ENT - Tinnitus Flashcards
What is tinnitus?
A persistent addition sound that is heard but is not present in the surrounding environment
Described as a ringing in ears, buzzing, hissing or humming noise
What causes of tinnitus?
Background sensory signal produced by the cochlea that is not effectively filtered out by the central auditory system
What is primary and secondary tinnitus?
Primary
Tinnitus with no identifiable cause, often occurring with sensorineural hearing loss
Secondary
Identifiable cause
List some causes of secondary tinnitus
- Impacted ear wax
- Ear infection
- Ménière’s disease
- Noise exposure
- Medications (e.g., loop diuretics, gentamicin, chemotherapy drugs)
- Acoustic neuroma
- Multiple sclerosis
- Trauma
- Depression
What systemic conditions may be associated with tinnitus?
- Anaemia
- Diabetes
- Hypothyroidism or hyperthyroidism
- Hyperlipidaemia
What is objective tinnitus?
When the patient can objectively hear an extra sound within their head, observable on examination
What can cause actual additional sounds in objective tinnitus?
- Carotid artery stenosis (pulsatile carotid bruit)
- Aortic stenosis (radiating pulsatile murmur sounds)
- Arteriovenous malformations (pulsatile)
- Eustachian tube dysfunction (popping or clicking noises)
How might primary tinnitus be explained to patients?
As the ears trying to ‘turn up the volume’ when they cannot hear surrounding noises well
Using hearing aids allows ears to pick up noises better and turn the volume down, improving tinnitus
What are the key aspects to assess in tinnitus symptoms?
- Unilateral or bilateral
- Frequency and duration
- Severity
- Pulsatile or non-pulsatile
What history and examination steps can help identify underlying causes of tinnitus?
- Contributing factors (e.g., hearing loss, noise exposure)
- Associated symptoms (e.g., hearing loss, vertigo)
- Stress and anxiety
- Otoscopy for ear wax or infection
- Weber’s and Rinne’s tests for hearing loss
What investigations might be considered for underlying causes of tinnitus?
- Full blood count (anaemia)
- Glucose (diabetes)
- TSH
- Lipids
- Audiology
- Imaging (CT or MRI), to investigate underlying causes e.g. vascular malformations or acoustic neuromas
What are some red flags that indicate a serious underlying cause of tinnitus?
- Unilateral tinnitus
- Pulsatile tinnitus
- Hyperacusis
- Associated unilateral hearing loss
- Associated sudden onset hearing loss
- Associated vertigo or dizziness
- Headaches or visual symptoms
- Associated neurological symptoms
- Suicidal ideation related to tinnitus
How does tinnitus typically progress over time?
It tends to improve or resolve over time without any interventions
What are some treatment options for tinnitus?
- Treating underlying causes (e.g., impacted ear wax, infection)
- Hearing aids
- Sound therapy
- Cognitive behavioural therapy
