This chapter describes the role of the otolaryngologist (ENT specialist) in the diagnosis and treatment of tinnitus.
Apart from the general practitioner, the otolaryngologist is the first point of contact for many tinnitus patients.
Otological diagnosis must be performed in patients with acute tinnitus and basic audiological screening must be arranged.
The acute treatment of new-onset tinnitus is also the domain of the otolaryngologist.
In patients with chronic tinnitus, the role of the otolaryngologist – ideally as part of a multidisciplinary team – is to coordinate further diagnostic and therapeutic measures.
KeywordsOtolaryngology Tinnitus Hearing loss Counseling
Introduction and History
Advances in science in recent decades have completely redefined the role of the otolaryngologist in terms of the diagnosis and treatment of tinnitus. In the past, the otolaryngologist was often working alone in managing patients with tinnitus. The spectrum of therapeutic options available to the otolaryngologist was soon exhausted, particularly when treating patients with chronic tinnitus with no underlying otological cause. The great suffering experienced by these patients prompted committed otolaryngologists to repeatedly undertake heroic, but usually frustrated curative efforts, even extending as far as sectioning the eighth cranial nerve . A wide variety of therapeutic approaches, all of which had the labyrinth as their focus, also failed to yield successful outcomes . The justifiable demands of patients for further help led in many cases to a profound disturbance of the doctor–patient relationship. “You must learn to live with your tinnitus” – a comment frequently heard from the lips of doctors – was tantamount to admitting further treatment attempts would be futile. The frustrated patient often looked for a new doctor or sought refuge in paramedical treatments. The recognition that mechanisms unfolding outside the ear are key factors in the etiology and perception of tinnitus brought with it a change in the management of tinnitus patients. It became clear that to concentrate solely on the labyrinth cannot do justice to the problem of tinnitus. The development of the neurophysiological model of tinnitus  showed how successful treatment strategies can be designed that are outside the core competency area of the otolaryngologist. In patients with chronic tinnitus, the brain has now become the focus of treatment attempts. Aside from diagnostic and exploratory measures, the role of the otolaryngologist – as part of a team – is to coordinate the treatment of patients with tinnitus in conjunction with specialists from other disciplines.
The Role of the Otolaryngologist in a Modern Tinnitus Clinic
Patients with new-onset tinnitus generally seek an appointment first with an otolaryngologist. Thus, it is an important part of the otolaryngologist’s role to be the primary point of contact for the tinnitus patient. In Germany, tinnitus patients make up a large proportion (20–25%) of people seeking medical help from an otolaryngology clinic . For this reason, every otolaryngologist in clinical practice should acquire competence in the management of tinnitus patients; as a rule, such competence should extend beyond the knowledge gained in the course of specialist training, which tends to focus on surgical treatments. The otolaryngologist should acquire the understanding of the pathophysiology of tinnitus and the capacity to empathize with the patient. During the initial consultation, it is important to collect information about circumstances relating to the onset of tinnitus, the nature of the tinnitus, any possible concomitant hearing loss, as well as the patient’s psychosocial background (see Chap. 47). The importance of this first contact with the patient is immeasurable. The needs of an otherwise healthy patient with the symptom “tinnitus” must be taken seriously, but every effort must be made to keep the patient from being overly focused on this symptom. Catastrophic statements such as “Your tinnitus might be a sign of a brain tumor” may have devastating consequences for the patient’s further clinical course.
Otological diagnosis is a core competency area for the otolaryngologist (see Chap. 48). The purpose of otological diagnosis is to identify potential diseases of the external ear, middle ear, or inner ear that might be a possible cause of tinnitus. In many patients, this may result in a straightforward therapy, such as the removal of wax from the ear canal. For other diseases, such as otosclerosis, surgery (see Chap. 83) may lead to the abolition of tinnitus. In most tinnitus patients, however, an otological examination will reveal no abnormal findings.
Otological diagnosis should always be followed by audiological testing, which can discriminate between different forms of hearing loss. Such information should enable the otolaryngologist to explain to the patient how the tinnitus might have developed. This can help many tinnitus patients cope with their tinnitus and perhaps require no further therapy.
For patients who need further therapy, the otolaryngologist should direct the patient to an appropriate specialist in areas, such as the temporomandibular joint, cervical spine, etc., for further diagnostic work up.
Once the results of all investigations have been completed by all the specialists involved, a team conference should be held to draw up a treatment strategy for the individual patient. The interdisciplinary approach permits personalized treatment strategies that can be tailored to the requirements of the individual patient. Even though many forms of tinnitus remain “incurable” in the classic sense, this modus operandi brings a higher degree of satisfaction both for patients and for the physicians treating them.
Tinnitus that occurs as a part of sudden hearing loss should be treated with appropriate medications, such as intravenous steroid therapy (see Chap. 56) and rheologically active medication . The usefulness of such vasoactive infusion therapies is still under debate in the English-speaking world .
The otolaryngologist can also make important contributions on a scientific level. As the first point of contact, the otolaryngologist will be familiar with many different patients and can therefore be useful in the recruitment, follow-up, and the assessment of patients in clinical studies.
- 1.House, JW and DE Brackmann. Tinnitus: surgical treatment. In Tinnitus (Ciba Foundation Symposium 85) 1981, Pitman: LondonGoogle Scholar