Tinnitus 2

ENT
Written By Maladywise

Fact Sheet

Evaluate

  • Pulsatile = ? Vascular

    • AVM, Vascular tumour, IIH, Atherosclerosis

  • Unilateral = ? Acoustic neuroma

  • Constant

    • Trauma

      • Loud noise, head injury, barotrauma

    • Chronic noise exposure

    • Medications + Ototoxicity

      • SSRI, TCA, Anti-epileptics, BP , ABx, Diuretics, NSAIDs, PPI, LA, CTx

  • Fluctuating = ? Meniere’s

    • Episodic vertigo, tinnitus, SNHL, aural fullness, attacks 1-24/24, age 20-50, M>F

Risk Factors

  • Noise exposure, age, male, smoking, HTN, atherosclerosis

Causes

  • Acute and chronic noise, wax, AOM, OE, cholestaetoma, neuritis, Meniere’s, otosclerosis, perforation

  • Less common = Anaemia, head + neck injury, ↑↓ TFT, Paget’s, TMJ, myoclonus, cancer

Consider

  • Anxiety + depression

Examine

  • EAC + remove wax

  • TM for effusion, infection, abn

  • Head + neck for injury, vascular, bruits

  • If unilateral > Neuro exam

    • CN, speech and affect, muscle tone, reflexes, power, coord, cerebellum, gait, sensation, cognition

Investigate

  • Audiogram = Everyone looking for asymmetrical hearing loss

  • Pulsatile tinnitus = CT with contrast of brain and skull base or MRI (exclude glomus jugulare +/- tympanicum tumour)

  • If unilateral = Consider MRI for small acoustic neuromas

Management

  • Exclude serious conditions

  • Medications generally no benefit (SSRI, Benzo, anti-epileptics)

  • Cease ototoxic meds

  • Referral audiology to consider hearing aids, masking devices, tinnitus retraining

  • Consider self help groups

Resources

Maladywise https://www.maladywise.org
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