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Tinnitus The sensation of sounds in the ears or head in the absence of an external sound source
Pathophysiology • Still poorly understood • Almost every ear disease and cause of deafness can be associated with tinnitus • Useful web resource if RNID website
Any area’s that want to discuss? • Current pathways: • Manage in primary care – the majority • Referral to ENT – who to refer and when?
History • Description of the sound • Pulse, ringing, whoosh • Unilateral, Bilateral • Intrusive (sleep interrupted?) • Persistent or intermittent • Associated symptoms • Hearing loss • Vertigo
Examination and Investigation • TM’s • EAM’s • Cranial, Carotid, Cardiac bruit – especially if pulsatile • Consider FBC, TFT
Management • Treat any underlying cause if found • Bilateral +/- symmetrical hearing loss, No other symptoms, not intrusive –advice • Unilateral < 3/12. No worrying feature. Manage primary care • Objective tinnitus - refer • Unilateral tinnitus > 3/12 refer - ?CPA lesion • Intrusive tinnitus – refer • Bilateral + asymmetrical hearing loss > 3/12 – refer • Tinnitus therapy • Masking with white noise therapy • Pillow radio • Bilateral, none intrusive tinnitus – Ok to manage in primary care • Advice and reassurance • RNID website useful
Management • Advice • Sound therapy • Tinnitus councelling