Tinnitus: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

• General physical examination – including blood pressure, pulse, body weight, height; furthermore:
  • Inspection (viewing) and palpation (palpation) of the thyroid gland.
  • Inspection and mobility testing of the spine [due todifferential diagnosis: cervical syndrome – diseases of the cervical spine].
  • Auscultation (listening) of the heart
• ENT medical examination – including inspection of the external ear and auditory canal.
  • Otoscopy (ear examination)
  • Tuning fork tests according to Weber and Rinne, to differentiate between: Middle ear and sensorineural hearing loss:
    • According to Weber (Weber experiment): Execution: the foot of a vibrating tuning fork is placed on the crown of the patient’s head. The sound is transmitted in phase to both inner ears via bone conduction. Normal hearing: Sound from the tuning fork heard equally in both ears (in the middle of the head), sound is not lateralized (lat. latus = side). Unilateral or asymmetric hearing disorder: tone of the tuning fork on one side, it is called “lateralization” (lateralization).
      • Unilateral sound perception disorder: the sound is perceived louder by the better hearing (normal) inner ear (patient lateralizes to the healthy ear).
      • Unilateral sound conduction disorder: the sound is heard louder in the diseased ear

      [Tympanic effusion (synonym: seromucotympanum): sound is heard louder in the affected ear when there is a unilateral conductive disorder]

    • According to Rinne (Rinne test): the Rinne test makes use of the physiological properties of the ear: When the patient has normal hearing ability, sound is heard louder via air conduction than via bone conduction because of the amplification properties of the ossicles and eardrum. A decaying tuning fork (tuning fork foot on the bone process behind the auricle), which is no longer heard via bone conduction, is heard longer via air conduction (tuning fork in front of the auricle). Procedure: A vibrating tuning fork is first placed on the patient’s bony process behind the auricle (“mastoid”, lat. Processus mastoideus) with the tuning fork foot. As soon as the patient gives a sign that he no longer hears the tuning fork, it is held directly in front of his auricle.
      • Rinne test positive: the patient can still hear the tuning fork → there is no sound conduction disturbance, but a sound sensation disturbance is not excluded with it.
      • Rinne test negative: The patient no longer hears the tuning fork → conductive hearing loss (= disorder in the outer or middle ear area).
      • If the patient credibly states not to perceive any tuning fork sound at all, a pronounced sensorineural hearing loss of both ears must be present.
• Health check