Fact Sheet

• Tinnitus Treatment - MaladyWise

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

  • See Diagnostic Imaging Pathways: Tinnitus

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

• Tinnitus - HNEPathways

• Diagnosis of Tinnitus - AAFP

• Tinnitus review - AJGP

• Tinnitus Treatment - MaladyWise