Table 3. Key Details of Medical History in the Tinnitus Patient
(continued)
Key issue Significance Implication
Medications and
potential ototoxic
exposures
Some medications such as salicylates
are associated with tinnitus.
Ototoxins can cause hearing loss
and tinnitus.
Interactions between medications
have unknown effects and can
exacerbate tinnitus symptoms.
Counseling regarding medication
use, etiolog y of tinnitus is
facilitated.
Patients can be provided a list of
known ototoxic medications as
part of counseling.
Comprehensive audiologic
assessment.
Unilateral or
asymmetric
hearing loss
Possible presentation of serious
lesion such as VS.
Audiologic and otologic
assessment.
Imaging where indicated.
Vertigo or
other balance
malfunction
Possible cochlear, retrocochlear,
or other central nervous system
disorder (Meniere's disease, superior
canal dehiscence, VS, other).
Audiologic, otologic, vestibular
assessment.
Imaging and referral where
indicated.
Symptoms of
depression and/
or anxiety
Tinnitus is oen accompanied
by symptoms of depression and
anxiety. e presence and severity
of such symptoms will dictate the
pace of evaluation and treatment as
well as the need for referral to treat
these issues.
Referral to mental health
professionals for assessment and
treatment of depression and/or
anxiety.
Urgent referral for suicidal
patients.
Apparent
cognitive
impairments
Elderly patients at risk for tinnitus
are also at risk for cognitive decline
from dementia.
e presence of dementia will
affect the results of tinnitus and
audiologic assessments.
Evidence Quality and Recommendation Grades
a
Evidence Quality for: Recommendation
Treatment and Harm Diagnosis Strength
A High-quality RCTs Systematic review of
consistent cross-sectional
studies
S Strong
recommendation
B Consistent RCTs Consistent individual cross-
sectional studies
R Recommendation
C Observational studies Nonconsecutive studies,
case-control studies, or other
studies of poor quality
O Option
D Case reports, consensus opinions
X Exceptional situations with clear benefit
a
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