First of all tinnitus is not a disease. It is a symptom stemming from one or several causes with a physical origin as well as an imbalance due to stress and mental dysfunction. To be able to help the patients we need to realize that tinnitus is a symptom. 

TINNITUS IS a interesting disease it can result from both the ear and  brain. Temporal lobe as well.

I suggest  first not to miss rare but easy to diagnosed conditions:

1) hear the skull and ear by fonendscope, allways!

Objective tinnitus is allways organic and vascular, eg cavernous sinus fistula (can go unrecognised for a long time but the noise is allways - if you to exclude the unprobable)

Pulsating tin. Is similar, fistula, severe artery stenosis or venous hypercirculation in cases with high and enlarged jugular bulbus syndrome

2)allways angiography exam of head and neck incl venograms!

3) temporomandibular joint exam incl rtg and stomatologa

As next step I suggest brain MRI and EMG look for T and mesiotemporal abnormalities of every  type!

Complete audiology is self-evident.

Hope that some helped.

With best regards 

"TINNITUS IS a interesting disease it can result from both the ear and brain. Temporal lobe as well."

I strongly disagree that there is any primary brain cause of tinnitus, as I think it always starts in the vicinity of the ear, though once started, it can, and probably does, rewire auditory areas in the brain, which can then lead to secondary psychological problems over and above the original symptom.

I realise this denial of central tinnitus is a controversial statement, but it is easily refuted by producing any case of definite discrete brain damage that causes tinnitus, where there has been a comprehensive otological and audiological examination to exclude peripheral ear disease.  (Freud made similar comments about supposed cortical cases of pure word deafness).  I have been checking the literature for 45 years and have not found such a case, nor did I come across one personally despite being on active lookout.

"Is there new technological solutions able to distinguish organic Tinnitus causes?" 

Could we have a definition, please, for Non-organic Tinnitus?

I agree with Mr. Černý.

İt's an interesrting situation but not a dissease. So we have to find out the dissease.

İt's interesting because of it's nature such as;

a. We know that hearing from both ears get together at the SOC level. so we accept that if the problem is under this level than there must be some periferal pathology. Mainly depends on the cohlea.

For tinnitus patient they can say that they heard the sound either one of their ears or some times in the brain. Maybe we can define the pathology with this knpoledge but my experimets says taht its not so easy.

b. Another interesting problem is related with masking. As we know all the pure tones can be masked by narrow band, white noise or the same pure tone. one of the exception for this is tinnitus because you can mask the tinnitus with the other frequencies (Feldman curves) 

And some other different and interesting parts it contains.

And other part that was related with your question. You said that "I can easily determine the tinnitus frequency" but this is a little bit diffuclt infact. Because we know that tinnitus frequency is not a pure tone so mostly the patients says that this likes  my tinnitus sound but not the same. For the tinnitus sound is a complex tone. The other problem was octave change make lots of problem (even for the musicians) so infact  we can't find out the frequency so easily.

For the organic tinnitus I think one of the most important thing is metabolic position tiroid function tests, and Ca, Fe and the glucoze level.

Also for the objektif pulsatil tinnitus it's better to check angiography but it's very rare.

First of all tinnitus is not a disease. It is a symptom stemming from one or several causes with a physical origin as well as an imbalance due to stress and mental dysfunction. To be able to help the patients we need to realize that tinnitus is a symptom. 

My hypothesis on tinnitus available at:

http://www.omicsonline.org/open-access/deciphering-tinnitus-from-the-shoulders-of-giants-a-kuhnian-shift-may-be-required-2161-119X-1000205.php?aid=59325

"My hypothesis on tinnitus"

I agree that tinnitus is not directly related to hearing loss or auditory deprivation, but nevertheless does originate from ear disease.  It is much more likely connected to cochlear hyperactivity, with secondary brain reorganisation.  However, I am still waiting for a reference to a single case of tinnitus from a central brain lesion (see my posting on Feb 6)  where peripheral otological disease has been excluded, without which the cortical primacy theory of tinnitus is like a bell without the clapper. 

For AG Gordon

1. "I realise this denial of central tinnitus is a controversial statement"

Are you aware of any patients with Autism Spectrum Disorder /Aspergers with tinnitus?

2. "I agree that tinnitus is not directly related to hearing loss or auditory deprivation, but nevertheless does originate from ear disease."

There is a self referential inconsistency in this statement. 

"Are you aware of any patients with Autism Spectrum Disorder /Aspergers with tinnitus?"

Yes, but am not sure of the point of the question.   Analogies with another condition of mysterious origin are not really helpful.   Actually, I do not accept that autism is primarily a central didorder.   All its symptoms can derive from a hyperactive condition of the inner ear early in life.  There is no cause of autism that is not also a cause of ear disease.

"There is a self referential inconsistency in this statement"

Ear disease has many forms.   There is often a hearing loss, as shown by impairment on a Pure Tone Audiogram.   However, because of recruitment or audiosensitivity there is rarely any sound deprivation as such, except in some conductive hearing losses with elastic tissue in the ossicular chain.  I do not think tinnitus (nor musical hallucinations for that matter) have anything to do with auditory deprivation or hearing loss per se, but can certainly be related to hyperactive states of the inner ear, which may or may not be associated with a hearing loss.  I think all tinnitus starts out as ear disease which may require sophisticated hearing tests to demonstrate.

