Tinnitus Flashcards
What is tinnitus?
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
What are the two types of tinnitus?
Non-pulsatile tinnitus
Pulsatile tinnitus
What is non-pulsatile tinnitus?
What conditions are associated with non-pulsatile tinnitus?
=> False perception of sound heard by affected individual (subjective tinnitus)
=> often a buzzing, high pitched tone or clicking & popping noise
Conditions:
- Noise induced hearing loss
- Presbycusis
- Meniere’s disease
- Head injury
- Otitis Media
- Drug related i.e. salicylates, NSAIDs, loop diuretics, quinines, Aminoglycosides
What is pulsatile tinnitus?
What condition are associated with pulsatile tinnitus?
=> Sound heard is synchronous with the heart-beat
=> Caused by turbulent blood flow that reaches the cochlear
Vascular causes:
- Atherosclerosis on the internal carotid artery
- Vascular malformations i.e. arteriovenous malformations/fistulas
- Glomus tumour (rare hyper vascular tumours arising from paraganglia cells)
Non-Vascular causes:
- Paget’s disease
- Otosclerosis
- Myoclonus of the middle ear
What are the 7 main causes of tinnitus?
- Idiopathic
- 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
- Hearing loss:
=> Excessive loud noise
=> Presbycusis
6. Drugs: => Aspirin/NSAIDs => Aminoglycosides => Loop Diuretics => Quinines => Salicylates
- Impacted ear wax:
=> Obvious on otoscopy
What is otosclerosis?
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
How is tinnitus investigated?
- If unilateral tinnitus + assoc. with hearing loss => MRI of the internal auditory canal to exclude acoustic neuroma (first line)
- Pulsatile tinnitus => MR or CT angiography for underlying vascular cause
- Audiology assessment to detect underlying hearing loss
How is tinnitus managed?
- Reassurance that tinnitus is common and can adapt to it
=> worrying makes it worse
=> silence makes it worse i.e. at night - Treat underlying cause i.e. hypertension, carotid stenosis, side effect of meds
- CBT for some patients by audiologists => coping strategies and tinnitus retraining therapy (TRT)
=> noise generator can mask tinnitus if interfering sleep
=> Tinnitus support group - Hearing aid may improve tinnitus if assoc. with hearing loss