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GPEP ENT > Tinnitus > Flashcards

Tinnitus Flashcards

1
Q

What is tinnitus

A

Perception of a sound without a corresponding external source;
Often described as a high-pitched ringing or buzzing

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2
Q

Common causes of tinnitus

A

Hearing loss e.g., presbyacusis
Noise exposure
Neck or head injuries e.g., whiplash
Ear related e.g., infection, damage from scuba diving, wax blocking canal
Stress or anxiety
Raised blood pressure
Ototoxic medication

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3
Q

Is tinnitus usually associated with serious pathology?

A

Serious pathology is rare

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4
Q

Patients with tinnitus and suspected hearing loss should ideally be referred to ___________

A

An audiologist for a hearing assessment

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5
Q

Sudden sensorineural hearing loss that has started in the last 30 days should be referred to…

A

Urgently referred to or discussed with ENT

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6
Q

Risk factors for tinnitus

A

Hearing loss
Older age
Noise exposure
Smoking

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7
Q

Causes of constant tinnitus

A

Recent trauma
Noise exposure
Ototoxic medication

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8
Q

Tinnitus due to trauma should resolve over _________ (timeframe)

A

Hours

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9
Q

Examples of trauma that can cause tinnitus

A

Loud noise
Head injury
barotrauma

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10
Q

Examples of ototoxic medications

A

Gentamicin
Vancomycin
Macrolides
Loop diuretics
Salicylates
NSAIDs
Quinine

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11
Q

Fluctuating tinnitus, with or without vertigo or deafness could suggest…

A

Meniere’s disease

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12
Q

Pulsatile tinnitus could suggest a ________ cause

A

Vascular

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13
Q

Examples of vascular causes of tinnitus

A

Atherosclerosis of vessels in the head and neck.
AV malformations
Vascular tumours
Benign intracranial hypertension

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14
Q

What co-morbidities are commonly associated with chronic tinnitus

A

Anxiety and depression which are commonly associated with chronic tinnitus

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15
Q

Examination should include…

A

Examine ears
Head and neck – If pulsatile tinnitus:
look for a vascular cause
Neurological examination, if unilateral tinnitus

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16
Q

Questions to consider when asking the patient to describe the tinnitus

A

What does it sound like? Is it heard in one ear, both ears or elsewhere inside the head? Is it pulsatile? Is it intermittent or continuous? Does anything make it better or worse?

17
Q

Associated symptoms - consider _________ if the patient reports otalgia, otorrhoea or aural fullness

A

Middle ear pathology

18
Q

Associated symptoms - vertigo may indicate…

A

Vertigo may indicate an inner ear disorder or a central cause, e.g. vestibular schwannoma (acoustic neuroma), vestibular migraine or stroke.

19
Q

A description of bilateral ringing/buzzing/hissing may suggest what cause of tinnitus?

A

Symmetrical sensorineural hearing loss (primary tinnitus)

20
Q

A description of pulsatile tinnitus (particularly if tinnitus is pulse-synchronous) may suggest what cause?

A

Vascular

21
Q

A description of rhythmic clicking could suggest what cause of tinnitus?

A

Palatal myoclonus

22
Q

A description of unilateral tinnitus may suggest what cause?

A

Conductive hearing loss
Ménière’s disease
Vestibular schwannoma (acoustic neuroma)
Vestibular migraine
Stroke

23
Q

A description of tinnitus as sounds that vary with head and neck movement could suggest what cause of tinnitus?

A

Somatosensory tinnitus

24
Q

The Weber test detects patients with _______________ hearing loss

A

Unilateral or asymmetric

25
Q

Normal Weber test

A

Sound is heard equally in both ears –> indicates normal hearing or symmetric hearing loss, e.g. age-related hearing loss

26
Q

Abnormal Weber test

A

Sound lateralises to one ear, i.e. is heard better in that ear –> indicates unilateral or asymmetric hearing loss

27
Q

An abnormal Weber test should be followed by _________ to determine what?

A

The Rinne test to determine whether there is conductive hearing loss in that ear (ipsilateral) or sensorineural hearing loss in the opposite ear (contralateral)

28
Q

Positive Rinne test; normal result

A

Patients with normal hearing or sensorineural hearing loss will hear the tuning fork best when it is held near the ear canal

29
Q

Negative Rinne test; abnormal result

A

Patients with significant conductive hearing loss will hear the tuning fork best when it is held to the mastoid process

30
Q

The Rinne test identifies patients with significant ________ hearing loss

A

Conductive

31
Q

Habituation with tinnitus

A

Most people report that tinnitus becomes less noticeable over time, similar to becoming accustomed to background sounds in the daily environment, e.g. air conditioning or a clock ticking

32
Q

Primary tinnitus management

A

Identifying and treating hearing loss
Providing appropriate education and addressing contributing lifestyle factors, e.g. stress, sleep
CBT could be considered for tinnitus-related distress

33
Q

Hearing aids for tinnitus

A

Hearing aids may be appropriate for some patients with hearing loss, and may also improve their tinnitus symptoms (if there are no other triggers).
The use of hearing aids to relieve tinnitus in people who do not have hearing loss is not recommended.

34
Q

How to explain tinnitus to patients

A

Tinnitus is often associated with or caused by hearing loss. Reduced hearing means the brain does not receive the same sound signals it used to, so the brain “turns up the volume” to try to detect the missing sounds—this can result in tinnitus. Reassure that tinnitus does not make hearing loss worse, and it is only rarely associated with more serious medical conditions

35
Q

Can tinnitus be treated/cured

A

For most the symptoms become less noticeable/annoying over time, although they may not completely go away.
In some cases tinnitus can be completely eliminated, esp if the cause of hearing loss is treatable

36
Q

What is sound enrichment

A

May be able to improve tinnitus symptoms in quiet situations by adding a background sound source.
Eg a sound that has a similar pitch and character as their tinnitus. Neutral noises (fan or nature sounds) are most effective. Best volume is just quieter than the tinnitus

37
Q

Are there any medicines that are effective in the treatment of tinnitus

A

None have sufficient evidence to recommend them for routine use
(exception: betahistine for Meniere’s)

38
Q

Management of patients with depression and tinnitus

A

Likely to benefit from antidepressants; effective treatment of depression may also alleviate their tinnitus

39
Q

Lifestyle measures apart from stress/sleep

A

Avoid exposure to loud noise.
Foods do not directly cause tinnitus but eliminating alcohol, caffeine, cheeses, salty food, and quinine (tonic water) may help.
Stopping smoking may help.
Advise regular exercise, relaxation, and avoiding becoming overtired.
Control blood pressure.

GPEP ENT (3 decks)

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