1: Tinnitus

Question 1

Define tinnitus

Answer 1

presence of sound in absence of external auditory stimulus

Question 2

How is tinnitus classified

Answer 2

primary or secondary

Question 3

What is primary tinnitus

Answer 3

no identifiable underlying cause

Question 4

What is primary tinnitus usually associated with

Answer 4

SNHL

Question 5

What is secondary tinnitus

Answer 5

underlying cause can be identified

Question 6

How is secondary tinnitus classified

Answer 6

1. Subjective

2. Objective

Question 7

What is objective tinnitus

Answer 7

Other individuals are able to hear it - usually a sound made by the body

Question 8

What is subjective tinnitus

Answer 8

Only individual can hear it

Question 9

what are 4 causes of objective tinnitus

Answer 9

1. Vascular
2. Myoclonus stapedius
3. High-output cardiac state
4. Patent eustachian tube

Question 10

what vascular disorder may lead to vascular objective tinnitus

Answer 10

AV Malformation

Question 11

what high-output cardiac states may result in objective tinnitus

Answer 11

Paget’s
Hyperthyroidism
Anaemia

Question 12

explain stapedius as cause of objective tinnitus

Answer 12

Myoclonus of the stapedius can result in an audible clicking

Question 13

explain patent Eustachian tube

Answer 13

If eustachian tube remains patent for long periods it can cause abnormal sounds to transmit to the ear

Question 14

what are the otological causes of tinnitus with SNHL

Answer 14

• Meniere’s

- Presbycusis

Question 15

what are the otological causes of tinnitus with conductive hearing loss

Answer 15

• Otosclerosis
• Otitis media w/effusion
• Cerumen impaction

Question 16

what medications can cause tinnitus and hearing loss

Answer 16

Amino-glycosides

Aspirin

Question 17

what metabolic conditions can cause tinnitus

Answer 17

High zinc

Hyperthyroidism

Question 18

what neurological disorders may cause tinnitus

Answer 18

Acoustic neuroma

MS

Question 19

explain psychiatric aspect of tinnitus

Answer 19

Anxiety and depression may exacerbate tinnitus

Question 20

how may tinnitus present

Answer 20

can be almost any noise including whistling, buzzing, ringing, hissing

Question 21

what 5 circumstances indicate urgent referral to ENT with tinnitus

Answer 21

1. Head trauma
2. Sudden onset SNHL
3. Pulsatile tinnitus
4. Significant neurology
5. Significant vertigo

Question 22

What should all patients with tinnitus be referred for

Answer 22

Comprehensive audiological assessment

Question 23

What does a comprehensive audiological assessment include

Answer 23

• Audiometry
• Tympanometry
• BP

Question 24

What blood tests may be sent in tinnitus

Answer 24

FBC
TFT
Lipid profile
Blood glucose

Question 25

What is considered in patients with unilateral tinnitus and SNHL

Answer 25

MRI CPA

Question 26

What is the curative management of tinnitus

Answer 26

Treat underlying cause

Question 27

What is the symptomatic treatment for tinnitus

Answer 27

- Hearing Aids - Psychoeducational - Sound therapy - CBT

Question 28

When would someone be offered hearing aids

Answer 28

Hearing loss >35dB

Question 29

What does tinnitus re-training therapy entail

Answer 29

Psychoeducational counselling Sound therapy

Question 30

What is sound therapy

Answer 30

Sound is used to reduce impact of tinnitus by masking it

Question 31

Who may someone with tinnitus be referred to

Answer 31

Hearing therapist - provide emotional support