A 45-year-old computer programmer presented to his family physician with a 3-year history of gradual onset "ringing" in both ears. The tinnitus was constant and was more noticeable when he went to bed. He believed that his hearing may have slightly worsened during the past 3 years as well, but was unsure. Medical history The patient denied otalgia, otorrhea, or vertigo. He had no history of otologic trauma or surgery, recreational or occupational noise exposure, or ear infections. He was not taking any medications, and he was a nonsmoker and nondrinker.
Physical exam The patient was not in acute distress and was cooperative on examination. All vital signs were within normal limits. Otoscopy revealed normal external auditory canals and clear tympanic membranes with normal mobility on pneumatic insufflation. His facial nerve function was grossly normal. Labs A Weber tuning fork test…
