. ENT involvement was observed in 15 (65.2%) of the 23 GPA cases identified. Otologic symptoms were noted in 3 (13.0%), nose and sinus symptoms in 13 (56.5%) and throat symptoms in 3 (13.0%) GPA patients. Epistaxis (39.1%) was the most prevalent nose and sinus symptom followed by sinusitis (30.4%), otitis media and hearing loss were the frequent otologic symptoms, oral ulcers and hoarseness of voice constituted frequent throat symptoms in GPA patients. Of the 15 ENT-GPA patients, 9 were males and 6 were females (male: female; 1.5: 1). Their mean age at disease onset was 33.8 ± 18.3 (range 11-57) years and mean duration of disease was 10.1 ± 5.9 (range 1-20) years. ANCA was positive in 93.3% ENT-GPA patients, 73.3% had c-ANCA and 20.0% had p-ANCA. Infections were noted in 33.3% ENT-GPA patients that included pneumonia, septicemia, esophageal candidiasis, bacterial meningitis and herpes zoster. All patients received oral prednisolone, 60.0% received intravenous cyclophosphamide, 20.0% refractory cases received rituximab doses, and the disease outcome was good. Comparison of ENT- GPA with non- ENT GPA cohort showed that 26.7% ENT-GPA patients had renal involvement compared to 87.5% non ENT-GPA patients (p = 0.009). Our study showed that the frequency of ENT symptoms in our GPA patients was less compared to other studies, and the disease outcome was good. Renal involvement was significantly less frequent in ENT-GPA cohort compared to non ENT-GPA cohort.

The Tornwaldt cyst

We report the case of a patient who presented otological and neurological symptoms; an endoscopic examination has objectified formation of the nasopharynx and the imaging has confirmed the cystic nature of this formation compatible with a Tornwaldt cyst. This lesion is quite rare, benign and often asymptomatic, its knowledge is important to eliminate other malignant causes and invasive management.

Otologic presentation of multiple myeloma with isolated temporal bone involvement: Diagnostic and therapeutic implications

Plasma cell disorder spectrum ranges from the benign plasma cell granuloma to malignant multiple myeloma characterized by the monoclonal proliferation of plasma cells. Multiple myeloma with temporal bone involvement is a rare entity and may present with nonspecific otological symptoms similar to chronic ear disease leading to a diagnostic challenge. Suspicion of multiple myeloma involving temporal bone primarily is difficult, and most of the cases are diagnosed after initial surgical excision. The differential diagnosis includes temporal bone carcinoma and glomus tumor due to similar radiological features. The final diagnosis is, however, made by the histopathological and immunohistochemical analysis. The mainstay of treatment of multiple myeloma is chemotherapy; however, surgical excision of the lesion is warranted in cases of pressure symptoms and intracranial involvement. We present a case who presented with ear canal mass, facial palsy, and cerebellar symptoms and was diagnosed to be a case of multiple myeloma with temporal bone involvement and was treated successfully. He is on regular follow-up for 1 year and remains in complete remission.

Drug-induced hearing loss as a manifestation of drug-induced ototoxicity

The ability of drugs to have an ototoxic effect has been studied for a long time, however, the true prevalence of this undesirable phenomenon is unknown, which is due to the use of various audiological protocols, a wide range of reactions to drugs in different ethnic groups, and most importantly, the lack of caution with regard to otological symptoms due to their reversibility or lack of immediate threat to life. Drug-induced ototoxicity is a functional disorder of the inner ear (cochlea and/or vestibular apparatus) or eighth pair of cranial nerves. Pharmacotherapy, associated with the development of ototoxic drug reactions, may remain undervalued for a long time, often until irreversible hearing impairment is formed. The most frequently prescribed drugs that cause ototoxic phenomena include anticancer drugs, antibacterial drugs of the aminoglycoside group, loop diuretics, calcium channel blockers, non-steroidal anti-inflammatory drugs, antimalarial drugs, salicylates, etc. Monitoring the degree of hearing impairment before and during therapy is important in preventing the development of drug-induced ototoxicity and makes it possible to consider alternative treatment regimens in a timely manner. It is in this connection that the role of participation in the appointment of rational pharmacotherapy to patients with a potential risk of developing otological phenomena of a clinical pharmacologist and audiologist undoubtedly increases.

