Tinnitus and hearing loss

Question 1

Most common causes of tinnitus

Answer 1

Idiopathic

Infective
- Otitis media

Loud noise exposure

Question 2

Other causes of tinnitus

Answer 2

Acoustic neuroma

Meniere’s disease

Cardiovascular disease

• Carotid artery/ aortic stenosis
• AV malformaiton

Eustachian tube dysfunction

Ototoxic medication

Psychological
- Depression

Question 3

Ototoxic medication that can cause tinnitus

Answer 3

Gentamicin

Chemotherapy

Loop diuretics

Question 4

Examination and investigations for tinnitus

Answer 4

Otoscopy

• Infective signs–> bulging membrane, erythema, ear debris, dischare
• impacted wax

Rinne’s and weber’s test
- Screening for hearing loss

Audiology

MRI
- Signs of red-flag neurosensory hearing loss

Question 5

Red flag signs in tinnitus

Answer 5

Unilateral tinnitus/ hearing loss

Sudden onset

Pulsatile

Hyperacusis

Vertigo

Headaches/ visual symptoms

CN 7 palsy/ neurological signs

Suicidal ideation

Question 6

Presentation of an acoustic neuroma

Answer 6

• Unilateral tinnitus, and progressive sensorineural hearing loss.
• Difficulty with localising sound
• Facial numbness (CN7 involvement)

signs

• Nystagmus
• Ataxia/ unbalanced
• Diplopia on lateral gaze
• CN5 palsy

Question 7

Complications of an acoustic neuroma

Answer 7

Space occupying effects

• Hydrocephalus, increased ICP
• Compression of cerebellar peduncle= cerebellar signs

Never palsies

• CN7= facial numbness, affected taste
• CN5 = slow blink, altered taste and hearing

Question 8

Diagnostic investigation for acoustic neuroma

Answer 8

MRI Head - gadolinium enhanced

- Shows uniformly enhanced mass extending into the Internal acoustic meatus.

Question 9

Management of acoustic neuroma

Answer 9

Small tumours (<1.5cm) and not growing
- Monitoring

Tumour > 1.5cm, or symptomatic/ compressing effects

• Focus radiation (<3cm).
• Surgical resection