The detection/diagnosis of tinnitus

Even if an initial diagnosis has already been given by a physician, it is key to consult an ENT specialist for a more definitive diagnosis. To be able to establish a diagnosis and the best treatment for the patient, a comprehensive examination takes place at the ENT doctor, such as an ear microscopy, hearing tests and special tinnitus tests.

In order to determine the hearing threshold, it is important to rule out other possible causes of tinnitus, such as ear diseases (e.g. an ear canal infection) or a plug of earwax .

When sounds hit the ear, the hair cells in the inner ear contract. The otoacoustic emission test (OAE) measures hair cell function in the inner ear.

To perform this test, microphones are placed in the external auditory canal. These highly sensitive microphones are able to register particularly quiet sounds, allowing the doctor to observe the various processes occuring in the inner ear in detail, including Spontaneous and evoked otoacoustic emissions.

• Spontaneous otoacoustic emissions (SOAE) are the continous sounds emitted from the ear produced without the influence of an acoustic stimulus.
• Evoked otoacoustic emissions are the sounds emitted from the ear produced by external acoustic stimuli. A distinction is made between: transitory evoked OAE (TEOAE), simultaneous evoked OAE (SEOAE) and distortion product OAE (DPOAE or DP).

Incidentally, this test is also used when screening the hearing of newborns and infants or for early detection of noise-induced hearing damage in occupational medicine.

BERA (Brainstem Evoked Response Audiometry) is another hearing examination commonly used to diagnose tinnitus. This examination tests the nerve reactions in the brain that take place during the processing of auditory stimuli. The examination of these early auditory evoked potentials (FEAP) is painless.

To perform this test, three to four electrodes are placed around the head to measure what happens in certain areas of the brain when a sound is processed. This can tell us a lot about the functionality of the auditory nerve, the auditory pathway and can help exclude an acoustic neuroma, a type of non-cancerous (benign) brain tumour that can trigger tinnitus.

Tinnitus sound therapy is a treatment that matches the frequency of your tinnitus tone. Since there is no way to objectively measure the frequency, the patient must "hear" for themselves when the frequency played through the headphones by the ENT doctor matches to their tinnitinus tone.

Once the ringing in the ears is superimposed by a tone, the ENT doctor can determine the frequency of the tinnitus condition.

Depending on the results of the initial hearing tests described above, ENT doctors may perform additional tests:

• Tuning fork test: This examination can help determine the patient's hearing threshold.
• MRI: An MRI is used to exclude certain causes for the tinnitus, such as an acoustic neuroma.). In some cases, an MRI of the cervical spine may also be taken.
• Ultrasound: An ultrasound is also used to identify the root cause of tinnitus.
• Balance disorder tests: These tests can help identify problems in the inner and middle ear.
• Angiography: A CT angiography or also an angio-MRI are used to examine the vessels, veins and arteries near the ear.
• Tympanometry: This hearing test provides clarity about the condition of the eardrum and middle ear.