Tinnitus - Subjective (heard only by patient) - 90% - Differential Diagnosis Algorithm

Unilateral On Audiogram - Perform MRI to rule out RC Lesion

 • Acoustic Neuroma

 • Lesion of Cochlear or Auditory Nerve

 • Brainstem Lesion

 • Multiple Sclerosis

 • Infarction

 • Méniére's Disease

Bilateral - No Hearing Loss:

 • Metabolic Causes: Thyroid Dysfunction, Vitamin A, B, Zinc Deficiency.

 • Psychogenic, Anxiety, Depression

 • Drugs (Salicyclates, Quinidine, Indomethacin)

 • Idiopathic

Bilateral - Conductive Hearing Loss:

 • Lesion of External or Middle Ear

 • Impacted Cerumen

 • Otitis Media

 • Otosclerosis

Bilateral - Sensorineural Hearing Loss:

 • Noise Induced

 • Ototoxicity

 • Presbycusis

 • Drugs (Propranolol, Levodopa, Loop Diuretics)

 • Congenital

Somatic:

 • TMJ

 • Bruxism

 • Whiplash

 • Skull Fracture

 • Closed Head Injury



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