Tinnitus
ALI KALAN
Consultant ENT Surgeon
Hillingdon, Mount Vernon, Central Middlesex &
Northwick Park Hospitals
North West London Hospitals NHS Trusts
Tinnitus
Tinnitus is defined as the “perception of a
sound” that is generated involuntarily
within the head of an individual
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
• Subjective
• Objective
Tinnitus - causes
The majority of patients with tinnitus do
not have any identifiable underlying
pathology except for age-related
sensorineural hearing loss
Condition
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Conductive hearing loss
Ossicular erosion
Ossicular fixation
Otosclerosis
Middle ear effusion/patulous ET
Neoplastic
Vestibular schwannoma
Glomus jugulare
Diagnosis
Clinical examination and audiology
MRI with DTPA-Gadolinium
Clinical examination and imaging
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Ototoxic drugs
Salicylates
Aminoglycasides
Loop diuretics
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Meniere’s disease
History, audiology, electrocochleography
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Vascular
Carotid artery stenosis
Venous sinus stenosis
IAM vascular loop
Clinical examination and duplex ultrasound scan
Angiography
MRI+ ⁄ - angiography
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Myoclonus
Stapedius
Tensor tympani
Palatal
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Other : Benign intracranial hypertension
puncture
History
History, clinical examination, tympanometry
History, clinical examination, MRI, lumbar
History --- what to cover ?
• Character :unilateral/bilateral
persistent/intermittent
type : clicking,pulsatile,whirring etc
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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
• Otoscopy
• Auscultation : neck
• Fundi : pappiloedema (BIH)
• oropharyngeal
Investigations
• Pure tone audiogram
• Impedance audiometry
• MRI brain
• Duplex ultrasound – carotid bruit
• Lumber puncture
Management
• Treat the organic pathology, when known, on its own
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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.