What is tinnitus?
Noises in the ear, real or imagined caused by prolonged exposure to noise that is high intensity
Name 3 places that objective sounds can come from?
- the temporo-mandibular joint
- eustachian tube
- carotid artery
What is the difference between objective and subjective tinnitus?
Subjective means that it can only be heard by the patient and objective means that other people can also hear the sound
What presentation of tinnitus requires a full neurological work-up and investigation?
Unilateral symptoms accompanied by hearing loss requires a MRI scan
What kind of sounds does the patient hear on subjective tinnitus?
- rushing
- hissing
- buzzing
What are the external ear causes of tinnitus?
wax
What are the middle ear causes of tinnitus?
- otosclerosis
- middle ear effusion
What are the inner ear causes of tinnitus?
- presbyacusis
- noise induced hearing loss
- ototoxic drugs such as aminoglycosides, loop diuretics, quinines
- menieres disease
- labyrinthitis
- trauma
What is the Mx of tinnitus?
- Most patients can live with it and can manage it
- some use tinnitus masking devices
- some surgery
- psychotherapy could also be useful
How do we separate the causes of vertigo?
- Central
2. Peripheral/otological causes
What is the definition of vertigo?
Hallucination of movement
What are the inputs that contribute to equilibrium?
- Eyes
- Ears
- Joint proprioception
- Higher centres-cerebellum, cortex
When considering peripheral causes of dysequilibrium, name some major causes?
- Benign paroxysmal positional vertigo
- Menieres disease
- Labyrinthitis
- Acoustic Neuroma
- fistula
- fracture of the petrous temporal bone
- alcohol/ anticonvulsants/tranquilisers/vestibulotoxins
When considering central causes of dysequilibrium name some major causes?
- cerebellum- cerebellitis
- CVA
- boxers
- age
- multplie sclerosis
What is the classical triad of Menieres disease?
- Sensorineural hearing
- tinnitus
- vertigo
pneumonic: MEN get STV’s
What is true vertigo and how does it present?
It is vestibular/peripheral vertigo
- It is episodic
- severe
- nystagmus starts 2-20 seconds after
- lasts less than 1 minute
- patient fatigues with repetition
- Usually with nausea and vomiting
What is not true vertigo?
It is central vertigo
- It is constant
- less severe
- Nystagmus starts immediately
- Patient does not fatigue after the episode
What is labyrinthitis and what are the features?
It is infection of the labyrinth from viral/bacterial components or destruction of the cochlea
It presents with rapid nystagmus, vertigo and hearing loss if it affects the cochlea
What is the Rx of labyrinthitis?
Viral: bed rest, steroids for the SNHL, monitor
bacterial: treat choleastatoma or middle ear infection
What is vestibular neuritis and what is the Rx?
It is inflammation of the nerve that gives the signal from the ears to the brain
-presents with nystagmus, no hearing loss, debilitating continuous vertigo
Rx: mobilise the patient to allow for central compensation
-it takes days to weeks to gradually improve
What is the management for menieres disease?
- stopping smoking, caffeine and salt intake
- Give diuretics to drain the endolymph fluid and betahistine which is a vasodilator
- surgery: labyrinthectomy, vestibular neurectomy
