Tinnitus

Question 1

Tinnitus definition

Answer 1

Sensation of sound without external sound stimulation

Question 2

Causes of tinnitus

Answer 2

Specific:
  Meniere’s
  Acoustic neuroma   Otosclerosis
  Noise-induced
  Head injury
  Hearing loss: e.g. presbyacusis   
General:
  ↑BP
  ↓Hb   
Drugs:
  Aspirin
  Aminoglycosides   Loop diuretics
  EtOH

Question 3

History of tinnitus

Answer 3

Character: constant, pulsatile
Unilateral: acoustic neuroma
FH: otosclerosis
Alleviating/exacerbating factors: worse at night? Associations
Vertigo: Meniere’s, acoustic neuroma
Deafness: Meniere’s, acoustic neuroma
Cause: head injury, noise, drugs, FH

Question 4

Examination for tinnitus

Answer 4

Otoscopy
Tuning fork tests
Pulse and BP

Question 5

Investigations for tinnitus

Answer 5

Audiometry and tympanogram

MRI if unilateral to exclude acoustic neuroma

Question 6

Treatment of tinnitus

Answer 6

Treat any underlying causes
Psychiatric support: tinnitus retraining therapy
Hypnotics at night may help