TINNITUS - A STEPWISE WORK-UP TO QUIET THE NOISE WITHIN

Patients with tinnitus-ringing in the ears or head-frequently present initially to their primary care physician. Tinnitus may be subjective (audible only by the patiient) or objective (audible to the examiner). Subjective tinnitus more common and may be due to peripheral or centr al auditory pathology, a metabolic abnormality, or anxiety/depression. Objective tinnitus is rare and is frequently due to a vascular or neu romuscular condition, intracranial or head/neck tumor, or some specifi c structural defect of the ear, cochlea, or retrocochlear area. The st epwise workup of tinnitus includes a comprehensive history and physica l exam, audiologic evaluation, blood profile analysis, and referral wh en necessary. Treatments include hearing aids, masking devices drugs, and biofeedback.