Tinnitus

Question 1

Important feature of tinnitus to differentiate in history

Answer 1

Pulsatile vs non-pulsatile tinnitus
- suggests underlying etiology

Question 2

What is described for pulsatile tinnitus?

Answer 2

Tinnitus is in sync with heartbeat/ sounds like a flow/ wind blowing/Whoosh whoosh rhythmic bruit
- Worse with exercise

Question 3

Gold standard dx for pulsatile tinnitus

Answer 3

Angiography/MRI

Question 4

Causes of pulsatile tinnitus

Answer 4

*suspect vascular in origin

Non-clicking
1. Intracranial AVM
2. AVF
3. Arterial bruit
4. Paraganglioma aka glomus tumour
- highly vascular, benign neoplasm of a nerve cell type
- if in the middle ear: red tumour behind ear drum

Clicking
- Neurological disorder causing myoclonus of palatal muscles of inner ear (twitching of the ear)

Question 5

Causes of non-pulsatile tinnitus

Answer 5

1. Presbycusis
2. High frequency hearing loss
3. Ménière’s disease
4. Otosclerosis
5. Eustachian tube dysfunction
6. Ototoxic drugs
7. Vestibular schwannoma
8. Multiple sclerosis
9. Chiari malformation

Question 6

Management for non-pulsatile tinnitus

Answer 6

If tinnitus is the only symptom, it’s benign

• Tinnitus counselling for distraction methods
• Neurobion, gingko for supplements (no evidence of treating tinnitus)

Question 7

2 Important questions to ask in history taking

Answer 7

1. Quality of tinnitus - pulsatile vs non-pulsatile
2. Does it affect their sleep?