Is There a Relationship Between Otological Symptoms and Temporomandibular Joint Disorders A Retrospective Study

Introduction: Otological symptoms are often associated with temporomandibular joint disorders (TMD). The exact correlation between these two phenomena is being controversially discussed in the literature for many years. This retrospective study aims to investigate the possible association of otological symptoms with specific TMD findings, as well as stress and chronic pain. Method: We analyzed the anonymized medical records of 56 patients. This included the assessment of the clinical functional status and Manual Structural Analysis (MSA) in accordance to the German Society for Functional Diagnostics and Therapy (DGFDT) and the Graded Chronic Pain Status (GCPS). Results: From all 56 patients with TMD 32 had otological symptoms. The most common TMD symptoms in patients with aural complains were pain by palpation of the m. masseter (81,82- 83,33%) and m. digastrics venter posterior (81,82% – 100%). Articular sounds were a prevalent finding especially in tinnitus patients (63,64%). An insufficient posterior static occlusion was present in 27,27% – 50% of the cases. Approximately half of the patients with aural complaints mentioned, that they feel stressed. Most of the patients suffered from a functional chronic pain (56,25%). A dysfunctional chronic pain was prevalent in 18,75% of the cases. Conclusion: The results indicate, that TMD patients with aural complaints have most often pain in the areas of m. digasticus venter posterior and m. masseter, so there might be an association of ear symptoms with a pathology of these muscles. However, no causal relationship could be proven. Arthropathology, malocclusion, psychological condition and stress levels are other factors, that seem to have influence. The etiology is multifactorial and remains unclear.

Otosyphilis: Resurgence of an Old Disease.

To describe the clinical characteristics of patients presenting with a new diagnosis of otosyphilis over the past 10 years in a large, urban, safety-net hospital affiliated with a large county sexually transmitted disease clinic. Retrospective case series. A chart review was performed of all patients who presented to an adult otolaryngology clinic with a new diagnosis of syphilis and hearing loss from January 2008 to December 2017. Twelve patients met the criteria for "suspected" or "likely" otosyphilis based on Centers for Disease Control and Prevention definitions. The average age was 48 years (range 19-59). All were male. Nine (75%) were men who have sex with men. Eight (67%) were positive for human immunodeficiency virus. One (8%) presented with primary, nine (75%) with secondary, and two (17%) with early latent syphilis. Seven (58%) presented with bilateral audiogram-confirmed hearing loss, two (17%) with unilateral hearing loss, and three (25%) with suspected hearing loss based on fluctuating symptoms. Nine (75%) presented with tinnitus and two (17%) with vertigo. The median duration of otologic symptoms prior to presentation was 2 weeks (range: 0-16 weeks). All presented within the last 2 years surveyed. We have seen an increase in the number of otosyphilis cases in our clinic. We suspect otosyphilis may be underdiagnosed and emphasize the importance of screening for syphilis in patients with new audiologic symptoms of vertigo, tinnitus, or hearing loss. 4 Laryngoscope, 129:1680-1684, 2019.

Association of asymptomatic otitis media with effusion in patients with adenoid hypertrophy

ObjectiveClinical symptoms of otitis media with effusion are rarely brought forward to the guardians of young children who the disease is most prevalent in. This often leads to poor scholastic performances and difficult social interactions. The objective of this study was to identify asymptomatic cases of otitis media with effusion present in individuals with adenoid hypertrophy. Material and MethodsIn a cross sectional study advocated in Justice K.S.Hegde Hospital, Karnataka India we evaluated one hundred patients above the age of three from August 2016 to December 2017. Candidates who presented with an adenoid nasopharyngeal ratio of more than 0.5 were selected for the study. Individuals who complained of otological symptoms were not considered for the study. Patients cleared of other pathological otological conditions were underwent audiological evaluation with pure tone audiometry and tympanometry for evaluating the middle ear status and hearing loss. ResultsThe study showed a total of 36% of patients evaluated presented with asymptomatic otitis media with effusion. In candidates who presented with a bilateral B tympanogram, 40% had significant conductive hearing loss of more than 25dB. ConclusionAn objective test such as impedance audiometry in all patients with adenoid hypertrophy would aid in the diagnosis of fluid in the middle ear, so that timely intervention can be done and possible complications be averted.

