If the patient reports hearing abnormal sounds, check for the following:
An unusual rushing sound may be due to a fistula involving the carotid artery. To check for this, auscultate the artery for a bruit. If present, gently pressing on the artery should change the quality of the sound perceived by the patient.
Patients with a ventriculoperitoneal shunt (for low pressure hydrocephalus) may hear a flowing sound.
Patients with myoclonus may hear clicking sounds.
Inadvertent catheterization of the internal jugular vein with subclavian line placement can produce a bubbling sensation in the ears.
Inflammation of the eustachian tube can produce a bright clicking sound heard by the examiner through the otoscope while the patient experiences it as tinnitus (Leudet's sign).
In otitis media patients may hear their own breath sounds.
Tinnitus with dizziness and vertigo that improves at high altitude such as in an airplane suggests Ménière's disease (Bigger's sign).
Tinnitus associated with crepitus in the jaw, headache, and ear pain suggest temporomandibular joint syndrome.
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