Tinnitus

Question 1

what is tinnitus

Answer 1

perception of sound within the human ear

described as a ‘ringing’

Question 2

what is pulsatile tinnitus

give examples

Answer 2

when a patient hears their own pulse / muscle contractions

GCA, IIH

Question 3

causes of tinnitus

Answer 3

SNHL - esp noise induced
neurological damage - MS
foreign body in ear / wax impaction 
Eustachian tube dysfunction 
drug induced - gentamicin, furosemide, chemo, salicylate, antidepressants, BZD withdrawal, chloroquine
transmitted noise - jaw, murmurs
CPA tumours - vestibular schwannoma 
metabolic - thyroid, Fe deficiency, B12 deficiency 
psychiatric - depression, anxiety

Question 4

what should you ask in a history of tinnitus

Answer 4

intermittent vs constant
pulsatile
QoL

Question 5

if a patient has unilateral SNHL, what should you do

Answer 5

MRI for vestibular schwannoma

Question 6

management of tinnitus

Answer 6

treat the cause
direct counselling and sound therapy 
hearing aids 
masking devices 
antidepressants in some cases