What is included in the physical exam for tinnitus?

Updated: Feb 27, 2020
  • Author: Aaron G Benson, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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The physical examination includes not just the ear but also the entire head, neck, and torso for signs of the origin of tinnitus. Include complete auscultation of the neck for bruits, which can be transmitted along the carotid artery, and for venous hums, which can be transmitted along the jugular vein. Auscultation should also be performed around the cranium to check for arteriovenous malformations and Paget disease, which can in rare cases contribute to tinnitus. Be sure to clean the ear canal of wax (a frequent cause of tinnitus).

The examination may reveal other causal indications of tinnitus (eg, red hue of otosclerosis, bluish tint of an uncovered jugular vein). An otomicroscopic examination may assist in this portion of the examination. The tympanic membrane can be examined for fluid or infections, which can contribute to tinnitus.

Other tumors of the middle ear, including glomus tumors, can be observed. The Brown sign, a middle ear bluish-red mass that blanches with positive pressure during pneumatic otoscopy, is a well-mentioned sign of glomus, although not always present. A Toynbee tube (stethoscope with olive tip) or an electronic stethoscope can be used to listen to the ear for objective tinnitus. With glomus tumors, the pulsatile rush of blood in the tumor can be heard. Tuning forks can be used to assess hearing, prior to obtaining audiometric data.

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