Case history
Case history
A 65-year-old man presents with a 2-year history of bilateral hearing difficulty with associated ringing sensation, especially when in a quiet environment. The sounds are usually heard several times a day and they last for a few hours. The patient has no history of vertigo, exposure to loud sounds, or trauma. He is otherwise healthy and takes no medication. On physical exam, no bruits or noise are heard on auscultation of the neck, mastoid, and ear. On otoscopic exam, external auditory canals and tympanic membranes are normal. Rinne test shows air conduction to be greater than bone conduction bilaterally.
Other presentations
A low-frequency tinnitus (humming or buzzing sounds) generally indicates a low-frequency hearing loss. Unilateral tinnitus can be the presenting sign in vestibular schwannomas, and pulsatile tinnitus may be associated with a glomus tumor, jugular bulb dehiscence, carotid artery dehiscence, turbulent blood flow (internal carotid artery or internal jugular vein), arteriovenous malformation, or a persistent stapedial artery.[6]
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