AGG

"Actually, I do not accept that autism is primarily a central didorder."

It is usually accepted that providing a statement must be supported by evidence supplied by the author of the statement. The following may serve to refute:

Koenig K, Tsatsanis KD, Volkmar FR (2001). Jacob A Burack, Tony Charman, Nurit Yirmiya, Philip R. Zelazo, eds.Neurobiology and Genetics of Autism : A Developmental Perspective. The development of autism: perspectives from theory and research (Mahwah, N.J.: L. Erlbaum,). pp. 73–92.ISBN 9780805832457. OCLC 806185029.

Minshew NJ. Brief report: Brain mechanisms in autism: Functional and structural abnormalities. Journal of Autism and Developmental Disorders. 1996;26(2):205–209.doi:10.1007/BF02172013. PMID 8744486.

Sugranyes G, Kyriakopoulos M, Corrigall R, Taylor E, Frangou S. Autism spectrum disorders and schizophrenia: meta-analysis of the neural correlates of social cognition. PLoS ONE. 2011;6(10):e25322. doi:10.1371/journal.pone.0025322. PMID 21998649.

I think all tinnitus starts out as ear disease which may require sophisticated hearing tests to demonstrate.

Again what evidence and what level of sophisticated tests - VHF testing? CERA? BERA? fMRI?

"I think all tinnitus starts out as ear disease which may require sophisticated hearing tests to demonstrate.  Again what evidence..?"

 "The following may serve to refute"

Those and other references do not contradict what I said.   They are at best ambiguous and at worst quite misleading since they rely on the unproven assumption that brain structure and function is the cause and not the result of autistic symptoms.   Various brain areas in the congenitally deaf rewire and reorganise, and I think the auditory problems of autistic inafnts are worse than those of the deaf since the input is so variable and inconsistent, hence non compensatable.

Rather than go into a detailed discussion, this can be stifled at source by nominating a cause for autism that is not also a cause of ear disease.  See my many publications on this topic.

AGG

Okay.The fallacy in thinking here, is the idea that if someone cannot provide evidence for something, the reverse must be true. If I cannot explain to you that God does not exist, then God must exist. But in science, belief should come from positive evidence in support of a claim, not lack of evidence for or against a claim.

"But in science, belief should come from positive evidence in support of a claim, not lack of evidence for or against a claim."

I have put forward a simple testable hypothesis that autism results in the first instance from an irritable inner ear in infancy.  I have published more than enough evidence for this as a viable proposition in numerous publications over 40 years, but have given up supplying more evidence as no one seems to be interested even if it were true.   I and many others are strong supporters of Karl Popper, that refutation is the basis for scientific advance.   My theory is so naive that that it should only take someone a few hours to refute it, were it untrue, for example by suggesting an autistic symptom that could not possibly be of inner ear origin, or due to secondary brain changes or compensation for such primary otological symptoms.  

AGG

The Planck problem huh?

"The Planck problem huh?"

I assume you are referring to this, from How Thinking goes Wrong by Michael Shermer, from his 1997 book Why People Believe Weird Things:

"Historians of science call this the Planck Problem, after physicist Max Planck, who made this observation on what must happen for innovation to occur in science: "An important scientific innovation rarely makes its way by gradually winning over and converting its opponents: it rarely happens that Saul becomes Paul. What does happen is that its opponents gradually die out and that the growing generation is familiarized with the idea from the beginning" (1936, p. 97).

Psychologist David Perkins conducted an interesting correlational study in which he found a strong positive correlation between intelligence (measured by a standard IQ test) and the ability to give reasons for taking a point of view and defending that position; he also found a strong negative correlation between intelligence and the ability to consider other alternatives. That is, the higher the IQ, the greater the potential for ideological immunity. Ideological immunity is built into the scientific enterprise, where it functions as a filter against potentially overwhelming novelty. As historian of science I. B. Cohen explained, "New and revolutionary systems of science tend to be resisted rather than welcomed with open arms, because every successful scientist has a vested intellectual, social, and even financial interest in maintaining the status quo. If every revolutionary new idea were welcomed with open arms, utter chaos would be the result" (1985, p. 35).

In the end, history rewards those who are "right" (at least provisionally). Change does occur. In astronomy, the Ptolemaic geocentric universe was slowly displaced by Copernicus's heliocentric system. In geology, George Cuvier's catastrophism was gradually wedged out by the more soundly supported uniformitarianism of James Hutton and Charles Lyell. In biology, Darwin's evolution theory superseded creationist belief in the immutability of species. In Earth history, Alfred Wegener's idea of continental drift took nearly a half century to overcome the received dogma of fixed and stable continents. Ideological immunity can be overcome in science and in daily life, but it takes time and corroboration."

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I think Shermer gives an excellent account of errors in reasoning about science.   However, I strongly disagree with his section on Burden of Proof, which he says always rests on the outsider.   Fair enough for the examples in the last paragraph, but I am proposing a simple refutable explanation for a potentially devastating, distressing, costly and fairly common human condition.   I have neither the ability, resources nor reputation to promote my theory, and getting more aggressive, committed or emotional will only increase bias and affect my judgement.  Surely the onus and ethical duty is on the professionals to shoot down my theory, which if false can easily be done at no cost and minimal allocation of their time?