Central nervous system neurodegeneration and tinnitus: a clinical experience. Part I: Diagnosis

In an evolving clinical experience since 1979, the medical significance of the symptom of tinnitus has been identified as a "soft" sign of neurodegeneration (ND) in the central nervous system (CNS) in a particular subset of tinnitus patients diagnosed with a predominantly central-type, severe, disabling, subjective idiopathic tinnitus. To highlight this experience, a retrospective review and analysis of consecutive tinnitus patients (N = 96) was conducted. Ninety-six tinnitus patients (ages 22-90 years) were seen in neurotological consultation from November 1, 2005, to June 30, 2007, all of whom had subjective idiopathic tinnitus of the severe disabling type (SIT). Of these 96 patients, 54 had SIT of the predominantly central type and of these, 18 (ages 39-75 years) were recommended for nuclear medicine imaging (single-photon emission computed tomography [SPECT] and fluorodeoxyglucose-positron emission tomography/computed tomography [FDG-PET/CT]). Patient selection for nuclear medicine imaging fulfilled the criteria of a medical-audiological ND tinnitus profile: completion of a patient protocol that diagnosed a predominantly central-type, severe, disabling, subjective, idiopathic tinnitus lasting in excess of 1 year, and failure of existing modalities of treatment attempting tinnitus relief. In 16 of the 18 patients, objective evidence of ND was reported in multiple neural substrates of brain obtained with SPECT or FDG-PET/CT of brain. Classification of CNS ND and tinnitus differentiated between (1) ND of nonspecific or unknown etiology; (2) ND manifested by perfusion asymmetries in brain associated with ischemia (n = 11/18); and (3) neurodegenerative CNS disease consistent with nuclear medicine criteria for senile dementia of the Alzheimer's type (n = 5/18). The diagnosis has been associated with cerebrovascular disease (n = 16/18). The identification of neurodegenerative CNS disease in a selected cohort of patients with subjective idiopathic tinnitus as a soft sign of such CNS disease has implications for diagnosis and treatment.