Otologic Outcomes After Blast Injury: The Brussels Bombing Experience.

After the suicide bombings in Brussels on March 22, 2016, many victims consulted our emergency department with otologic symptoms. The aim of this study was to report the otologic morbidity and outcome after acute acoustic trauma in these patients. Prospective cohort study. Tertiary referral center. Patients reporting subjective hearing loss, tinnitus, feeling of pressure in the ear, vertigo or hyperacusis after witnessing these bombings were included. All included patients were treated with systemic corticosteroid therapy, concurrent hyperbaric oxygen therapy (HBOT) was advised to each and every included patient. Participants underwent a routine otologic work-up including otoscopy, liminal audiometry, and subjective outcome measures related to tinnitus at baseline and at follow-up. Primary outcome was to describe the otologic morbidity after acute acoustic trauma (AAT). Secondary outcome was to evaluate the recovery of hearing loss, subjective symptoms, and tympanic membrane perforations. Fifty-six patients were included in our population with an average age of 27 ± 13 years, and 46% women/54% men. Thirty-two patients reported subjective hearing loss, 45 reported tinnitus, 45 reported a feeling of pressure in the ear, 2 patients experienced vertigo, and 18 patients reported hyperacusis. Otoscopic examination revealed three tympanic membrane perforation (TMP). Sensorineural hearing loss (SNHL) was observed in 41% (n = 23) and mixed hearing loss in 3.6% (n = 2). No conductive hearing loss (CHL) was observed. Follow-up was obtained in 76.8%, with the last follow-up available at 47 ± 74 days. Two perforations closed spontaneously, while one persistent perforation was successfully reconstructed with complete air-bone gap closure. There was a significant improvement in subjective symptoms. SNHL improvement was observed in 52.6% (10/19), mixed hearing loss improved in both patients. Improvement in hearing thresholds was seen in patients treated with steroids and in those treated with steroids and HBOT, there was no significant difference in the degree of improvement between these two groups. Blast-related otologic injuries have a significant impact on morbidity. Comprehensive otologic evaluation and state-of-the-art treatment may lead to a significant improvement in symptoms and hearing loss.

Incidental mastoiditis on magnetic resonance imaging scans: clinical relevance and cost implications.

To determine: (1) the incidence of incidental 'mastoiditis' reported on magnetic resonance imaging scans performed in patients with asymmetrical sensorineural hearing loss and/or unilateral tinnitus; (2) how many of those patients have actual otological pathology and/or require treatment; and (3) the financial implications of such a reporting practice. Retrospective case series. Between October 2015 and November 2016, 500 patients underwent magnetic resonance imaging of the internal auditory meatus to rule out cerebellopontine angle lesions. There was an incidental finding of increased mastoid signalling in 5.8 per cent (n = 29), of which 20.7 per cent (6 of 29) were reported as bilateral cases. The diagnosis of 'mastoiditis' was found in 39.7 per cent (29 of 73). None of these patients had any pathology identified clinically. Other significant pathology was identified in a further 8.8 per cent (n = 44). The diagnosis of mastoiditis is primarily clinical. An incidental finding of high signalling in the mastoid region on magnetic resonance imaging is highly unlikely to represent actual clinical disease. In patients who are scanned for other reasons and who do not complain of otological symptoms, such findings are unlikely to require otolaryngology input.

Tinnitus: The Sound of Stress?

Background:Emotional stress is frequently associated with otologic symptoms as tinnitus and dizziness. Stress can contribute to the beginning or worsening of tinnitus.Objective:The objective of the study is to evaluate the presence of stress symptoms in patients with chronic, subjective tinnitus, and correlate its presence to annoyance associated with tinnitus.Methods:This is a cross-sectional study. One hundred and eighty patients with chronic, subjective tinnitus were included. Patients answered the Tinnitus Handicap Inventory (THI) to evaluate the impact of tinnitus in the quality of life and answered the Lipp's inventory symptoms of stress for adults (ISSL). The data obtained was organized using Excel® 2010, mean values, linear regression and p-value were calculated.Results:Of the 180 patients included in the study, 117 (65%) had stress symptoms, 52 of the 117 (44%) were in the resistance phase and 23 of the 117 (20%) in the exhaustion phase, the remaining was in the alert phase. There was a clear progressive increase in stress as THI raised, with more impact of tinnitus in quality of life.Conclusion:The presence of stress symptoms, measured by ISSL was observed in most of our patients with chronic subjective tinnitus, specially in the resistance and exhaustion phases and it is directly associated with tinnitus annoyance.

