What is tinnitus?
Perception of sound in the absence of any external sound. Often ringing, whooshing, humming or buzzing.
Prevelance ~15%
What are the features of tinnitus to ask about?
Unilateral or bilateral
Pulsatile or non-pulsatile
Character of sound:
-Ringing, hissing or buzzing suggests an inner ear or central cause
-Popping or clicking suggests problems in the external or middle ear or palate
How can tinnitus be classified?
Objective- audible to the examiner
Subjective- audible only to the patient
What are some causes of objective tinnitus?
Pulsatile tinnitus is often objective. May be caused by vascular disorders (AV malformations, carotid pathology), high output cardiac states (hyperthyroidism, anaemia), myoclonus of palatal or stapedius/tensor tympani muscles causing audible click.
What must be ruled out with tinnitus?
Acoustic neuroma- if unilateral tinnitus
What are some causes of subjective tinnitus?
- Most commonly associated with other causes of SNHL such as presbyacusis, noise induced hearing loss, Meniere’s
- Ototoxic drugs causing bilateral tinnitus associated with SNHL
- Otitis media +/- effusion
- Associated with hyper/hypothyroidism, diabetes, MS
- Unilateral tinnitus should be investigated for acoustic neuroma
Note- anxiety and depression are frequency associated with and may exacerbate tinnitus
What is the treatment for tinnitus?
- Treat underlying causes
- Stop ototoxic drugs
- Explain that it is common and usually improves with time
- Psychological support- Manage depression anxiety or insomnia
- Hearing aids if poor hearing loss (as background noise reduces perception of hearing)
- CBT to help with unhelpful thoughts and behaviours
What might cause tinnitus with associated vertigo?
Meniere’s disease
What drugs can cause tinnitus?
Aminoglycosides Aspirin Quinine NSAIDs Macrolides
