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ENT Secrets > Chapter 34 - Tinnitus > Flashcards

Chapter 34 - Tinnitus Flashcards

1
Q

Percentage of people with tinnitus

A

15%

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2
Q

Hypothesized reason for tinnitus

A

change in peripheral auditory function –> central neural hyperexcitability, cortex reorganization

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3
Q

Percentage of tinnitus pts w/ NL hearing on audiogram

A

10%

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4
Q

2 potential causes of pulsatile tinnitus

A

vascular malformation

neoplasm

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5
Q

Causes of clicking tinnitus

A 
Mandibular condyle (TMJ)
palatal or stapedial myoclonus
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6
Q

Type of HL associated with tinnitus caused by high dose salicylates

A

reversible mild to moderate SNHL (flat)

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7
Q

somatosounds

A

objective tinnitus, may be audible to examiner
myoclonus of tensor tympani
pulsatile variation in vessels near ear

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8
Q

phantom limb concept of tinnitus

A

In animal studies, auditory cortex reorganizes after sensory deprivation similar to how somatosensory cortex reorganizes after amputation

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9
Q

Vascular tinnitus

A

glomus tumor
dehiscent jug bulb, ICA
AVMs between occipital a (medial to mastoid) and transverse sinus
loop compressing CN VIII

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10
Q

Venous hum tinnitus - causes

A

Impingement of jugular vein by C2

High output heart (anemia, exercise, pregnancy, thyrotoxicosis)

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11
Q

Causes of pulsatile tinnitus other than vascular

A 
otitis media
otosclerosis
Paget disease
IIH
MS
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12
Q

EAC pathologies causing tinnitus

A

cerumen
foreign body
hair, insect, other small objects

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13
Q

Muscles involved in palatal myoclonus

A

TVP, LVP, salpingopharyng, superior constrictor

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14
Q

How to evaluate palatal myoclonus

A

Nasopharyngoscopy, as opening mouth wide could cause the myoclonus to stop

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15
Q

Systemic diseases causing tinnitus

A

MS, stroke, tumor, trauma, syphilis, malaria, psychogenic, other degenerative processes

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16
Q

Objective findings in patients with tinnitus and normal audiometric thresholds

A

smaller wave I ABR amplitude

suggests early cochlear damage –> reduced neuronal input

17
Q

Can noise exposure lead to tinnitus

A

Isolated loud noise tinnitus resolved in hours to days

Repeated episodes –> may be permanent

18
Q

Relationship between tinnitus and hyperacusis

A

May be same central cause (decreased cochlear input)

Almost all hyperacusis pts eventually develop tinnitus

19
Q

How to salicylates cause hearing loss

A

competitive inhibitors of chloride at anion binding site of prestin (motor protein of outer hair cell) –> reversible alteration of outer hair cell function
Reverse within 1-3 days of d/c

20
Q

List of drugs causing tinnitus

A

ACEi, anesthetics (lidocaine, bupivacaine, dyclonine), aminoglycosides, imipenem, Vanc, bactrim, aztreonam, erythromycin, cipro, antidepressants, phenergan, sudafed, anti-malarials, B blockers, CCB, diuretics, NSAIDs, sedatives
Misc: albuteraol, carbamazepine, flexeril, cyclosporine, benadryl, flecainide, isotretinoin, lithium, methergine, nicorette, prazosin, omperazole, Hep B vaccine, sodium nitroprusside, tocainide

21
Q

Percent of acoustic neuromas with tinnitus

A

10% present this way

80% eventually have it

22
Q

Treatment of tinnitus with auditory stimulation

A

fan, radio, generator, TV
Hearing aid (if frequency in amplification range)
custom devices

23
Q

Tinnitus retraining therapy

A

Counseling to educate on cause of tinnitus, decouple tinnitus from emotional response
Sound therapy to gradually habituate and thus reduce strength of tinnitus

24
Q

Meds for tinnitus

A

None better than placebo
Can treat stress/anxiety accompanying it with TCA, SSRI, benzo
Botox for myoclonus

25
Q

How IV lidocaine stops tinnitus

A

augments natural central inhibition of auditory firing (which may be lost and then cause tinnitus, one theory)

26
Q

Transcranial magnetic stimulation for tinnitus

A

low level electric brain currents which inhibit hyperexcited regions of brain

27
Q

Treatment of tinnitus associated with bilateral profound HL

A

CI - cures tinnitus in 86% of cases

28
Q

Treatment of myoclonus tinnitus

A

botox

tympanostomy tubes

ENT Secrets (79 decks)

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