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Tinnitus Tests and Diagnosis
Most of the time, the real cause of tinnitus is not known. The person who usually is responsible for diagnosing tinnitus will be either an otolaryngologist or an otologist. Both of these health professionals are ear specialists. A complete clinical assessment including the medical regimen and complete patient history of the patient is first done to see if he is positive for tinnitus and to ascertain the cause of the condition. To diagnose tinnitus certain tests may be performed. Some of these tests can assess the specific characteristics of the tinnitus itself and can involve:
- Audiogram
- X-rays
- Tinnitus pitch match
- Evoked response audiometry
- Maskability of tinnitus
- Tinnitus loudness match
- Residual inhibition
Audiogram
This test is also known as a hearing acuity test and it uses a chart that rates the patient’s ability to identify various speech sounds and to hear sounds. Since an amount of hearing loss can come about with tinnitus, an audiogram test can be a good diagnostic tool for properly identifying tinnitus.
X-rays
The head is usually x-rayed to see if there are structural problems existing in the ear that may be the ones causing tinnitus. If these tests are inadequate then a CT scan or an MRI may be requested.
Tinnitus Pitch Match
Tinnitus Pitch Match is based on the belief that physical tones have a pitch that relates to the frequency of each tone. The number of cycles a sound wave makes in a second is called a frequency. Sound waves vary in frequency – some may be high or very high and some may be low or very low.
To match the pitch tinnitus makes, the patient needs to choose from a number of external noises or tone. Of course the tones that closely correspond to tinnitus will be the one selected by the patient. A study done regarding tinnitus have revealed that most tinnitus patients rate tinnitus with a pitch match of around 3,500 Hz which is a little lower than the highest tone a grand piano can make which is a little above 4,000 Hz. A 3,500 Hz will have tones that may be of a screeching, unpleasant sound.
Evoked Response Audiometry
This test is performed typically for patients suffering tinnitus in one ear only. The evoked response audiometry test uses non-invasive computerized inner ear recordings that can be somewhat analogous to computer “fault-finding” checks used by computerized car engines found in certain car garages.
Maskability of Tinnitus
This is a test that rates the level to which tinnitus can be drowned out or “masked” by external sounds.
The maskability of tinnitus test utilizes a spectrum of noises for the masking or drowning of external sound. The noise spectrum or noise band may range from about 2,000 Hz to up to 12,000 Hz. This band is tested using earphones on the patient’s problematic ear.
The test entails the progressive but slow increase in the frequency or the pitch of the masking sound until it is distinctively heard by the patient. The pitch is then increased further up to the point wherein the patient no longer hears the tinnitus in his ear. The way the MML or minimum masking level is rated is in SL or dBsensation level. For the majority of the population, their MML is around 8 dB SL or lower. There are very rare cases, though, where the MML can go 22 dB SL and beyond.
Tinnitus Loudness Match
This test is to analyze the loudness of tinnitus by manipulating the volume of an external tone to match it as close to the tinnitus sounds as possible. The test progresses until the external tones are as comparably loud as the tinnitus.
The specific loudness of the patient’s tinnitus can be measured and usually the measure is around 4 to 7 dB or decibels which are comparable to a whisper and just a little above the verge of hearing. Curiously people with tinnitus usually complain of their tinnitus sounds as very loud sounds; however, the fact is that what they’re hearing is only about 4 to 7 decibels.
To assess between the perceived loudness of the tinnitus sounds and their actual loudness, the specialist can perform another test called the Visual Analog Scale.
Visual Analog Scale is some type of a measurement for assessing the loudness of the patient’s tinnitus. The scale rates the sound on a scale of zero to 10 with 10 being the loudest tinnitus sound possible and zero meaning “no tinnitus.”
The patient will then choose the number that best typifies the sound volume of his tinnitus. Based on numerous tests of this scale, around 70% of patients selected a rating of 6 or above. This assessment seems to suggest that the perceived tinnitus sound in a majority of patients is high.
Residual Inhibition
The residual inhibition test monitors the amount of time the tinnitus noise in the ear dissipates or vanishes following a period of masking. In this test, the patient’s tinnitus is masked by sounds measuring 10 dB for a full minute. Afterwards, the test measures the duration for the tinnitus sound to go away, if it does indeed go away.
Most tinnitus patients (about 85% of them) who have undergone this test showed either partial or complete residual inhibition. This means the tinnitus noise gradually dissipated in their ear. On the average, the time it took for the noise to go away was around 65 seconds.
