Tinnitus

Question 1

What is tinnitus?

Answer 1

Perception of sound typically in absence of auditory stimulation
2/3 have associated SNHL

Question 2

What does ringing, hissing or buzzing tinnitus suggest?

Answer 2

Inner ear or central cause

Question 3

What does popping or clicking suggest?

Answer 3

External ear
Middle ear
Palate

Question 4

How can tinnitus be classified?

Answer 4

Objective (audible to the examiner)

Subjective tinnitus - audible only to the patient

Question 5

What are causes of objective tinnitus?

Answer 5

Vascular disorders:Pulsatile vibratory sounds from AV malformations, carotid pathology, tumours
High output cardiac states: Paget’s, hyperthyroidism, anaemia
Myoclonus of palatal or stapedius/tensor tympani muscles resulting in audible click
Patulous Eustachian tube: prolonged opening causing abnormal transmission of sound to ear

Question 6

What are causes of subjective tinnitys?

Answer 6

Commonly associated with SNHL disorders
Prebycusis
Noise induced hearing loss
Menieres

Conductive deafness is less commonly associated e.g. from impacted wax, otosclerosis
Ototoxic drugs cause bilateral tinnitus with associated hearing loss, Cisplatin, aminogolucosides, aspirin, NSAIDs, quinine, macrolide, loop diuretics
Otitis media ± effusion

Acoustic neuroma - unilateral

Question 7

What investigations in tinnitus?

Answer 7

Audiometry
Tympanogram
If unilateral - MRI to exclude acoustic neuroma

Question 8

What is management of tinnitus?

Answer 8

Treat underlying cause
Explain that it is common and improves via habituation
Manage depression, anxiety or insomnia

Hearing aids if hearing loss > 35dB
Psychological support - sound therapy - use of background sound to reduce impact of tinnitus, psychoeducation (e.g. white noise)
CBT - thoughts and behavioural modification
Patient support groups

Question 9

What drugs cause tinnitus?

Answer 9

Cisplatin, aminogolucosides, aspirin, NSAIDs, quinine, macrolide, loop diuretics