Hanyang Med Rev.  2016 May;36(2):99-108. 10.7599/hmr.2016.36.2.99.

Objective Tinnitus

Affiliations
  • 1Department of Otolaryngology-Head & Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea. snparkmd@catholic.ac.kr

Abstract


Objective
tinnitus originates from the para-auditory structures of the head and neck and can be heard or documented by examiner. Three representative forms of objective tinnitus, according to the causal organs are myoclonic tinnitus, vascular tinnitus and tinnitus caused by the patulous Eustachian tube. Etiologies, pathologic mechanisms, diagnostic approaches, and proper treatment methods of objective tinnitus are comprehensively discussed with a review of literatures. Objective tinnitus can be cured in many cases. Clinicians need to be well aware of the clinical characteristics of objective tinnitus since early, correct diagnosis with proper management are mandatory for its cure.

Keyword

Tinnitus; Objective; Myoclonic; Vascular; Patulous Eustachian Tube

MeSH Terms

Diagnosis
Eustachian Tube
Head
Neck
Tinnitus*

Figure

  • Fig. 1 The pre-injection electromyogram of the the tensor veli palatini muscle showed the bursts of electrical activity with different frequencies and amplitudes (A). Botulinum toxin injection to the tensor veli palatini muscle was accomplished through an EMG-guided external approach (B).

  • Fig. 2 Diagnostic methods of middle ear myoclonic tinnitus. Direct observation of To-and-fro, or inward-and-outward motion, mostly in the posterior part of the tympanic membrane by otoendoscopic examination (A, arrows), sound evoked tremor-like motion of tympanic membrane which is also frequently observed in acoustic reflex decay test (B) are useful tools. Strong inward-and-outward motion of tympanic membrane in middle ear myoclonic tinnitus associated with a forceful eyelid closure syndrome can be documented even in a static compliance test (C).

  • Fig. 3 Vascular tinnitus diagnosed by imaging studies (arrows). High jugular bulb detected in temporal bone computed tomogram (A), intracranial aneurysm in 3D-reconstructed Brain CT angiogram (B), arteriovenous fistula in magnetic resonance arteriography (C), and glomus tympanicum in Gd-enhanced temporal bone magnetic resonance imaging (D).

  • Fig. 4 Diagnosis of the patulous Eustachian tube. Otoendoscopic examination of the tympanic membrane during forceful inspiration and expiration with the contralateral nostril blocked demonstrates the inward-and–outward motion of the total tympanic membrane according to the respiratory status. Outward buldging of tympanic membrane during expiration is shown in this otoendoscopic finding (A). It can also be documented by tympanogram in accordance with forceful respiration which shows severe and irregular perturbation (B).


Cited by  1 articles

Tinnitus: Overview
Chul Won Park
Hanyang Med Rev. 2016;36(2):79-80.    doi: 10.7599/hmr.2016.36.2.79.


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