ENT \ Tinnitus

Question 1

What is tinnitus?

Answer 1

• The perception of sound when there is no actual external acoustic signal.
• The patient may describe any number of sounds including humming, clicking, whistling, pulsatile whoozing, etc

Question 2

What is the difference between objective tinnitus and subjective tinnitus?

Answer 2

• Objective tinnitus means the sound the patient hears is an actual sound coming from within the head/neck (such as a bruit)
• in subjective tinnitus no actual sound is occurring (more common than objective tinnitus)

Question 3

What are some common causes of tinnitus?

Answer 3

• Noise-induced hearing loss
• Meniere disease
• acoustic neuroma
• ototoxic medications (chemotherapy, aminoglycosides, some diuretics, etc)
• multiple sclerosis
• depression and anxiety

Question 4

What is the most common cause of tinnitus?

Answer 4

Noise-induced hearing loss

Question 5

What are the basic first steps in the evaluation of tinnitus?

Answer 5

• Perform history and physical focused on diseases of the ear and causes of objective tinnitus (such as a bruit);
• order an audiogram to assess for hearing loss

Question 6

What is the most worrisome cause of unilateral tinnitus?

Answer 6

• Acoustic neuroma

Question 7

What is the most common cause of medication-induced tinnitus and what is the treatment?

Answer 7

• Aspirin and aspirin-containing products.
• Discontinuation of product resolves tinnitus.

Question 8

For most patients with mild to moderate tinnitus, what simple conservative measures achieve some symptom improvement (or at least prevent worsening)?

Answer 8

• Avoid hazardous noise (if exposure is necessary, wear proper ear protection)
• limit caffeine intake
• avoid silence (keep a low level of background noise, such as a fan)
• manage stress.

Question 9

What imaging would you order if you suspect that a patient has a pulsatile tinnitus of vascular origin?

Answer 9

• MRI/MRA