ENT - tinnitus

Question 1

Causes of tinnitus

Answer 1

Primary - no identifiable cause (often occurs with sensorineural hearing loss)

Secondary:

• Wax impaction
• Ear infections
• Meniere’s disease
• Noise exposure
• Medications (e.g., loop diuretics, gentamicin and chemotherapy drugs such as cisplatin)
• Acoustic neuroma
• Multiple sclerosis
• Trauma
• Depression

May also be associated with systemic conditions e.g. anaemia, diabetes, thyroid problems, hyperlipidaemia

Question 2

Questions to ask in relation to tinnitus?

Answer 2

Unilateral or bilateral
Frequency and duration
Severity

Pulsatile or non-pulsatile (pulsatile may indicate a cardiovascular cause, such as carotid artery stenosis with a bruit)

Associated Sx - hearing loss, vertigo, pain, discharge
Noise exposure

Question 3

Examinations that can be done

Answer 3

Otoscopy

Rinne’s and Weber’s

Question 4

Investigations

Answer 4

Test for possible underlying causes

Full blood count (anaemia)
Glucose (diabetes)
TSH (thyroid disorders)
Lipids (hyperlipidaemia)

Audiometry
Imaging - e.g. MRI/CT if suspecting acoustic neuroma

Question 5

Red flags in tinnitus

Answer 5

Unilateral tinnitus
Pulsatile tinnitus
Hyperacusis (hypersensitivity, pain or distress with environmental sounds)
Associated unilateral hearing loss
Associated sudden onset hearing loss
Associated vertigo or dizziness
Headaches or visual symptoms
Associated neurological symptoms or signs (e.g., facial nerve palsy or signs of stroke)
Suicidal ideation related to the tinnitus

Question 6

Management of tinnitus

Answer 6

Many tend to improve/resolve with time without interventions

Treat underlying causes e.g. infection, wax impaction

Hearing aids can be considered