A one minute residual inhibition test that results in a 65 second residual inhibition does not necessarily entail that an hour-long residual inhibition test will mean an hour’s worth of residual inhibition.
Increasing the sound volume of the masking sound will not prolong or add to the time or the level of the residual inhibition. There are venturous people though, who have used residual inhibition technique that involved extended amounts of time and have resulted in them enjoying several hours of residual inhibition.
Daniel Haun is a licensed acupuncture practitioner and the clinical director of Bailey & Haun Acupuncture in Oceanside, CA.
Tonsillitis Treatments and Drugs
You may not need to worry whether or not your tonsillitis stems from a bacterial or viral infection since your body’s immune system will resolve this infection in a matter of days. You can assist your body by doing some helpful things in the meantime.
You need to feed your child with lots of food and drink if he has tonsillitis even if he finds it hard to swallow. A dehydrated and hungry child can lead to unnecessary symptoms like tiredness and headaches. Surgery may be needed if your child constantly suffers from tonsillitis.
Self-help
Analgesics bought over-the-counter (OTC) like ibuprofen and paracetamol can help assuage symptoms such as sore throat. Younger children need small dosages so seek advice from your pharmacist on what dosage is right for your child. If your child is below 16 years, never give him aspirin.
Oral sprays and lozenges bought OTC can also relieve sore throat.
You can also gargle with a light antiseptic solution or even with just warm salty water for sore throat relief. A liter of water can be added with about half a teaspoonful of salt. For younger children the salt solution should not be tried since they may tend to swallow the solution.
Antibiotics
If tests reveal that you suffer from bacterial tonsillitis, that doesn’t automatically mean you will be prescribed antibiotics. Why? There are two reasons for this:
Most tonsillitis cases have shown that antibiotics do not really work or speed up the healing process. Moreover, they have negative side effects like feeling sick and abdominal pain.
Frequent use of an antibiotic will lead to antibiotic resistance making it useless when a serious infection occurs.
Antibiotics may be given if:
Your child’s immune system is weak
His symptoms do not get better
He shows severe symptoms
Doctors usually recommend a 10-day penicillin course for the aforementioned circumstances. If you or your child has penicillin allergy, other antibiotics like erythromycin may be given. Side effects caused by penicillin include:
Rash
Diarrhea
Upset stomach
Surgery
This procedure is now only performed if your child suffers from repeated bouts of tonsillitis or if his tonsillitis is especially disabling and severe that it causes work or school absences. A tonsillectomy is done to remove the tonsils.
This surgical procedure often entails the use of a general anesthetic and this implies that you will be sleeping the whole duration of the surgery. No skin incision is required and your mouth will be open during the surgery to enable surgeon to see and remove your tonsils.
The surgeon can opt for different surgical techniques to remove your tonsils:
Cold steel surgery – This technique uses a surgical knife to sever the tonsils out. Bleeding is regulated by using pressure or sometimes by searing shut the blood vessels through a process called diathermy.
Diathermy – The surgeon uses a diathermy probe in order to obliterate the surrounding tissue and eventually to excise the tonsils. The heat from the diathermy simultaneously shuts the blood vessels to prevent any bleeding.
Cold ablation or coblation – This is a similar technique as diathermy but instead of using heat the surgeon applies a 60 degree centigrade temperature to remove the tonsils. Coblation inflicts less pain to the patient compared to diathermy.
Lasers – Laser beams of the high energy sort are used as knives to slice out the tonsils and with the laser heat shut the underlying blood vessels.
Ultrasound – The surgeon uses high energy ultrasound waves instead of lasers to excise the tonsils.
Tonsillectomy is a minor procedure with the patient all ready to go home within the day of or the day after the surgery.
Post surgery
There will be some pain felt on the surgery site for up to a week after the operation. To address the pain, analgesics can be prescribed by the surgeon.
If a child has had a tonsillectomy he should not go to school for a couple of weeks. This precaution is important to prevent him from being infected by another child that can cause him discomfort and pain.
After surgery, the child will experience swallowing difficulties. However, it is essential that you make your child eat solid foods to make the healing process quicker. Your child may need to drink copious amounts of liquids although acidic juices such as orange juice should not be given as it can sting your child’s throat.
Make sure your child’s teeth are kept clean to prevent any pathogen from infecting his mouth.
After the first week of the operation the pain gradually dissipates. There may be earaches felt from time to time which is a common occurrence with tonsillectomies and is something not to worry about.
