Tinnitus, acoustic neuroma and hyperacusis

Question 1

Causes of central tinnitus (3)

Answer 1

Local:

• hearing loss
• septic otitis media
• presbyacusis
• noise induced
• head injury
• otosclerosis/post-stapedectomy
• meniere’s
• wax
• glomus tumour

General:
-HTN, low Hb, heart failure

Drugs:

• aspirin
• loop diuretics
• aminoglycosides
• quinine
• alcohol

Question 2

Causes of pulsatile tinnitus (2)

Answer 2

carotid artery stenosis/dissection

AV fistulae

Question 3

Mx of tinnitus (5)

Answer 3

hearing aids>less apparent tinnitus

psychological support

music

massage

intratympanic dexamethasone+alprazolam PO

Question 4

Features of acoustic neuromas (2)

Answer 4

benign

subarachnoid tumour causes problems via local pressure.

Question 5

Presentation of acoustic neuromas (4)

Answer 5

ipsilateral tinnitus+/-sensorineural hearing loss (cochlear nerve compression)

raised ICP

cerebellar signs-nystagmus

loss of corneal reflex (VI)

Question 6

Ix, DDx and Rx of acoustic neuromas

Answer 6

MRI

meningioma

can be left alone, gamma knife to debulk

Question 7

Hyperacusis-definition and causes (7)

Answer 7

increased sensitivity to certain frequencies of noise

causes:

• VIIth nerve palsy
• MS
• Myasthenia
• tympanoplasty
• AV malformation
• migraine