Unilateral hearing loss plus tinnitus should increase suspicion for acoustic neuroma. Objective tinnitus usually is caused by vascular abnormalities of the carotid artery or jugular venous systems. Tinnitus may be present for months or years before hearing loss or vertigo is noticed. Patients with vascular abnormalities complain of pulsatile tinnitus. Leading causes of conductive hearing loss include cerumen impaction, otitis media, and otosclerosis. Characteristically, patients presenting with glomus tumors are women 40 to 50 years of age who report pulsatile tinnitus and hearing loss. Sudden, fluctuating, unilateral hearing loss, tinnitus, episodic vertigo. Patients present with rapidly progressive bilateral sensorineural hearing loss and poor speech discrimination scores, and they also may have vertigo or disequilibrium. Patients usually present with gradual hearing loss, unilateral pulsatile tinnitus, and lower cranial nerve deficits. Tumor: Facial Nerve Neuroma A nonmalignant fibrous growth may occur in the facial nerve itself, producing a gradually progressive facial nerve paralysis. A sensation of fullness or pressure in the ear may accompany the vertigo attack as well. In fact, many times the cause of the tinnitus is attributable to the hearing loss itself.
Core symptoms are vertigo, tinnitus and fluctuating hearing loss with a sensation of aural pressure. Acute attacks typically last minutes-hours, often 2-3 hours. Most patients develop unilateral symptoms initially. Common causes of conductive hearing loss include wax accumulation, ear drum rupture, infections of the outer or middle ear, stiffening or fixation of the small middle ear bones, cholesteatoma (abnormal accumulation of skin in the middle ear), and other less common causes including superior semicircular canal dehiscence syndrome and malformations of the middle or inner ear bony architecture. Typically, there is no identifiable underlying cause, and this is called benign essential tinnitus. In most patients, a history of eustachian tube dysfunction is also present that can be secondary to chronic allergies, sinus infections, or other immune deficiencies. Presbycusis, or age-related hearing loss, is a common cause of hearing loss in adults worldwide. Presbycusis is a complex and multifactorial disorder, characterized by symmetrical progressive loss of hearing over many years. In studies of temporal bones from patients with typical presbycusis, the degree of hearing loss was associated with disorders of a number of vital cochlear anatomic structures 1. This should be particularly considered if there is associated unilateral or pulsatile tinnitus, vertigo, or other cranial nerve deficits.
Usually patients complain of associated tinnitus, aural fullness, and vertigo. At the present time only cytomegalovirus and the mumps virus have been cultured from the perilymph of affected ears. They generally do not have the typical hearing loss of Meniere’s disease and vestibular function testing is many times normal. In the case of the vestibular part of CN VIII, the symptoms are vertigo or imbalance, although visual disturbance when moving may also be a complaint. It also affects hearing, with tinnitus (usually a buzz or hum) and hearing loss (usually of low tones). While damage to the cochlear nuclei, located at the lateral aspect of the pontomedullary junction (where CN VIII enters the brain), can cause unilateral hearing loss, damage to other regions of the central nervous system is unlikely to cause recognizable hearing loss. Such patients are unable, with eyes closed, to localize an auditory stimulus with their eyes closed in the auditory field opposite the damaged hemisphere. It most commonly presents with pulsatile tinnitus followed by hearing loss. Patients usually present with a gradual unilateral or bilateral conductive hearing loss.
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This often causes the patient to abandon attempts to get treatment. Tinnitus caused by sensorineural hearing loss is usually high pitched. Noise-induced hearing loss can be unilateral or bilateral, depending on the source of the noise, and is often accompanied by hyperacusis, which is a lowered tolerance to elevated levels of sound. Tinnitus in these patients is most often unilateral and may be present for months to years before hearing loss or vertigo are noted. Progressive hearing loss may be a sign of presbycusis, particularly in aging patients. Although bilateral, nonpulsatile tinnitus is usually benign; pulsative tinnitus can be a sign of a more serious vascular etiology. Episodic tinnitus, along with concurrent symptoms such as vertigo, hearing loss, and aural fullness are associated with Meniere disease.