Post surgical bleeding
Post surgical bleeding usually occurs on the surgical site. This usually happens during the first day post surgery or up to ten days post surgery. Statistics reveal that about one child in 100 as well as one adult out of 30 adults will develop post surgical bleeding. After-surgery bleeding should not be a concern since the bleeding resolves by itself. To limit the bleeding, you can gargle using cold water since cold water can constrict the blood vessels and limit the bleeding. There are a few cases where bleeding can be a lot resulting in the patient coughing up or vomiting out blood. When this happens, see your doctor immediately.
When a patient suffers from extensive bleeding, he may be required to undergo another surgery or given blood transfusion.
Acupuncture
For people who want a more natural approach to tonsillitis treatment, acupuncture can be a good, safe and natural procedure to relieve sore throat pain. Acupuncture can likewise help the body overcome whatever infection is causing the tonsillitis. If you have a chronic case of tonsillitis, acupuncture can help enhance the immune function of your body and stop recurrence. In addition, Chinese herbal medicine possesses a lot of antibiotic properties to stem the irritation and inflammation; you need a qualified acupuncturist that is well experienced in treating your particular symptoms.
Tinnitus Symptoms
People experience tinnitus in different ways. There are others who are mildly affected by tinnitus while some may be severely impacted by this ear condition. There are individuals with tinnitus who may develop hypersensitivity compared with others to everyday sounds. A person with tinnitus, for example, may find the sound from a TV or a radio excruciatingly loud even when they are set at a normal volume. This symptom of tinnitus is called hyperacusis. Tinnitus symptoms can arise during specific situations or in certain times. A person having a mild form of tinnitus, for example, will more likely notice it when he or she is in a quiet environment while a noisy place can drown out those tinnitus sounds.
There are tinnitus cases that can be related with your posture. You can, for example, hear sound when you turn your head, sit down or lie down. Whenever you turn your head, sit or lie down, your blood vessels, muscles and nerves experiences changes in pressure that can cause the noises in your ear related to tinnitus.
Types of tinnitus
Tinnitus sounds can also be heard as a sound of buzzing, whistling or hissing that is high-pitched. However, these are just some of the sounds tinnitus can produce.
There are individuals with tinnitus who hear tinnitus in a deep droning, rumbling, murmuring or humming sound. Some tinnitus sufferers may hear repeated songs, musical tunes or other musical hallucinations in their ear.
These are so-called the less typical forms of tinnitus and they are depicted in more detail below.
Musical hallucinations – These symptoms of tinnitus often are heard by people who have hearing loss or long-term tinnitus. They can also be occasionally experienced by individuals having normal hearing as well as those with hyperacusis or hypersensitivity to sound. Musical hallucinations as with other kinds of tinnitus have really no explainable reason. Stress, however, can be a trigger for them.
Low-frequency noise – Some tinnitus sufferers can also experience low-frequency noise that they usually mistake as emanating from an outside source rather than coming from inside their ears or head.
Some of the sounds of low-frequency noise an individual can hear can include:
- Air conditioners
- Refrigerators, fans and other home appliances
- Underground gas pipes
- Air and road traffic noises
Sounds of thunder, the sea or wind can also be other natural low-frequency noise that one with tinnitus can hear.
To ascertain whether the sound you hear may be coming from within or from without, you can ask people beside you whether they can hear what you hear. If they hear what you also hear, then the noise is obviously not caused by tinnitus. If you hear the noise all the time wherever you go instead of from only one place, then you may likely have tinnitus. A recent illness or stress can be connected to your symptoms.
Pulsatile tinnitus
This is a form of tinnitus where you may hear noises with either a rhythm or pulse that may synch with your pulse or heart beat. Pulsatile tinnitus can be caused the result of:
- Enhanced awareness of the flow of blood near your ears
- Changes in your blood flow in the blood vessels near your ear
Sometimes an artery may develop a blockage restricting blood flow. Plaques or fatty deposits can accumulate on the interior arterial wall causing it to narrow. This condition is called atherosclerosis. When the artery becomes constricted, it limits blood flow making it noisy which can be heard by a person with pulsatile tinnitus.
A person with a hearing problem/ impaired hearing caused by a perforated eardrum, for example, may be more acutely aware of the sounds his body functions make like the sound of his blood flow. Pulsatile tinnitus makes the person more sensitive to internal sounds in his body as long as they are not masked by external sounds.
Dr. Jeda Boughton is a licensed acupuncture physician and the medical director of BodaHealth in Vancouver, BC.