A clinical study to determine the effects of adenoidectomy in cases of secretory otitis media in school going children

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Secretory otitis media (SOM) is common otological symptom in children. If left untreated it leads to hearing and speech impairment. Surgical management is effective in serious cases. The present study was done with the objective&lt;strong&gt; &lt;/strong&gt;to assess the effect of adenoidectomy by pure tone and impedance audiometry in cases of SOM with hypertrophied adenoids.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study comprised 50 cases, who were aged 5-12 years and diagnosed as SOM with adenoid hypertrophy. It was carried out for a period one and half years from December 2015 to July 2017 at Mamata Medical College and Research Hospital, Khammam, Telangana. After detailed history and clinical examination, investigations such as pure tone audiogram, impedance audiometry, X-ray nasopharynx and diagnostic nasal endoscopy were carried out to confirm the diagnosis. All patients were posted for adenoidectomy and when indication was present tonsillectomy was also done. They were followed up at 1st, 3rd and 6th month for pure tone audiometry and impedance was done at 6th month of surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In this study, maximum number (60%) of cases belonged to 5-7 years age group, with slight male preponderance (56%). On pure tone audiometry 68% had 16-25 dB and 32% had 26-40 dB hearing loss and average being 24.95 dB. On impedance only 14% had peak preoperatively. Postoperatively, no peak/peak conversion was seen in 33% of cases and mean A-B gap improvement at 1st, 3rd and 6th month was 13 dB, 13.2 dB and 12.7 dB respectively (p value is 0.0001,&amp;lt;5%) when compared to preoperative findings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Adenoidectomy is effective in the management of middle ear infection in children having hypertrophied adenoids.&lt;/p&gt;

Otological findings and other symptoms related to temporomandibular disorders in young people

In a prospective, observational study between April and November 2017 we evaluated the correlation between temporomandibular disorder (TMD), and otological signs and other symptoms in a sample of 251 patients. First, a simplified anamnestic questionnaire was applied for the diagnosis of TMD and the following symptoms were recorded: otalgia, tinnitus, vertigo, pruritus of the ear, feeling of hearing loss, fullness in the ear, headache, pain in the eye, neck pain, back pain, and dizziness. Some degree of TMD was detected in 177 of the participants (70.5%). Among the otological symptoms studied, significant associations were found with tinnitus (<0.001), ear pain (<0.001), feeling of hearing loss (<0.001), and vertigo (<0.001). There were also significant associations with non-otological symptoms, the most common being back pain (<0.001), headache (<0.001), neck pain (<0.001), pain in the eye (<0.001), and dizziness (0.001). Our findings show that the higher incidence of both otological and non-otological symptoms was associated with a progressive increase in the severity of TMD.

Congenital Cholesteatoma: The Silent Pathology

Background: Congenital cholesteatomas (CC) arise from epithelial remnants around the petrous bone. They enlarge gradually causing progressive destruction and functional damage to the ear and surrounding structures. Because of their insidious course, most patients are misdiagnosed and present late with complications. Methods: This is a retrospective study of 41 cases diagnosed as CC and followed up for 2 years. All patients underwent full audiological evaluation and a radiological study (CT, MRI). Results: The male:female ratio was 2.3: 1, and the mean age was 30.89 years. The mean delay before presentation was 13 months. The commonest presentations in order of frequency were: discharge (60.9%), hearing loss (51.2%), facial paralysis (31.7%) and intracranial complications (31.7%). Forty patients were treated surgically by a variety of approaches depending on the extensions and functional status. The facial nerve was decompressed in 9 cases and cable grafted in 4. Two cases underwent VII-XII anastomosis later on. Conclusion: CC present with a myriad of clinical manifestations and should be suspected in all patients with unexplained otological signs and symptoms. They must be completely excised and the functional status of the ear rehabilitated either immediately or later. Follow-up must be indefinite as they have a high recurrence rate.

