Patient D.G. is a 46 year old female who was seen at Nova Southeastern University for constant, high-pitched squealing tinnitus bilaterally and inability to tolerate loud sound.  The tinnitus began about a year ago, with onset being around the time at which she had a hysterectomy. For the past 6 months, it has been more disturbing, presently rated as disturbing 100% of the time.  Neuromonics treatment was recommended by her sister, who is an audiologist living in another state. She has had an ENT work up and neurology consult; the tinnitus is considered secondary to hearing loss and not due to otoneurologic problems.  She did have episodes of vertigo within the past year, but VNG was negative and the problems were attributed to her “lazy eye.”  She is a migraineur who takes an antidepressant at night to help control the migraines.

Tympanograms were normal. Otoscopy was normal.  Word recognition test results were not reported.

The tinnitus was rated as 8/10 on the pitch scale.  It loudness matched to 8k Hz at 7 dB SL (55 dB HL).  The tinnitus was masked by 32 dB SL broad band noise, and 24 dB SL narrow-band noise.

Modified loudness discomfort level (LDL) testing, using a 9 point scale, was administered. Where normal LDLs would be ~90 dB HL, her LDLs ranged from 42 to 54 dB HL.

On the date of evaluation, all transient otoacoustic emissions were absent; however, subsequent retesting showed mostly present emissions.

Her TRQ was obtained. The score is 62 out of 104.  The completed questionnaire itself can be viewed at the end of the page.

• Is DG a candidate for amplification?
• Is she a candidate for Neuromonics?
• Why were acoustic reflex thresholds not obtained?
• How would you characterize the TRQ score?

Case credits: Paul Davis, PhD, then of Nova Southeastern University was preceptor for this case.