Post on 22-Dec-2015
TinnitusTinnitus
ALI KALANALI KALAN
Consultant ENT SurgeonConsultant ENT Surgeon
Hillingdon, Mount Vernon, Central Middlesex Hillingdon, Mount Vernon, Central Middlesex & Northwick Park Hospitals& Northwick Park Hospitals
North West London Hospitals NHS TrustsNorth West London Hospitals NHS Trusts
TinnitusTinnitus
Tinnitus is defined as the “perception of a sound” that is generated involuntarily within the head of an individual
TinnitusTinnitus
PrevalencePrevalence
in the adult population of around 10%.
severe in 1 % -- affecting daily life routinesevere in 1 % -- affecting daily life routine
78 % of adult population will experience 78 % of adult population will experience tinnitus at least once during their lifetimetinnitus at least once during their lifetime
Tinnitus -- TypesTinnitus -- Types
• SubjectiveSubjective
• ObjectiveObjective
Tinnitus - causesTinnitus - causes
The majority of patients with tinnitus The majority of patients with tinnitus do notdo not have any identifiable have any identifiable underlying pathology except for age-underlying pathology except for age-related sensorineural hearing lossrelated sensorineural hearing loss
Condition Diagnosis
• Conductive hearing loss Clinical examination and audiology Ossicular erosion Ossicular fixation Otosclerosis Middle ear effusion/patulous ET• Neoplastic Vestibular schwannoma MRI with DTPA-Gadolinium Glomus jugulare Clinical examination and imaging
• Ototoxic drugs Salicylates History Aminoglycasides Loop diuretics
• Meniere’s disease History, audiology, electrocochleography
• Vascular Carotid artery stenosis Clinical examination and duplex ultrasound
scan Venous sinus stenosis Angiography IAM vascular loop MRI+ ⁄ - angiography
• Myoclonus Stapedius History, clinical examination,
tympanometry Tensor tympani Palatal
• Other : Benign intracranial hypertension History, clinical examination, MRI, lumbar puncture
History --- what to cover ?History --- what to cover ?
• CharacterCharacter :unilateral/bilateral :unilateral/bilateral persistent/intermittentpersistent/intermittent type : clicking,pulsatile,whirring etc type : clicking,pulsatile,whirring etc • Intensity/severity – “Klockhoff & Lindblom Grading Intensity/severity – “Klockhoff & Lindblom Grading
““• Hyperacusis – Hyperacusis – 40% (recruitment)40% (recruitment)• Impact on quality of lifeImpact on quality of life : :
sleep(35%),depression,suicidalsleep(35%),depression,suicidal• Associated otological symptomsAssociated otological symptoms• MedicationsMedications :salicylates,loop diuretics etc :salicylates,loop diuretics etc
ExaminationExamination
• OtoscopyOtoscopy
• Auscultation : neckAuscultation : neck
• Fundi : pappiloedema (BIH)Fundi : pappiloedema (BIH)
• oropharyngealoropharyngeal
InvestigationsInvestigations
• Pure tone audiogramPure tone audiogram
• Impedance audiometryImpedance audiometry
• MRI brainMRI brain
• Duplex ultrasound – carotid bruitDuplex ultrasound – carotid bruit
• Lumber punctureLumber puncture
ManagementManagement• Treat the organic pathology, when known, on its Treat the organic pathology, when known, on its
own meritsown merits• Counselling : mainstayCounselling : mainstay• Hearing aid : when hearing loss accompaniedHearing aid : when hearing loss accompanied• Tinnitus maskers (adaptation)Tinnitus maskers (adaptation)• Medication : no roleMedication : no role• Surgery : rarely consideredSurgery : rarely considered• Cognitive behavioural therapy : for selected Cognitive behavioural therapy : for selected
refractory tinnitusrefractory tinnitus• Habituation therapy (tinnitus retraining): for Habituation therapy (tinnitus retraining): for
refractory casesrefractory cases• Complementary therapies : no evidenceComplementary therapies : no evidence• Self help groups : British Tinnitus association etc.Self help groups : British Tinnitus association etc.