External auditory meatus involvement in nasopharyngeal carcinoma

AbstractBackgroundNasopharyngeal carcinoma with local extension to the external auditory meatus is rarely reported.Case presentationWe present two cases of nasopharyngeal carcinoma with invasion to the external auditory meatus. First case at initial presentation; and the second at disease recurrence. Both patients presented with unilateral otologic symptoms corresponding to the affected site; as well as being heavily node positive. Otoscopic examination and 18F-fluorodeoxyglucose positron-emission topography demonstrated the involvement of external auditory meatus.ConclusionsThese two cases highlight the need of careful otoscopic examination and functional imaging to diagnose such cases.

Clinical Characteristics of Temporal Bone Metastases.

Objectives The purposes of this study were to evaluate the clinical characteristics of temporal bone metastasis (TBM) and to determine whether the characteristics differed according to primary malignancy.Methods We retrospectively analyzed data on 20 patients diagnosed with TBM between January 2000 and January 2017. Demographics, the period from diagnosis of primary malignancy to TBM diagnosis, the period from TBM diagnosis to death, the type and staging of primary malignancy, otologic manifestations, and TBM sites were assessed. After the primary malignancies were divided into solid cancers and hematologic malignancies, each parameter was compared between the two groups.Results The most common primary malignancy with TBM was lung cancer (45%). The most common otologic symptoms and signs were facial palsy (30.5%) and hearing loss (30.5%). The temporal squama (23%) and the facial nerve (20%) were the most commonly involved. Most TBMs occurred late in the disease process after the primary malignancy first metastasized to other organs. Hematologic malignancies metastasized significantly more frequently to the external auditory canal and the middle ear/mastoid compared to solid cancers (P=0.001 and P=0.004, respectively).Conclusion If otologic manifestations such as facial palsy and hearing loss are presented in patients at advanced stages of malignancy, TBM of primary malignancy should be suspected. In addition, hematologic malignancies tend to metastasize to the external auditory canal and the middle ear cleft more commonly than solid cancers do.

Diagnosis and management of conductive hearing loss in children with trisomy 21.

The objective of this study is to review the prevalence and degree of hearing loss in children with trisomy 21, their response to intervention and the presence of concomitant pathologies. The project will also highlight the experiences of the children from their parents' and guardians' perspective and the link between perceived service quality and an objective improvement in their hearing after rehabilitation. All patients with trisomy 21 who were referred to district general otolaryngology outpatient clinics between 2014 and 2016 were included. A retrospective analysis of the medical notes and audiograms along with a qualitative questionnaire to the children's parents was utilised to gather the information. The study showed that 77% (17/22) of children suffered from hearing loss, with a moderate degree being most prevalent. The majority of patients (14/17, 82%) were managed conservatively, undergoing a period of watchful waiting (9/17, 53%) or receiving hearing aids (5/17, 30%) and 3 of 17 (17%) were managed with grommet insertion. The improvement in hearing with hearing aids was comparable with grommet insertion and hearing aids scored highest in the post-intervention qualitative assessment with grommet insertion scoring the lowest. Functional hearing has been shown to be key in developing speech and language skills. In children with trisomy 21, behavioural and anatomical abnormalities make the diagnosis and intervention technically more challenging. This study demonstrates that in the absence of other otological symptoms, hearing loss can be managed effectively and with the least distress to the children with hearing aids.

A review of tinnitus

Tinnitus is one of the most common otological symptoms. In recent times our understanding of tinnitus has significantly progressed. Tinnitus may be defined as conscious awareness of a sound in the absence of an external auditory stimulus. People with tinnitus almost always seek the attention of their general practitioner, who is best placed to assess, investigate and provide appropriate counselling. The aim of this article is to define and provide guidelines on causes, assessment, appropriate investigation and management of tinnitus. Tinnitus may be categorised as subjective, objective, primary or secondary. The assessment of tinnitus begins by determining which of these types with the patient presents with. All patients with tinnitus warrant formal audiometric assessment, and a proportion will warrant further imaging. Management requires treatment of reversible causes. Those with subjective, bothersome chronic tinnitus require tinnitus-specific therapies.