Virtual Patients - Otology - Unilateral Tinnitus

A 66-year-old woman comes to you complaining of tinnitus in her left ear. It has been present for 6 months and is disturbing her sleep. She says that she has hearing loss as well and that this is worse in her left ear. Her problems started after a road collision during which she bumped her head but did not lose consciousness.

 

Her balance is normal and she has no ear discharge or pain. She has not had surgery to the ear in the past and does not remember ear infections as a child.

 

Examination finds normal pinnae, ear canals and eardrums. Tuning fork tests show a Weber that lateralises to the right. Both Rinne’s tests were negative.

Question

 

What should your first investigation be?