Tinnitus Flashcards
Probability diagnosis
Ear wax or debris
Sensorineural hearing loss (esp. noise induced)
Otosclerosis
Ageing
Ear infection (e.g. viral cochleitis)
Meniere syndrome
Serious disorders not to be missed
Vascular:
- arteriovenous malformation
- carotidovenous fistula
- arterial bruits (esp. carotid)
- venous hum (jugular)
Infection:
- suppurative otitis media
Cancer/tumour:
- acoustic neuroma (unilateral)
Other:
- head injury
Pitfalls (often missed)
Impacted wisdom tooth
Temporomandibular injury/dysfunction
Alcoholism
Rarities:
- superior canal dehiscence
- glomus jugulare tumour
- syphilis
Masquerades checklist
Anaemia (severe)
Depression
Drugs;
- aspirin
- NSAID
- loop diuretics
- marijuana
- quinine
- aminoglycosides
Spinal dysfunction
Is the patient trying to tell me something?
Consider if subjective tinnitus.
Key history
Recent onset or longstanding
Pulsating or non-pulsating
Head injury
Exposure to loud noise
Upper respiratory infection
Otitis externa
Key examination
Otoscope of ear
Cardiovascular (esp. auscultation neck)
Key investigations
Audiogram
Tympanogram (middle ear function)
FBE
MRI or CT scan (esp. if head injury)
Diagnostic tips
Think otosclerosis in young.
Tinnitus may precede other symptoms of Meniere syndrome by months.
Non-pulsative and continuous → inner ear.
Venous hum → jugular vein.
Vascular symptoms → organic disorder.
Stress and anxiety exacerbate tinnitus.
Associated depression may lead to suicide.
