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Tinnitus. ALI KALAN Consultant ENT Surgeon Hillingdon, Mount Vernon, Central Middlesex & Northwick Park Hospitals North West London Hospitals NHS Trusts. Tinnitus.

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Tinnitus


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tinnitus
Tinnitus

ALI KALAN

Consultant ENT Surgeon

Hillingdon, Mount Vernon, Central Middlesex & Northwick Park Hospitals

North West London Hospitals NHS Trusts

tinnitus2
Tinnitus

Tinnitus is defined as the “perception of a sound” that is generated involuntarily within the head of an individual

tinnitus3
Tinnitus

Prevalence

in the adult population of around 10%.

severe in 1 % -- affecting daily life routine

78 % of adult population will experience tinnitus at least once during their lifetime

tinnitus types
Tinnitus -- Types
  • Subjective
  • Objective
tinnitus causes
Tinnitus - causes

The majority of patients with tinnitus do not have any identifiable underlying pathology except for age-related sensorineural hearing loss

slide6
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 ?
  • Character :unilateral/bilateral

persistent/intermittent

type : clicking,pulsatile,whirring etc

  • Intensity/severity – “Klockhoff & Lindblom Grading “
  • Hyperacusis – 40% (recruitment)
  • Impact on quality of life : sleep(35%),depression,suicidal
  • Associated otological symptoms
  • Medications :salicylates,loop diuretics etc
examination
Examination
  • Otoscopy
  • Auscultation : neck
  • Fundi : pappiloedema (BIH)
  • oropharyngeal
investigations
Investigations
  • Pure tone audiogram
  • Impedance audiometry
  • MRI brain
  • Duplex ultrasound – carotid bruit
  • Lumber puncture
management
Management
  • Treat the organic pathology, when known, on its own merits
  • Counselling : mainstay
  • Hearing aid : when hearing loss accompanied
  • Tinnitus maskers (adaptation)
  • Medication : no role
  • Surgery : rarely considered
  • Cognitive behavioural therapy : for selected refractory tinnitus
  • Habituation therapy (tinnitus retraining): for refractory cases
  • Complementary therapies : no evidence
  • Self help groups : British Tinnitus association etc.