Tinnitus Flashcards
Tinnitus
Persistent background sound that is heard but is not present
It may be described as a “ringing in the ears”, buzzing, hissing or humming noise
Pathophysiology of tinnitus
Background sensory signal produced by the cochlea that is not effectively filtered out by the central auditory system
Causes of tinnitus
Primary - idiopathic
Secondary:
- Impacted ear wax
- Ear infection
- Ménière’s disease
- Noise exposure
- Medications
- Acoustic neuroma
- Multiple sclerosis
- Trauma
- Depression
Which medications can cause tinnitus
Loop diuretics
Cisplatin
Gentamicin
Systemic conditions associated with tinnitus
Anaemia
Diabetes
Hypothyroidism or hyperthyroidism
Hyperlipidaemia
Tinnitus history
- Unilateral or bilateral
- Frequency and duration
- Severity
- Pulsatile or non-pulsatile - pulsatile may indicate carotid artery stenosis with a bruit
- Contributing factors, such as hearing loss or noise exposure
Associated symptoms
Stress and anxiety
Symptoms associated with tinnitus
Hearing loss
Vertigo
Otalgia
Discharge
Investigations for tinnitus
Otoscopy - exclude causes such as ear wax or infection
Weber’s and Rinne’s tests for hearing loss
Full blood count (anaemia)
Glucose (diabetes)
TSH (thyroid disorders)
Lipids (hyperlipidaemia)
Audiology
Imaging (rare) if acoustic neuroma suspected
Red flags for tinnitus
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
Management of tinnitus
Normally resolves over time naturally
Can treat underlying cause
Supportive:
- Hearing aids
- Sound therapy
- CBT
Sound therapy
Adding background noise to mask the tinnitus
