Tinnitus

Question 1

The word ‘tinnitus’ comes from the Latin word for ‘ringing’ and is the perception of sound in the absence of any corresponding external sound. This noise may be heard in one ear, in both ears or in the middle of the head or it may be difficult to pinpoint its exact location. The noise may be low, medium or high‑pitched. There may be a single noise or two or more components. The noise may be continuous or it may come and go.

What causes tinnitus?

Answer 1

• not fully understood
• anyone can get tinnitus
• 10% adults have it all the time
• 25-30% of over 70s
• unusual to be a major problem - 1% of adults affected majorly

Question 2

What is important to elicit in the history and examination for tinnitus? What are the red flags?

Answer 2

• History → characteristics, bilateral/unilateral, how it affects pt, triggers
• Examination → otoscopy + audiometry, BP, auscultation for bruits, cranial nerves
• Red flags → unilateral, pulsatile, asymmetrical hearing loss, dizziness, unexplained neuro symptoms

Question 3

What investigations can be done for tinnitus?

Answer 3

• audiometry → SNHL or conductive
• FBC → anaemia
• TFTs → hyper causes pulsatile tinnitus, severe hypo can cause SNHL
• lipid profile → inc can cause inner ear stroke therefore tinnitus
• fasting glucose → DM can cause tinnitus
• MRI head → in all pts w/ unilateral SNHL and/or pulsatile tinnitus
• CT temporal bones → in those w/ conductive hearing loss
• MR/CT angiography → in those w/ pulsatile objective tinnitus
• auditory brainstem response → to exclude tumours, MS etc

Question 4

Treatment is challenging, as tinnitus is a symptom not a disease; intervention depends on treating the underlying cause. Persistent tinnitus should be managed with symptomatic treatment.

What is the treatment of tinnitus?

Answer 4

• education + counselling → avoidance of ototoxic drugs, loud noises + triggers (trial avoidance for 6-8wks)
• relaxation techniques, hypnosis or biofeedback techniques → reduce anxiety
• CBT → help identify and manage negative behaviours, beliefs + reactions
• hearing aids if hearing loss present
• white noise generators → background masking, wear during day + night
• neuromonics → device w/ music and an acoustic neural stimulus
• integrative therapies → hypnosis, acupuncture, supplements, herbs
• SSRIs, TCAs + anxiolytics → in those w/ associated depression or anxiety

A multi-disciplinary team approach is appropriate - involving the audiologist, hearing therapist and psychologist.