Tinnitus Flashcards
What is tinnitus?
Tinnitus is the perception of sound in the absence of any external auditory stimulus.
How may a patient describe tinnitus?
Sounds may be described as ringing, humming, buzzing, hissing, clicking, or pulsing.
May occur intermittently or constantly.
Briefly describe the pathophysiology of tinnitus
The additional noise experienced with tinnitus is thought to be the result of a background sensory signal produced by the cochlea that is not effectively filtered out by the central auditory system. In a quiet enough environment, almost everyone will experience some background noise (tinnitus). This becomes more prominent the more attention it is given.
Briefly differentiate beween primary and secondard tinnitus
Primary tinnitus has no identifiable cause and often occurs with sensorineural hearing loss.
Secondary tinnitus refers to tinnitus with an identifiable cause
What are the causes of secondary tinnitus?
Secondary tinnitus refers to tinnitus with an identifiable cause. Causes include:
- Impacted ear wax
- Ear infection
- Ménière’s disease
- Noise exposure
- Medications (e.g., loop diuretics, gentamicin and chemotherapy drugs such as cisplatin)
- Acoustic neuroma
- Multiple sclerosis
- Trauma
- Depression
What systemic conditions are associated with tinnitus?
Tinnitus may also be associated with systemic conditions:
- Anaemia
- Diabetes
- Hypothyroidism or hyperthyroidism
- Hyperlipidaemia
What is objective tinnitus?
Objective tinnitus refers to when the patient can objectively hear an extra sound within their head. This sound can also be observable on examination by auscultating with a stethoscope around the ear.
What cn cause objective tinnitus?
Actual additional sounds may be caused by:
- Carotid artery stenosis (pulsatile carotid bruit)
- Aortic stenosis (radiating pulsatile murmur sounds)
- Arteriovenous malformations (pulsatile)
- Eustachian tube dysfunction (popping or clicking noises)
Briefly describe the assessment of tinnitus
Note: important questions to ask the patient
Ask about the pattern of symptoms:
- Unilateral or bilateral
- Frequency and duration
- Severity
- Pulsatile or non-pulsatile (pulsatile may indicate a cardiovascular cause, such as carotid artery stenosis with a bruit)
A focused history and examination can be used to identify any underlying causes, including:
- Contributing factors, such as hearing loss or noise exposure
- Associated symptoms (e.g. hearing loss, vertigo, pain or discharge)
- Stress and anxiety
- Otoscopy to look for causes such as ear wax or infection
- Weber’s and Rinne’s tests for hearing loss
What investigations should be ordered for tinnitus?
- Bloods (FBC, glucose, TSH and lipids)
- Audiology
- Imaging (MRI or CT)
Why investigate tinnitus using blood tests?
The NICE clinical knowledge summaries suggest considering blood tests for possible underlying causes:
- Full blood count (anaemia)
- Glucose (diabetes)
- TSH (thyroid disorders)
- Lipids (hyperlipidaemia)
When may imaging be used to diagnose tinnitus?
Imaging (e.g. CT or MRI) may be rarely required to investigate for underlying causes such as vascular malformations or acoustic neuromas.
What are the red flags of tinnitus?
Red flags that could indicate a serious underlying cause and the need for specialist assessment include:
- Unilateral tinnitus
- Pulsatile tinnitus
- Hyperacusis (hypersensitivity, pain or distress with environmental sounds)
- Associated unilateral hearing loss
- Associated sudden onset hearing loss
- Associated vertigo or dizziness
- Headaches or visual symptoms
- Associated neurological symptoms or signs (e.g., facial nerve palsy or signs of stroke)
- Suicidal ideation related to the tinnitus
Briefly describe the management of tinnitus
Tinnitus tends to improve or resolve over time without any interventions.
Underlying causes of tinnitus can be treated, such as impacted ear wax or infection.
Several measures can be used to help improve and manage symptoms:
- Hearing aids
- Sound therapy (adding background noise to mask the tinnitus)
- Cognitive behavioural therapy
What are the complications of tinnitus?
- Sleep deprivation
- Anxiety
- Depression
