Clinical Update: Tinnitus
Robert Thayer Sataloff
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Joseph Sataloff
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Steven Mandel
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Abstract

Momentary or intermittent tinnitus—perceived sounds that originate within a person's head rather than in the outside world—is common; continuous tinnitus is abnormal but not unusual. According to the National Center for Health Statistics, 32% of US adults acknowledge having experienced tinnitus at some time; 6.4% characterize the condition as debilitating or severe; and prevalence increases with age to approximately 70 years and declines thereafter. A patient with tinnitus is assessed initially using a comprehensive otologic and neurotologic history, a physical examination, and selected tests of otologic function. Current tests can evaluate hearing and balance, but no good, comprehensive, objective methods exist to determine the presence of tinnitus, quantify the symptoms, or assess its severity. For these reasons, there are no scientific data on which to base a judgment regarding impairment or disability, and tinnitus alone generally is not considered compensable. The AMA Guides to the Evaluation of Permanent Impairment allows some adjustment for unilateral, but not bilateral, tinnitus that may impair speech discrimination. No scientific justification supports this policy, and there is no defensible basis for this disparity. Thus, additional research is necessary before this subjective symptom can be used reliably in impairment and disability determinations.

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