Can an Audiologist Diagnose Tinnitus?
Tinnitus is the perception of hearing a sound when no actual outside sound or noise is present. Often, it is described as “ringing in the ears,” but tinnitus can have many different perceptions of sound, including buzzing, hissing, whistling, swooshing, and clicking. In some rare cases, tinnitus patients report hearing music. Tinnitus can be both an acute (short-term, less than 6 months) condition or a chronic (continued, greater than 6 months) health disease.
Audiometric Evaluations for Hearing Loss and Tinnitus
The first step to treating hearing loss and tinnitus is to get an audiometric evaluation completed by an audiologist. A full diagnostic hearing evaluation can include any of the following tests and sometimes more depending on your medical case history: pure tone audiometric testing, speech recognition testing, and tympanometry.
Pure tone audiometric
Pure tone audiometric testing includes obtaining thresholds (or the softest sound you can hear) of hearing for low, medium, and high-frequency sounds.
Speech recognition testing
Speech recognition testing is completed to get insight into the connection between the ears and our brain, and how well a listener can understand words. This typically includes repeating recorded words to obtain both a threshold level and an accuracy score. Speech recognition thresholds (SRTs) are obtained to determine the lowest volume needed for the listener to repeat 50% of the spondaic words (balanced) correctly and help determine the validity of pure tone testing.
Word recognition scores (WRS) are obtained to determine the percent accuracy of words when presented at a comfortable listening level.
Tympanometry
If there are concerns for the outer or middle ear disorder, including fullness, ear pain, or an ear infection, tympanometry can be completed. This test involves presenting a low tone noise that creates pressure within the ear canal to test the motility of the eardrum.
Additional testing
Additional testing includes otoacoustic emissions (OAEs) and acoustic reflex testing.
OAEs are commonly used as a hearing screener as they provide a pass or fail result and test the function of the outer hair cells within our permanent inner ear of hearing.
Acoustic reflex testing tests our middle ear reflex arc that includes connections to the lower level of the brainstem. This test is commonly used when there is concern for abnormal growth along the auditory nerve.
Tinnitus evaluation
Once the hearing evaluation is complete, the next step is to complete a tinnitus evaluation. While there is currently no way to objectively test for tinnitus, there are several protocols to measure the patient’s subjective perception of tinnitus sound, pitch, and volume. Specifically, the doctor may test pitch and loudness matching, minimum masking level, and loudness discomfort levels.
Key Tinnitus Testing Methods
Pitch and Loudness Matching
Pitch and loudness matching allow the patient to subjectively match their tinnitus to the closest available sound.
Minimum Masking Level
Minimum masking is then completed to determine whether outside noise can cover the tinnitus, meaning the brain can focus on other stimuli when given the opportunity.
Loudness Discomfort Levels
Loudness discomfort levels are usually incorporated for patients who have sound sensitivity and determine the highest volume of pure tone sounds and speech a patient can hear before it becomes overwhelming.
The Subjective Nature of Tinnitus Testing
While there is currently no way to objectively test for tinnitus, there are several protocols to measure the patient’s subjective perception of tinnitus sound, pitch, and volume. Specifically, the doctor may test:
After the completion of the hearing evaluation, your audiologist may move on to tinnitus testing. This testing is subjective and dependent upon your perception of your tinnitus and your responses to the testing parameters.
Step-by-Step Testing Process
Pitch Matching
The first measurement is pitch matching. You will hear a sound in your ear(s) and you will be asked to “match” the pitch or frequency of the sound to your tinnitus.
Loudness Matching
Next, the sound will stay on the identified pitch and you will tell the audiologist to increase or decrease their sound to match the loudness of your tinnitus.
Minimal Masking Level
The final step will be to find the minimal masking level which will happen when the audiologist increases the loudness level of their sound until you tell them their sound is hiding or covering up your tinnitus. This may only last for a few seconds or longer.
These measurements help your audiologist be able to “map out” your tinnitus in relation to your hearing abilities. This is a helpful measurement when creating a management plan specifically tailored to you.
The Importance of Ongoing Evaluation
A diagnostic audiological evaluation provides valuable information to your audiologist about your hearing and tinnitus health. These measurements are able to be tracked and monitored. Sometimes, your results might warrant a referral to an Ear Nose, and Throat specialist for further medical evaluation.
The 3rd largest disability in the United States is hearing loss, yet, it’s the least regularly monitored.
Preventive and Routine Care
At the end of the day, healthy hearing starts before hearing loss and or tinnitus. Once either has started, annual or bi-annual evaluations are a way to monitor the progression and keep the recommended treatment and management plans current.
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