Tinnitus Flashcards

1
Q

What is tinnitus?

A

Tinnitus = perception of sound when no external sound is present

Tinnitus also described as sound of silence
=> usually masked with background noises

Objective tinnitus = apparent to the examiner

Subjective tinnitus = only apparent to the patient

*Tinnitus commonly assoc. with hearing loss

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2
Q

What are the two types of tinnitus?

A

Non-pulsatile tinnitus

Pulsatile tinnitus

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3
Q

What is non-pulsatile tinnitus?

What conditions are associated with non-pulsatile tinnitus?

A

=> False perception of sound heard by affected individual (subjective tinnitus)

=> often a buzzing, high pitched tone or clicking & popping noise

Conditions:

  1. Noise induced hearing loss
  2. Presbycusis
  3. Meniere’s disease
  4. Head injury
  5. Otitis Media
  6. Drug related i.e. salicylates, NSAIDs, loop diuretics, quinines, Aminoglycosides
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4
Q

What is pulsatile tinnitus?

What condition are associated with pulsatile tinnitus?

A

=> Sound heard is synchronous with the heart-beat

=> Caused by turbulent blood flow that reaches the cochlear

Vascular causes:

  1. Atherosclerosis on the internal carotid artery
  2. Vascular malformations i.e. arteriovenous malformations/fistulas
  3. Glomus tumour (rare hyper vascular tumours arising from paraganglia cells)

Non-Vascular causes:

  1. Paget’s disease
  2. Otosclerosis
  3. Myoclonus of the middle ear
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5
Q

What are the 7 main causes of tinnitus?

A
  1. Idiopathic
  2. Meniere’s disease:
    => assoc. with hearing loss, vertigo, tinnitus, sensation of fullness or pressure in one or both ears
3. Otosclerosis:
=> Onset 20-40years
=> Conductive deafness
=> Tinnitus
=> Normal tympanic membrane (10% with flamingo tinge due to hyperaemia)
=> +ve Family hx
4. Sudden onset sensorineural hearing loss (SSNHL):
=> 80% acoustic neuroma 
=> Hearing loss, vertigo, tinnitus
=> Absent corneal reflex
=> Assoc. with Neurofibromatosis type 2
  1. Hearing loss:
    => Excessive loud noise
    => Presbycusis
6. Drugs:
=> Aspirin/NSAIDs
=> Aminoglycosides
=> Loop Diuretics
=> Quinines 
=> Salicylates 
  1. Impacted ear wax:
    => Obvious on otoscopy
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6
Q

What is otosclerosis?

A

Stapes gets stuck in place and cannot vibrate

No vibration = no sound transmitted/amplified

This is because of an abnormal bony tissue growth in middle ear

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7
Q

How is tinnitus investigated?

A
  1. If unilateral tinnitus + assoc. with hearing loss => MRI of the internal auditory canal to exclude acoustic neuroma (first line)
  2. Pulsatile tinnitus => MR or CT angiography for underlying vascular cause
  3. Audiology assessment to detect underlying hearing loss
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8
Q

How is tinnitus managed?

A
  1. Reassurance that tinnitus is common and can adapt to it
    => worrying makes it worse
    => silence makes it worse i.e. at night
  2. Treat underlying cause i.e. hypertension, carotid stenosis, side effect of meds
  3. CBT for some patients by audiologists => coping strategies and tinnitus retraining therapy (TRT)
    => noise generator can mask tinnitus if interfering sleep
    => Tinnitus support group
  4. Hearing aid may improve tinnitus if assoc. with hearing loss
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