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.