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:
- Tinnitus pitch match
- Evoked response audiometry
- Maskability of tinnitus
- Tinnitus loudness match
- Residual inhibition
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.
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.
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.