Vestibular findings in a patient presenting with tinnitus

Ear, Nose & Throat Journal, Sept, 2004 by Kenneth H. Brookler

A 75-year-old woman presented with a chief complaint of constant tinnitus of 2 months' duration. She described it as a hissing sound in the left ear and/or on the left side of her head. She reported no tinnitus in the right ear or the right side of the head. She was aware of some hearing loss in the left ear, but she was not sure when it started. She said there might have been some minor fluctuation in her hearing in the left ear. She had experienced no aural fullness, dizziness, or balance problems.

Audiology revealed that the patient had a moderate sensorineural hearing loss in the low tones and a mild loss at 3 through 6 kHz in the left ear. Her speech reception threshold was 30 dB, and her speech discrimination score was 88% at 70 dB hearing loss.

Electronystagmography showed nystagmus while the patient was lying on her right side; the nystagmus was unaffected by neck torsion. The alternate binaural bithermal caloric test showed no abnormal reduced vestibular response or directional preponderance. The simultaneous binaural bithermal test elicited a type 3 response with a left-beating nystagmus on both cool and warm stimuli. Ocular fixation suppression was present during all responses to both calorie and positional stimuli.

This case serves as an illustration of abnormal vestibular findings on electronystagmography in a patient presenting with tinnitus. In the absence of dizziness, the vestibular findings suggest a peripheral origin of the tinnitus despite her inability to specifically localize the tinnitus either to her ear or her head.